In recent years, the continuous advancement of endoscopy technology has also made thoracoscopy widely used. Thoracoscopy and treatment can be used for the diagnosis and estimation of pleural, lung and esophageal diseases, biopsy to obtain pathological diagnosis, and treatment for lung resection, laser pulmonary bulla resection, esophageal surgery, pericardial resection, sympathectomy, Removal of masses in the mediastinum and some spinal cord surgery, tissue damage is less than conventional surgery. The operation time of early thoracoscopic surgery was relatively short. With the continuous development of thoracoscopic surgery, the types of operations have become more and more complicated, and the anesthesia before thoracoscopic surgery has also become more demanding.
Assess risk factors before anesthesia
In addition to a comprehensive assessment of the condition, the evaluation of respiratory and circulatory functions should also be emphasized, with particular attention to the following risk factors:
patients with a history of smoking are prone to hypoxemia and atelectasis after surgery, and severe cases of lung complications The incidence of symptoms is 2 to 3 times higher than that of non-smokers.
People older than 60 years old have a significantly higher incidence of cardiopulmonary disease; those older than 70 years have a significantly increased risk of postoperative atelectasis; those over 80 years old need respiratory support for more than 24 hours after surgery.
The risk of coronary heart disease in patients with coronary heart disease mainly depends on the degree of coronary artery obstruction, left ventricular function and the presence or absence of complications. Once myocardial ischemia is clinically diagnosed, the risk of cardiac complications during surgery increases; for some patients with severe coronary heart disease, symptomatic treatment must be performed before surgery.
Obesity is prone to hypoxemia during surgery due to decreased lung compliance and reduced functional residual energy.
Improve cardiopulmonary function before surgery
In addition to fully preparing for anesthesia, the anesthesiologist should also focus on improving the patient’s heart function and lung function. Such as:
1. Ask the patient to stop smoking immediately and continue smoking for more than 4 weeks, in order to promote the reduction of the patient’s airway secretions, reduce their irritability, and effectively improve the bronchial epithelial cilia motor function.
2. Effectively prevent and control the patient’s airway infection, reduce the amount of sputum as much as possible, use antibiotics prophylactically to control infection if necessary, and actively encourage patients to spit out sputum on their own.
3. Ensure that the patient’s airway is unobstructed and prevent bronchospasm. At present, effective drugs for the treatment of bronchospasm in my country include theophylline drugs, adrenal glucocorticoids and β2-adrenergic receptor agonists.
4. Require patients to fully exercise their own breathing function.
5. For patients with hypoxemia, inhaled low-concentration oxygen can be appropriately administered before surgery.
Most patients choose general anesthesia
Most thoracoscopic surgeries need to be performed under general anesthesia. Therefore, accurate insertion of the double-lumen tube is the prerequisite and key to the success of the operation. During the anesthesia process, fiberoptic bronchoscopy should be used to further confirm the accuracy of the catheter position. Under normal circumstances, when the time required for thoracoscopic surgery is relatively short, drugs with short action time and quick recovery should be selected. You can choose propofol to maintain a good anesthesia effect and avoid the use of vasodilators during surgery. At the same time, during the process of anesthesia, the patient should inhale high-concentration oxygen appropriately.
Intraoperative monitoring is essential
In thoracoscopic surgery, in most cases, routine monitoring methods are used to monitor the patient’s vital signs. Among them, the monitoring of electrocardiogram, blood pressure and pulse oxygen saturation is essential. At the same time, the patient’s airway pressure changes and end-expiratory carbon dioxide partial pressure must be closely monitored to accurately understand and master the patient’s airway resistance and lung ventilation. The actual situation of the state. In addition, the patient’s blood gas analysis should also be monitored to more accurately determine the patient’s oxygenation, ventilation and acid-base electrolyte status.
Intraoperative anesthesia 2 Attention
1. Generally, intravenous anesthesia or intravenous inhalation is used, and the inhalation concentration is generally below 1MAC.
2. During the operation, if the patient needs one-lung ventilation, the operation must be performed carefully to prevent the thoracoscopic sleeve from causing damage to the patient’s lung tissue during the insertion process.
3. One-lung ventilation should be performed before the operation to isolate the affected lung to prevent liquid secretion from flowing into the contralateral lung.
4. At the end of the operation, the collapsed lung should be expanded slowly many times to prevent the patient’s lungs from developing atelectasis and recruiting pulmonary edema after the operation.