The article was consulted professionally by Specialist I Tran Thi Anh Hien – Department of Surgical Anesthesithesi – Share99 Central Park International Hospital, Master, Dr Ta Quang Hung – General Surgery Department – Share99 Da Nang International Hospital.
Insymed administration is a difficult anesthesia technique and carries a high risk of accidents. Therefore, the implementation of the in-administration procedure should be prescribed by specialists at qualified medical facilities.
1. What is in-administration anesthesia?
In-administration anesthesia is a technique of general anesthesia with in-administration tubes with the aim of controlling respiration during surgery and post-surgical resuscitation. During surgery, under the effects of anesthesia the patient will lose sensation and consciousness temporarily, but the patient can still breathe on his own or breathe mechanically through the inttular tube. Accordingly, anesthesia with in-administration tubeing has the following benefits:
- Helps maintain upper respiratory tract absorption for patients.
- Makes bronchial air suction easy.
- Make it easy for your doctor to breathe support or command.
In addition, in-administration also ensures respiration during body anesthesia in different locations, in critical stages and post-surgery resuscitation.
2. Intraining and contrain specifying of the method of anesthesia with intt management tubes
Based on the history of the person suffering from the disease, doctors will prescribe and contrain designation of subjects using intt management anesthesia techniques.
In-administration anesthesia is in the following cases:
- Cases of deep organ surgery, large surgeries, there is a need for muscle softness.
- Cases of patients with shock, multiple injuries.
- Thoracic surgery, cranial surgery.
- Surgery on patients with a full stomach.
- Where respiratory control with a mask is difficult.
- Surgeries have an unusual position such as in jaw, head, neck, inclined or lying on the stomach.
- Cases where anesthesia should be maintained with respiratory anesthesia to breathe on their own in young children and babies.
The method of intt management anesthesia is absolutely contrained in the following cases:
- Medical facilities do not have sufficient resuscitation facilities.
- There are no qualified people to perform.
The method of inttat anesthesia is relatively contrained in the following cases:
- Patients with acute inflammation of the upper respiratory tract.
- Patients with severe ingmana tuberculosis.
- Patients with esophagus cancer.
3. In-in-administration process
To achieve high therapeutic results it is necessary to fully follow the steps in the technique of in-administration anesthesia. It is necessary to first prepare:
- Preparation of hearing tubes, suction machines, vascular examination, temperature, blood pressure for patients.
- Preparation of anaesthetic drugs.
- Give the patient 100% oxygen, at least 3 minutes.
Step 1: Start anesthesia:
- Mostly starting with Fentanyl
- Sleeping pills such as Thiopental, Propofol, Etomidate, Ketamin.
- Muscle relaxers such as: Norcuron, Succinylcholine, Pavulon, Arduan Tracrium. Muscle relaxer should only be given when respiration with a mask has taken effect.
- About the dosage of the drugs used in doses of intravenous anesthesia.
Step 2: Local anesthesia
Local anesthesia is performed using Xylocain 5% spray after the rye lamp is inserted to the patient's bar cap.
- Spray on the bar 4-7 times.
- Spray on the sound bar 4-7 times.
- Spray into the ina <1> administration 4-7 times.
These three positions spray up to no more than 25 times.
Step 3: Perform in-administration techniques
- Insymed administration through the mouth
- Place the patient in a position to lie on his back, so that when looking at the mouth, the samerynx andrynx are located on a straight shaft. The commonly used position is from the modified Jackson position: the knee is 8 – 10cm higher than the shoulder.
- The person holds the checkered light on the left hand, and the right hand opens the patient's mouth. It is necessary to expand the patient's mouth to avoid damage to the lower lip, avoiding the obstruction of the teeth, of the tongue when inserting the lamp.
- The lamp is inserted into the right lip side, then gradually pushed downwards along the tongue, in the middle line, and shifts the tongue to the left, until the tip of the lamp arrives at the edge of the tongue – the cap of the velothe.
- Raise the lights high and gently move forward until the bar hole is visible.
- Next, use your right hand or the woman will press or gently push the armor cartilage to the side so that the bar can be seen. Then insert the ineocular tube into the corner of the right lip and insert it into the bar hole.
- After the ball of the intt management tube passes the sound cords about 2 cm, then stop.
- Using a 10ml injection pump to pump the ball, the amount of gas inserted is just enough so as not to leak during breathing.
