Complications from laryngotracheal mask anesthesia laparoscopic proximal total thyroidectomy in Basedow's disease

The article was consulted with Specialist Doctor I Nguyen Duc Thong - Anesthesiologist - General Surgery Department - Vinmec Danang International General Hospital.

Complications due to laryngeal mask anesthesia laparoscopic surgery to remove the entire thyroid gland in the treatment of Graves' disease can cause some typical complications such as reflux of gastric juice into the airways, constriction of the larynx - gas - bronchi. , fold or slide the laryngeal mask.

Laryngeal mask anesthesia is increasingly being used. In particular, it is preferred in cases of difficult or impossible intubation; airway control during general anesthesia for surgery, including thyroidectomy for the treatment of basedow's disease.
This is because the laryngeal mask provides better airway control and delivers a much larger amount of oxygen than an open mask. Compared with endotracheal intubation, the procedure of placing a laryngeal mask is easier to perform and causes less complications. Specifically, less stimulation of the larynx - trachea, causing laryngotracheobronchial constriction; At the same time, it reduces sympathetic reflexes, causing an increase in heart rate and blood pressure.

Laryngeal mask anesthesia for laparoscopic thyroidectomy basedow treatment is performed through the following steps:

The team includes: Anesthesiologist and nurse
Patient: The patient can be provided with sedation in the evening before surgery (if needed, the patient is too worried). When you come to the operating room, you will be explained by the doctors about the procedure of anesthesia and thyroidectomy; undergo pre-anesthesia risk screening. Finally, the doctor will assess the difficulty in placing the laryngeal mask before proceeding with the procedure. Instruments: Tools include anesthesia system, vital function monitor, defibrillator, expectorant sputum extractor, laryngeal mask, squeeze balloon, oropharyngeal cannula, syringe to inflate balloon (cuff), Cuff pressure gauge. The drugs lidocaine 10% spray, salbutamol spray. In addition, it is necessary to have an endotracheal tube and a backup laryngoscope ready.

Check the patient's medical record Check the patient: Vital signs, health status, complete tests before conducting anesthesia for thyroidectomy Perform anesthesia technique General steps : Position: Put the patient in supine position, breathe 100% oxygen 3 - 6 liters/minute before starting anesthesia for about 5 minutes Install a monitor to monitor vital signs during anesthesia: Heart rate, electricity Cardiovascular, arterial blood oxygen saturation (SpO2), respiratory rate, monitoring of anesthesia (Entropi) Intravenous line establishment Pre-anesthesia (if necessary) Intravenous midazolam. Anesthesia: Initiate anesthesia with the following drugs: Sleeping pills: Intravenous anesthetics (propofol, etomidate), volatile anesthetics (sevofluran, desfluran) Analgesics: fentanyl, Sufentanil Muscle relaxants: rocuronium, vecuronium, etc. Placing a laryngeal mask: The laryngeal mask is only placed when the patient is in deep sleep, can wait until there is enough muscle relaxation (TOF muscle relaxation monitor). Place the patient's head in an intermediate position or slightly tilted back. Hold the larynx mask like a pen, place the index finger at the junction between the mask and the larynx. One hand opens the patient's mouth, the other hand holds the mask. larynx through the dental arches to the base of the tongue, press the back of the mask on the hard palate, push the mask to slide along the hard palate to enter the hypopharynx Stop, do not continue to push further when encountering resistance Inflate the cuff properly The volume is guided on the laryngeal mask, measuring cuff pressure 40 -50 cmH2O. Check the tightness of the laryngeal mask (no air leaks, easy ventilation) Check the correct position of the laryngeal mask by listening to 2 lungs in 4 positions and checking for 3 consecutive EtCO2 waves. Secure the laryngeal mask with adhesive tape to the cheeks and lips. Maintenance of anesthesia: Maintain anesthesia with a target concentration-controlled intravenous anesthetic (TCI) or a volatile anesthetic. May be repeated injections of pain relievers and muscle relaxants (if surgery time is prolonged). Control your breathing with an anesthetic machine that helps you breathe (volume or pressure control).

The manifestation of gastric reflux into the airways is the appearance of digestive juices in the oral cavity and airways. The treatment is to remove the fluid by suction machine, put the patient in a low head position, tilt the head to one side. This is followed by rapid intubation and aspiration of airway fluid. Finally, monitor and prevent lung infections after surgery.

Patients may have low or high blood pressure, arrhythmia (bradycardia, tachycardia, arrhythmia) during anesthesia. Treatment is medication depending on symptoms and causes.

The laryngeal mask cannot be placed Due to many reasons, it may be due to the patient's oropharyngeal structure, the doctor's inexperience, or the inappropriate size of the laryngeal mask. Treatment depends on the cause, and there are remedies. Vocal - tracheobronchospasm manifests as difficulty or inability to ventilate, auscultating crackles or silence in the lungs. Management: Provide adequate oxygen, add sleeping pills and muscle relaxants, ensure ventilation. Bronchodilators and corticosteroids can be used if necessary. If airway is still not controlled, proceed to intubation. Injuries during the placement of the laryngeal mask Some common injuries are bleeding caused by rubbing of the oropharyngeal mucosa, damage to the vocal cords, and foreign objects falling into the airways. Treatment: Depends on the type of injury. Appropriate management after thyroidectomy.

Some common respiratory complications such as folding and slipping of the laryngeal mask; open respiratory system; out of oxygen supply; soda lime is not effective leading to CO2 stagnation. Treatment: Immediately ventilate the patient, provide oxygen at 100% concentration, find the cause and fix it.

Depending on the complications after removing the laryngeal mask, there are different treatments. Some possible complications include:
Respiratory depression Sore throat, hoarseness Vocal - air - bronchial spasms Upper respiratory tract inflammation Complications from anesthesia mask larynx laparoscopic surgery to remove the entire thyroid gland in Treatment of Graves' disease can occur from many different causes. Therefore, in order to minimize complications, patients need to choose a reputable medical facility, hospital with a team of experienced anesthesiologists and fully equipped with modern medical equipment to do anesthesia. surgery.
Vinmec Hospital's operating room is equipped with modern machinery: anesthesia machine to help breathe with many breathing modes, Monitor to monitor all parameters (electrocardiogram, pulse, blood pressure, blood oxygen concentration, CO2 gas). Exhalation, analysis of anesthetic gas, monitoring of anesthesia (Entropi, BIS), muscle relaxation monitor (TOF), intraoperative heating We use 2nd generation laryngeal mask capable of sucking gastric juices To avoid reflux of gastric juice into the trachea during anesthesia, when performing anesthesia, we have full equipment to control difficult airways: endotracheal light with camera, flexible endotracheal tube. ..So the work of anesthesia, laryngotracheal mask placement / intubation always ensures the highest safety
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with the team. Leading medical team, modern equipment and technology system, but also outstanding with comprehensive and professional medical examination, consulting and treatment services; civilized, polite, safe and healthy medical examination and treatment space. sterilization ng max.