Selection Of Methods For The High-risk Tracheotomy And Prevention And Treatment For Complications

Objective: To investigate the effective way for the different high-risktracheotomy and to minimize complications.Methods: the patient supine, shoulder pads, head leaned back as much aspossible to stretch the cervical trachea exposure obviously; Forced body position oftracheotomy should be done by the help of the anesthesiologist in the operating room;The first tracheotomy implementation are improved. the emergency high-risktracheotomy surgery should using cervical midline and Adam’s apple as landmark, Forthe non-emergency high-risk tracheal incision, the first row CT and other tests shouldbe conduct, and then the purposes of the different methods.①tracheotomy inlaryngeal mask anesthesia.②if the tumor involving the cervical trachea of thecircumferential Tracheotomy could conducted in laryngeal mask anesthesia; or usefiber laryngoscope under topical anesthesia guided tracheal intubation and thenoperate the tracheotomy.③if the tumors involving the of unilateral cervical trachea,we can pull out tumors aside, and Under topical anesthesia and awake intubation, thentracheotomy, we can also available fiber laryngoscope to guide the endotrachealintubation.④if the level of the neck structure is unclear, to make full use of theneck to the midline, and Adam’s apple marked, again with the syringe of salinenavigate to the tracheal line tracheotomy.⑤if you suspect that coagulant functionabnormality, anticoagulant treatment should be suspended anticoagulant treatment; the number of platelet count less than30,000/μl, or/and clotting time prolongation,preoperative infusion of platelet concentrates and fresh plasma added clotting factorenhance the body’s own coagulation function. Tracheotomy precise hemostasis andmade the orotracheal mucous membranes and skin on the seam.⑥for tracheotomyin children, as much as possible before intubation and then implementation of thetracheotomy.Results: The Tracheotomy are successfully in all the cases.3patients in thisgroup of severe bleeding, the will need to open the surgical field to the suture to stopbleeding. One cases of infection in the blood stopped, dressing lasted two months;Including two cases of patients with systemic subcutaneous and mediastinalemphysema. Emphysema subsided in the implementation of the subcutaneousexhaust.1patient pneumothorax occurred after the trachea incision, and then closedchest drainage emergency purposes; One cases of patients in the surgery, asphyxia,after successful treatment inserted after the cross-sectional tracheal identify trachealstump anesthesia endotracheal intubation; One cases of patients can not extubationafter the the implementation of the tracheotomy,Re-admitted to hospital to theremoval of the tracheal tube to the the implementation of stenosis granulationexcision.Conclusion: Familiar with the different high-risk tracheotomy and complicationsprevention, treatment can minimize the risk of high-risk tracheotomy.