- Then the bar lamp will be taken out gently.
- Keep the inngocular tube close to the edge by clamping between the thumb and index finger.
- Conduct hand-breathing and check the location of the in-administration tube to see if it is in the correct position by listening to two scraps and two armpits. If the inhalation is clearly heard and the alveolar barrier on both sides of the lungs is clearly in place.
- After the pipe has been determined, it is placed in the right position to proceed to fix it with adhesive tape or cloth strips.
- Finally put the canuyn in the mouth to prevent the patient from biting the tube.
- Insymed administration through the nose
- The usual tube is inserted through the right nostril, the beveled edge of the tube is directed at the nasal septum.
- Pipes are always in an angular line with a face plane.
- Both slightly rotate and push the tube in to alleviate the risk of a nasal twist injury.
- Coordination of local anesthesia helps to increase the diameter of the nostrils and reduce the risk of bleeding.
- After inserting the cathetro 15 – 16cm, use the checkered light as the technique of inserting the lamp in the technique of placing the oral cathetro above.
Step 4: Maintain your fascination:
- Depending on the patient' case, it is possible to breathe on their own or breathe command.
- In case of self-breathing with vaporizing anesthesies, anesthesia is used and controlled through a specialized u-comment.
- In case of mechanical respiration or hand squeeze: maintain anesthesia with respiratory anesthesia, coordinate anesthesia, muscle relaxer, fentanyl by injection or maintenance through an electric injection pump.
- Before the end of surgery, the dose of anesthesia should be reduced.
- In case of use of respiratory anesthesia, it is necessary to stop the drug at the end of the surgery, open the valve to the full, increase the notification, squeeze the reserve balloon to discharge the anesthetic within the anesthesia.
- During the process, the following parameters should be monitored: Pulse, blood pressure, SaCO2, EtCO2 (CO2 gas in exhalation).
Step 5: In-administration tube drainage after in-administration anesthesia
Standard of in-administration tube withdrawal after in-administration anesthesia:
● Patients who are awake, can follow the commands: open their mouths, stick their tongues, open their eyes, hold their hands tightly, lift their heads high and hold for 5 seconds.
● Patients can breathe deeply, evenly, without prompting, breathing frequency >14 times /min, circulation volume 8ml/kg weight.
● Patient's pulse and blood pressure are stable.
● SaO2: 98 – 100%.
● 90% ≥ recovery
If the patient does not meet the above criteria, the doctor needs to re-evaluate the patient's condition, the effect of muscle relaxes, the respiratory inhibitor effect of Fentanyl to use muscle relaxes or take Naloxon.
In-in-administration tube drainage technique:
- Suck out the throat and mouth with the no. 1 homeless straw.
- Suck a gastric cathetro if available.
- Remove the in-in-administration tube ball.
- Insert 2 aseptic straws into the in-administration tube, both sucking and withdrawing the tube.
4. Some complications may occur with in-administration anesthesia
- Accidents encountered during in-administration tubes:
- Failed to place the tube.
- Put the wrong tube in the stomach.
- Injuries when placing in-administration tubes: lip tearing, tooth fracture, hoarseness …
- Rapid pulse, hypertension during ineocular tube.sis.
- Accidents of folding pipes, dropping tubes, in-management tubes are pushed deep to exclude one side of the lungs.
- Accidents caused by muscle relaxes, anesthesia.
In-administration anesthesia is a difficult technique, which should be performed by highly qualified specialists, and the medical facility must have all the necessary equipment to achieve the highest efficiency and prevent possible accidents.
Share99 International Hospital currently has in-administration anesthesia during surgery performed by a team of skilled and experienced doctors, with advanced and modern medical equipment.
Graduated from the training program of Resident Doctor, Dr. Tran Thi Anh Hien has undergone many different working environments such as Binh Dan Health Hub, Ho Chi Minh City University of Medicine and Pharmacy Health Hub and French Vietnamese Health Hub before returning to work at Anesthesiological Unit – Surgical Anesthesiological Department – Share99 Central Park International Health Hub
Master. Dr Ta Quang Hung has over 10 years of experience in teaching and practice in the field of Resuscitation Anesthesia. Currently, he is an anesthesithesithesisithesiist, General Department – Share99 Da Nang International Health Hub
For detailed advice on in-administration anesthesia techniques at Share99, please go directly to Vinmec health system or register for an online examination HERE.
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