Altun Demet, Yılmaz Eren, Başaran Bora, Çamcı Emre
Department of Anaesthesiology and Reanimation, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Department of Ear Nose and Throat, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey.
Turk J Anaesthesiol Reanim. 2014 Aug;42(4):220-2. doi: 10.5152/TJAR.2014.16362. Epub 2014 May 29.
Following the use of an endotracheal or tracheostomy tube, circumferential lesions, stenosis, or granulomatous lesions at the cuff level or tip of the tube may be observed on the tracheal wall. This injury mainly occurs due to excessive pressure of the cuff on the tracheal wall and may be prevented by a high-volume, low-pressure cuff and a carefully monitored tracheostomy tube. Although there is an overall improvement in the design of high-volume cuffs, hyperinflation of these cuffs may still contribute to tracheal injuries. If the size of the granuloma is limited, the lesion is treated by excision (microlaryngeal surgery) under general anaesthesia. Using jet ventilation during the operation minimizes the trauma caused by intubation and reduces the risk of oedema and the risk of barotrauma, as it provides ventilation over a possible stenosis. In addition to providing better visualization of the surgical field and superior surgeon comfort, jet ventilation also increases the success of the operation. In this case report, we aimed to present a successful anaesthesia technique performed by jet ventilation in a patient with a postintubation granuloma, which was excised by microlaryngeal surgery without the need for reintubation.
在使用气管内插管或气管造口管后，可在气管壁上观察到气管造口管套囊水平或尖端处的环形病变、狭窄或肉芽肿性病变。这种损伤主要是由于套囊对气管壁的压力过大所致，大容量、低压套囊和仔细监测的气管造口管可预防这种损伤。尽管大容量套囊的设计有了整体改进，但这些套囊过度充气仍可能导致气管损伤。如果肉芽肿的大小有限，可在全身麻醉下通过切除（显微喉手术）治疗病变。手术期间使用喷射通气可将插管引起的创伤降至最低，并降低水肿风险和气压伤风险，因为它可在可能存在的狭窄部位提供通气。喷射通气除了能更好地观察手术视野并提高外科医生的舒适度外，还能提高手术成功率。在本病例报告中，我们旨在介绍一种在插管后肉芽肿患者中通过喷射通气实施的成功麻醉技术，该患者通过显微喉手术切除肉芽肿，无需再次插管。
