Procedure of endotracheal anesthesia for endotracheal surgery to treat biliary tract bleeding and liver resection

This is an automatically translated article.

The article was professionally consulted with Master, Doctor Le Hong Duong - Anesthesiologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.
Endotracheal anesthesia is applied in laparoscopic surgery to treat biliary tract bleeding and liver resection. This is a technique of general anesthesia to control the anesthesia and respiratory and circulatory activities of the patient during and after surgery.

1. Endotracheal anesthesia What is endoscopic surgery for biliary bleeding and hepatectomy?

In laparoscopic surgery to treat biliary tract bleeding and liver resection, the technique of general anesthesia with tracheal intubation, also known as endotracheal anesthesia, is used to control the patient's respiratory activities. during and after surgery.

2. What to prepare for endotracheal anesthesia for laparoscopic surgery for biliary bleeding and liver resection?

To perform endotracheal anesthesia for endoscopic surgery to treat biliary tract bleeding and liver resection, the following means, machinery, equipment, and medications are required:
The system includes an anesthetic machine (with breathing) , hand ball, oxygen, monitor of vital functions (such as arterial blood pressure, breathing rate, temperature, ECG, EtCO2, SpO2), suction machine, defibrillator, ... Tube sizes endotracheal tube for placement, laryngoscope, mask, suction tube, oropharyngeal cannula, squeeze balloon, soft mandrin, Magill forceps. Salbutamol and Lidocaine 10% spray. Other means of supporting endotracheal anesthesia in case of difficult intubation: laryngeal mask, Cook tube, flexible bronchoscope, mouth opening pliers, tracheostomy kit, ...

3. Procedures for endotracheal anesthesia for endotracheal surgery to treat biliary tract bleeding and liver resection

Before performing surgery, patients need to be examined under anesthesia to promptly detect and prevent possible risks, as well as evaluate difficult intubation status.
Procedures for endotracheal anesthesia for endoscopic surgery for biliary bleeding and liver resection include the following steps:
Step 1: Put the patient in a supine position, at least 5 minutes before induction of anesthesia, give breathing 100% oxygen at a dose of 3 - 6 liters/minute. Install machines to monitor and set up transmission lines. If necessary, the patient can be given sedatives from the night before surgery. Step 2: Initiation of anesthesia begins with intravenous injection (drugs, etomidate, propofol, ketamine, thiopental, ...), volatile anesthetics (Isoflurane, sevofluran...), analgesics (fentanyl, morphine, fentanyl, etc.) ...), use a muscle relaxant if necessary (rocuronium, succinylcholine, vecuronium, ...). It is necessary to ensure conditions for endotracheal intubation in laparoscopic surgery to treat biliary tract bleeding and liver resection (patients sleep deeply, muscle relaxation is adequate). Step 3: Perform endotracheal intubation. You can choose one of two ways to place it: oral or nasal. The technique of oral intubation is performed as follows: (1) Open the patient's mouth, insert the laryngoscope into the right side of the mouth, move the tongue to the left side of the mouth, insert the light deeply, and combine Use the right hand to press the cricoid cartilage to find the lid and glottis; (2) Perform rapid induction of anesthesia and perform the Sellick maneuver when the stomach is full (as soon as the patient loses consciousness, press the cricoid cartilage 20 - 30 kg until the intubation process is complete); (3) Gently insert the endotracheal tube through the glottis, when the endotracheal tube passes through the vocal cords about 2-3 cm, stop; (4) Gently withdraw the laryngoscope; (5) Intubation of endotracheal balloon; (6) Listen to the lungs, see the EtCO2 index to check that the endotracheal tube is in place; (7) Use adhesive tape to fix the endotracheal tube. In case, if it is necessary to avoid biting the endotracheal tube, the cannula can be placed into the patient's mouth. Nasal intubation can be carried out as follows: (1) Instill a vasoconstrictor on the side of the nose selected for catheterization; (2) For the nasal passage, choose an endotracheal tube with a smaller size than the oral route; (3) Lubricate the endotracheal tube with lidocaine grease and insert the tube into the nostril. Follow-up steps are similar to oral intubation. However, in unfavorable cases, it is necessary to use Magill pliers to guide the end of the endotracheal tube into the correct glottis, and at the same time, have an auxiliary medical staff push the endotracheal tube in from the outside. Note, apply difficult intubation procedure for difficult intubation cases.
Step 4: The next step in endotracheal anesthesia for endoscopic surgery for biliary bleeding and hepatectomy is to maintain anesthesia with anesthetics (intravenous or vapor), analgesics, and muscle relaxants (if necessary. needed) and control the patient's breathing with a machine or hand squeezer.

