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The article is professionally consulted by Master, Doctor Ta Quang Hung - Department of General Surgery - Vinmec International General Hospital Da Nang.Endotracheal anesthesia for endoscopic carpal tunnel release is the preferred technique for use when the patient refuses regional anesthesia, the patient is uncooperative or has contraindications to the placement of a laryngeal mask for the purpose of control. respiratory control during and after surgery.
1. Effect of endoscopic carpal tunnel release surgery
Previously, it was predicted that the main cause of carpal tunnel injuries was trauma from overuse of the wrist joints. In recent times, there are also a number of theories that cause disease such as genetics, racial characteristics or consequences after trauma such as fractures, sprains,...Medical treatment does not bring too many effective because it only has a temporary pain reliever effect and does not help release the nerve from the compression. Therefore, surgical intervention is the most effective method. Endoscopic carpal tunnel decompression surgery will help patients improve pain, numbness, and improve functional activities significantly. Not only that, surgery also helps to completely solve the symptoms caused by carpal tunnel.
Nguyên nhân gây nên các tổn thương ống cổ tay là do chấn thương
2. When to perform endotracheal anesthesia laparoscopic carpal tunnel release
There are many anesthetic methods for endoscopic carpal tunnel release, in which endotracheal anesthesia is preferred in some special cases.Endotracheal anesthesia is performed when the patient is indicated for laparoscopic carpal tunnel release.
Some relative contraindications of the method:
The patient does not agree to perform. Generalized TB, COPD... Anesthesia works well and is safer than general anesthesia if it has the same indications. The hospital lacks equipment for anesthesia and resuscitation. The operator is not proficient in the technique of endotracheal anesthesia.
3. Steps to perform endotracheal anesthesia for endoscopic carpal tunnel release
First, the doctor will do a general examination of the body before performing anesthesia and surgery. Then will explain to the patient about the technique, some possible complications for the patient to cooperate. In some cases, the patient should be sedated the night before surgery.After checking the medical record and the patient, the anesthesiologist will perform the technique.
3.1. General steps to take
Put the patient in the supine position, at least 5 minutes before the induction of anesthesia, give the patient 100% oxygen from 3-6l/min. Install the monitor and set up the transmission. Perform pre-anesthesia if necessary Induction of anesthesia: In turn, use intravenous anesthetics, volatile anesthetics, analgesics, muscle relaxants (if necessary). Conditions for endotracheal intubation: The patient must sleep deeply, in most cases, the muscle relaxation must be adequate. Perform oral or nasal intubation.3.2. Oral intubation
Open the patient's mouth, illuminate the larynx to the right of the mouth, and then move the tongue to the left to identify the lid and glottis. Insert the endotracheal tube through the glottis, after going through the vocal cords from 2-3cm, stop. Gently withdraw the laryngoscope. Endotracheal balloon pump. Auscultate the lungs and check the EtCO2 result (with at least 3 continuous waves) to see if the endotracheal tube position is correct. Secure the tube with adhesive tape. In some cases, it is advisable to put the cannula in the mouth to prevent the patient from biting the tube.3.3. Nasal endotracheal intubation
The nasal endotracheal tube is smaller in size than the oral endotracheal tube. The nasal endotracheal tube must be lubricated with lidocaine grease and then inserted into the patient's nose. Identification of the epiglottis and glottis is similar to that of an oral intubation technique. After inserting the endotracheal tube through the glottis, 2-3cm away from the vocal cords, use magilli pliers to guide the tip of the endotracheal tube into the correct glottis. In difficult cases, the assistant doctor will push the endotracheal tube from the outside. The next steps are similar to oral endotracheal intubation. In difficult cases, it is necessary to switch to difficult intubation option.3.4. Maintain patient anesthesia
Maintain anesthesia with intravenous anesthetics, volatile anesthetics, analgesics, muscle relaxants. Respiratory control by automatic computer or manual hand squeezer. Monitor the depth of anesthesia based on parameters such as heart rate, blood pressure, sweat, tears, BIS, MAC, Entropy (if any). Prevent problems with endotracheal intubation.
Thực hiện gây mê nội khí quản phẫu thuật nội soi giải phóng ống cổ tay
4. When should the endotracheal tube be removed?
The patient must meet the following conditions for the doctor to perform the extubation of the endotracheal tube:Be awake, follow the doctor's orders. Head cyst over 5 seconds, open mouth, stick out tongue, raise head for 5 seconds, 10 seconds If there is an extensometer, the TOF value is above 0.9. Pulse and blood pressure are stable. There were no complications after anesthesia and surgery.
5. Some complications of endotracheal anesthesia
Gastric juice backs up into the airways. Hemodynamic disorders. Complications of endotracheal intubation. Respiratory complications. Complications after extubation. Depending on the complications and specific characteristics of the patient, the doctor will offer the most appropriate treatment plan.Laparoscopic carpal tunnel decompression is a technique that is not too complicated and has many anesthetizing methods for the patient. Endotracheal anesthesia is a common technique, but the operator needs to have a lot of experience to avoid unwanted complications.
Master. Doctor Ta Quang Hung has over 10 years of experience in teaching and practicing in the field of Anesthesia and Resuscitation. Currently, he is an Anesthesiologist, General Surgery Department - Vinmec International Hospital Da Nang.
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