Clinical Observation On The Effect Of Double Tube Displacement Laryngocarcinoma Patient's Second Operation

In most cases a patient operated with tracheotomy will always be placed with a medical steel tracheal cannula. If a surgery needed later, the steel tracheal tube must be required to replaced into the common endotracheal one to facilitate the ventilation management through the operation. It is more common in the example of patients falling into the disease of laryngeal cancer who are empirically firstly put with silicone special tube then have to be displaced into steel tracheal one under non-anaesthesia condition one month later.As the interface of the normal clinical steel tracheal tube does not match that of the threaded pipe in anaesthesia machine, two parts can not always be coincided harmoniously which threatens the effect of ventilation in a less airtight manner.It is clinically applied the replacement of steal tracheal tube with a common endotracheal one in an intravenous anaesthesia during the previous anaesthesia implementation. Although the displacement is a minimal move, it often leads to the two following problems:The first one is coming symptom of violent cough and the volatility of heart rate as well as blood pressure resulting form the uncomfortness of a patient when the anaesthesia is partially light; The second one is the phenomenon of respiratory depression and a rapid decrease of SpO2 even the arrival of cyanogen when the anaesthesia is partially too deep or in an fast delivery of medicine. The double problems might also take place in the end of operation when it is necessary to change the common endotracheal tube with a steal tracheal tube. Purpose: To search for a new secure replacement of endotracheal tubes during the second throat surgery.Method: Select out of the cases 20 male patients who were operated semi-laryngectomy after laryngeal surgery during March, 2008 and March, 2010. The research objects, aged 50-85 years old, weighed 50-75 kilogram and examined II- III in ASA level, are proved in good health condition with normal standard in basic medical laboratory tests without any cardiovascular or other diseases including the pneumocardial disease or coronary heart ones.To pick up Drager FabiusGS band multifunctional anaesthesia machine, confirm the leak /compliance testing and set the levels of oxygen and flow sensor calibration. And then ensure the patient's respiratory rate at 16 times/min with inspiratory/expiratory ratio of 1:2, and in 100% oxygen concentration atmosphere.After the patient enters the operating room, conduct regular medical monitoring practice and set up a normal infusion pathway. Then laying a germfree sheet and guaranting in a sterilized condition, a doctor firstly inserts the ID 4.0 mm extra strong endotracheal tube into steel tracheal one and fully aerate the air bag at the end of the endotracheal tube. And then furthermore connect the anaesthesia machine with sterile thread pipe in operating table and begin to execute conventional anaesthesia induction to vanes, with the substance -midazolam1-3mg, fentanyl 3-4μg/kg, propofol 1-2.5 mg/kg and cisatracurium 0.15mg/kg, after importing the patient sufficient oxygen for 3 minutes. Afterwards with the weakness of patient's breathing, by slowly squeezing the air bag, conform to mechanical oxygen supplying and provide gas by proper volume to assure patient's basic breathing by VT equaling 6 ml/kg in IPPV. Finally replace the general tracheal tube with ID 7.5 mm with steel tracheal one and record the patient's level of blood gas and the amount of SPO2, heart rate and blood pressure before and after the conversion of tubes.During the operation also provide the patient with oxygen as proper volume to control his basic breathing and record the amount of Paw when given the IPPY by VT equaling 8, 10 ml/kg. For a particular time in operation, by oxygen pressure, patient's basic breathing is compulsory to controlled and the VT in IPPV, when given him the PAW equaling 20,30cmH2O, is required to recorded.Make anaesthesia in tracheal topical surface by squirting into the trachea lidocaine in 2-3 ml volume at the density of 2% 15--20 minutes prior to the end of surgery. At the end of the operation a doctor exchanges the medical steel tracheal cannula, inserted in advance by a endotracheal tube with ID 4.0 mm tube, with a normal tracheal one when the sick is still in the state of deep anaesthesia with no spontaneous breathing and immersed in full musclerelaxation .Furthermore fully aerate air bag while connect the anaesthesia machine with sterile thread pipe of operating table. During the operation provide the patient with oxygen as proper volume to control his basic breathing and record the amount of Paw when giving the IPPY by VT equaling 8,10 ml / kg. For a particular time in operation, employ the oxygen pressure to control the patient's basic breath while record the amount of VT in IPPV when giving the PAW equaling 20,30cmH2O. Finally record the patient's level of blood gas and the amount of SPO2, heart rate and blood pressure before and after the conversion of tubes.When the patient was bringed out the ID4.0mm reinforced tracheal tube out of the steel tracheal one which will be carried with the patient when he leaves the operation room.Results: (1)Table 4.2 and Table 4.4 shows the first and second for control of blood pressure, heart rate, oxygen saturation was no significant difference. Figure 4.1 shows before and after the two-for-control blood pressure, heart rate, oxygen saturation no significant changes. (2) arterial blood gas analysis, PaO2 = 297.75±40.72 mmHg, PaCO2=37.75±3.95 mmHg, PaO2 and PaCO2 were within the normal range. (3) ID4.0mm pressure controlled ventilation in Paw = 20 cmH2O, you can more easily obtain a satisfactory tidal volume. (4)Table 4.10 and 4.12 show: ID 4.0 and 7.5 mm tube capacity control breathing, VT=6,8,10 ml/kg of young and old Paw, no significant difference.Conclusion: 1 Double-tube method with conventional anesthesia, blood pressure, heart rate and oxygen saturation no significant changes in anesthesia than the smooth, safe and effective way to ventilation and oxygenation, no accumulation of carbon dioxide is a safe, reliable, simple method. 2 ID4.0mm tube pressure controlled ventilation in Paw=20 cmH2O, it easier to obtain a satisfactory tidal volume and airway pressure satisfactory. In other words, smaller diameter, the pressure pattern is more superior than the capacity mode. This may reduce lung compliance and the patient, the airway resistance increased, the small diameter. 3 laryngeal carcinoma lung function of middle age and old closer, laryngeal cancer lung function of young people have more serious damage.