4. Monitoring during endotracheal anesthesia laparoscopic surgery for biliary bleeding and hepatectomy

During endotracheal anesthesia for endoscopic surgery for biliary bleeding and liver resection, the following signs and indicators should be monitored:
Depth of anesthesia: Monitor blood pressure, heart rate, blood pressure , sweat, tears, BIS, MAC, Entropy (if any) ... Vital signs: Monitor blood pressure, heart rate, body temperature, EtCO2, SpO2 indicators. Monitor in case of wrong position of endotracheal tube, or blocked, folded tube. At the end of endotracheal anesthesia, laparoscopic surgery for biliary bleeding and liver resection, the following criteria should be met before extubation:
The patient is awake and can follow orders. Breathe spontaneously, breathe evenly, breathing rate is within normal limits. Blood pressure and pulse are stable. Body temperature over 35 degrees Celsius. Raise head >5 seconds, TOF index >0.9 (if any). The patient had no complications from anesthesia and surgery.

5. Management of complications after endotracheal anesthesia laparoscopic surgery for biliary bleeding and liver resection

During endotracheal anesthesia, endoscopic surgery to treat biliary tract bleeding and liver resection may occur some complications that need to be handled as follows:
Gastric juice reflux into the airways: When digestive juices are detected In the oral cavity and airway, immediately aspirate the fluid, place the patient in a low lying position and tilt the head to the side. Rapidly intubate the endotracheal tube and remove all fluid from the airway. Monitor patients for lung infections after surgery. Hemodynamic disorders: Depending on the cause and symptoms such as arrhythmia, increase or decrease in blood pressure, ... will be treated appropriately. Difficult intubation in anesthesia laparoscopic surgery for biliary bleeding and liver resection: difficult endotracheal intubation procedure is applied according to international guidelines updated annually. Misplaced endotracheal tube into the stomach: Re-intubate the endotracheal tube when misplaced with symptoms of auscultation of the lungs without alveolar murmurs, no measurement of EtCO2. Constriction of the larynx, trachea, bronchi: Complications in endotracheal anesthesia endoscopic surgery for biliary bleeding and liver resection may cause difficulty or inability to ventilate, at this time there will be a crackling sound when listening to the lungs. Or maybe the lungs are dumb. For management, it is necessary to provide adequate oxygen, and at the same time give sleeping pills and muscle relaxants, bronchodilators and corticosteroids to ensure ventilation. In case of respiratory failure, difficult intubation procedure should be applied. Trauma in endotracheal intubation: Depending on the damage such as tooth fracture, bleeding, foreign body in the airway, ... will be treated appropriately. Respiratory complications: Find and treat the cause, ensure ventilation and provide 100% oxygen during endotracheal anesthesia laparoscopic surgery to treat biliary tract bleeding and liver resection causing respiratory complications such as endotracheal tubes The trachea is folded, retracted or pushed deep into one lung, open or collapsed the respiratory system, the oxygen is exhausted, the effect of soda is gone, causing hypoxia. Complications after extubation: Depending on the cause, choose appropriate management when symptoms appear after extubation such as respiratory failure, hoarseness, sore throat, laryngospasm, gas trachea, bronchi, laryngotracheal and tracheal stenosis, upper respiratory tract infection.

Endotracheal anesthesia Laparoscopic surgery to treat biliary tract bleeding and liver resection can be intubated in the nasal or oral route. During and after anesthesia, surgery needs to be monitored and promptly treated for possible complications.
Vinmec International General Hospital has applied endotracheal anesthesia technique in examination, diagnosis and treatment of many diseases. The procedure of endotracheal anesthesia at Vinmec is carried out methodically and according to standard procedures by a team of highly skilled doctors and modern machinery. As a result, complications after anesthesia and surgery are always minimized to the maximum extent.

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