Anesthesia mask larynx conjunctival tumor surgery

The article was professionally consulted by Specialist Doctor II Nguyen Binh - Department of General Surgery - Vinmec Ha Long International Hospital.

Laryngeal mask anesthesia is performed by an anesthesiologist, indicated in many surgeries including surgical techniques to remove conjunctival tumors to help patients feel no pain and anxiety during the surgery. conjunctiva.

The conjunctiva is a thin, transparent mucous membrane that covers the back of the eyelids and then bends forward and spreads over the surface of the eyeball to the edge of the cornea. Ocular conjunctival tumor is a tumor arising from the conjunctiva which can be benign or malignant, may affect only aesthetics, may also affect vision of the eye, metastasize to nearby organs. affecting the patient's life
Conjunctival neoplasms include sessile papilloma, pedunculated papilloma, conjunctival mucinous tumour, conjunctival melanoma. Treatment indications vary from case to case. The usual treatment for benign tumors is surgical resection of the tumor. For melanoma that has not metastasized, surgical resection is required in combination with chemotherapy and radiotherapy. In the case of conjunctival tumor with extensive invasion, the surgery is very complicated, even forced to dredge the entire eye socket to save the patient's life, then cosmetic correction.
The tumor surgery process causes a lot of pain for the patient, the eyes have many small details, so the surgery time is long, it is not possible to give local anesthesia, so the anesthesiologist needs to perform the masking procedure. management of patients during conjunctival tumor resection.

Laryngeal mask anesthesia is a general anesthetic technique with a laryngeal mask placed for the purpose of breathing control during surgery with the following advantages:
Ensure airway ventilation during surgery. Ensure breathing during general anesthesia in positions, in critical and post-operative resuscitation stages. Easy to perform assisted respiration Anesthesia Placing a laryngeal mask is an easy technique to perform, does not require a lot of experience, little stimulation when extubating, is very suitable for ophthalmic surgery.

Indications for anesthesia with laryngeal mask for conjunctivectomy
Patients with intraocular hypertension are difficult to control breathing with a mask. It is necessary to maintain inhalation anesthesia or intravenous anaesthesia, in order to self-medicate. Breathing or respiratory control Contraindications to anesthesia laryngeal mask laryngectomy surgery
Inadequate resuscitation facilities Medical facilities Incompetence with technique Contraindications to the use of laryngeal mask

Preparation:
Laryngeal mask, masks of different sizes suitable for each age Intubation equipment, endotracheal tube to prevent failure of laryngeal mask placement. Ball system for manual breathing. Anesthesia Aspirator, ventilator, anesthetic machine, or hand squeeze device. Technique:
Step 1: The patient lies in the supine position
Step 2: Initiating anesthesia
Put the masque on the patient to breathe 100% oxygen Most people start with fentanyl. Sleeping pills (Propofol, volatile anesthetics). Muscle relaxants can be used Step 3: Put the mask on the larynx
Place the larynx mask according to the technique of the index finger holding the mask. Hold the junction between the mask and the tube, push the mask to slide along the upper wall of the palate towards the back of the throat . Continue sliding until you meet resistance and reach the vestibule of the larynx. If necessary, increase the thrust but not too strong to put the mask in place, the laryngeal mask lying face down on the laryngeal vestibule is the correct position. Step 4: Fix the laryngeal mask, check
When the mask is in position for cuff pumping, the number of ml of water injected depends on the specified mask size, during the mask pumping process is pushed out about 1 cm. Check that the mask is in place by listening with a stethoscope in the patient's neck for good ventilation. Secure the tube with two pieces of adhesive tape.

Step 5: Maintain anesthesia
Anesthesia The laryngeal mask can be self-breathing or breathing under command depending on each case. For self-breathing with an evaporative anesthetic, an evaporative anesthetic is used and controlled via a special vessel. Breathe by machine or squeeze hands and maintain anesthesia with inhalation anesthetic, combination with fentanyl, anesthetic, muscle relaxant When using inhalation anesthetic, stop the drug at the end of surgery, open Valve fully inflated, hyperventilation, squeezing the reserve balloon to release anesthetic during anesthesia.

Monitor parameters while maintaining anesthesia: pulse, blood pressure, SpO2, EtCO2 (CO2 gas in exhaled breath). For the laryngeal mask, it is necessary to aspirate the throat and mouth with a sterile straw, do not remove the cuff of the laryngeal mask, pull the mask in the anatomical direction of the oral cavity to bring the rest of the remaining sputum out. In case the mask cannot be placed, the cause may be because the anesthesia is not deep enough, the anesthesia is deep enough to reset the mask. Identify the correct placement position by hearing laryngeal squeaks. Note complications due to reflexes during surgery. Eye area causes: Slow pulse, arrhythmia,... Folding of laryngeal mask tube, mask drop, mask is out of position: monitor respiratory parameters (SaO2, EtCO2, airway pressure) to detect folding , laryngeal mask drop. Note the complications caused by muscle relaxants, morphine: relax muscle and stop morphine antagonists: naloxone.

To improve the medical examination and treatment process, now Vinmec International General Hospital has applied anesthetic technique of laryngeal mask for conjunctival tumor surgery. The technique of laryngeal mask anesthesia for conjunctivectomy at Vinmec is performed methodically and in accordance with standard procedures by a team of highly skilled medical professionals and modern machinery, thus giving excellent results. contribute significantly to the effective treatment of diseases.
Doctor Nguyen Binh has more than 20 years of experience in the field of anesthesia - resuscitation in thoracic surgery, anesthesiology resuscitation for elderly patients,... Currently a Doctor of General Surgery, General Hospital Vinmec Ha Long International.
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