无管场麻醉用于外科手术中取出抽吸的内窥镜胶囊

IF 0.8 Q3 ANESTHESIOLOGY Anaesthesia reports Pub Date : 2023-08-14 DOI:10.1002/anr3.12242
G. S. Grounds, H. Dent, C. Nunes, V. Dhar
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引用次数: 0

摘要

胶囊内窥镜检查是一种安全、微创的方法,用于调查不明原因的消化道出血,这些出血在初次内窥镜检查阴性后持续存在或复发。胶囊内窥镜检查最常见的不良反应包括腹痛、恶心和呕吐。肺胶囊误吸虽然是一种罕见的并发症,但在文献中已有报道。大多数报告的病例无需进一步的医疗干预即可解决。在这些情况下,胶囊要么通过咳嗽排出,要么重新进入口咽,然后被吞下。在少数情况下,胶囊留在肺中,不能被咳出。这需要及时诊断并在全身麻醉下急诊支气管镜切除。由于胶囊表面光滑、圆润,可能难以把握,因此提取可能在技术上具有挑战性。现有文献包含有限的麻醉和手术方法,以管理吸入性内窥镜胶囊。在这个病例报告中,我们提出了在一个地区综合医院,其中胸外科手术是不可用的吸入性内窥镜胶囊的管理。在没有患者转移的情况下,使用当地资源来处理这种可能危及生命的并发症。在我们的病例中,我们提供了一个无管场来优化手术通路。这有助于手术成功地从左主支气管取出内窥镜胶囊。
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Tubeless field anaesthesia for surgical removal of an aspirated endoscopy capsule

Capsule endoscopy is a safe, minimally invasive procedure used to investigate gastrointestinal bleeding of unknown origin that persists or recurs after a negative initial endoscopy. The most common adverse effects of capsule endoscopy include abdominal pain, nausea and vomiting. Capsule pulmonary aspiration, although a rare complication, has been reported in the literature. Most reported cases resolve without further medical intervention. In these cases, the capsule is either expelled by coughing, or it re-enters the oropharynx and is then swallowed. In a small number of cases, the capsule remains in the lung, unable to be expectorated. This requires prompt diagnosis and emergency bronchoscopic removal under general anaesthesia. Due to the smooth, rounded surfaces of the capsule, it may be difficult to grasp, and consequently extraction may be technically challenging. The existing literature contains limited documentation on anaesthetic and surgical approaches for managing an aspirated endoscopy capsule. In this case report, we present the management of an aspirated endoscopy capsule in a district general hospital, in which thoracic surgery was not available. Local resources were used to manage this potentially life-threatening complication without patient transfer. In our case, we provided a tubeless field to optimise surgical access. This facilitated the successful surgical extraction of the endoscopy capsule from the left main bronchus.

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