高流量鼻插管加氧及氧储备指数监测对妊娠双侧声带肉芽肿的麻醉处理1例

IF 0.1 Q4 SURGERY Surgical Techniques Development Pub Date : 2023-09-07 DOI:10.3390/std12030015
Hyo Sung Kim, S. Oh, Jae Eun Lee, Hyun Ah Lee, Jae Gu Cho
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引用次数: 0

摘要

麻醉管理的孕妇患有气道病理提出了独特的挑战。双侧声带肉芽肿的存在增加了麻醉管理的复杂性,因为它可能导致气道受损和呼吸窘迫。本病例报告一位双侧声带肉芽肿的孕妇,采用高流量鼻插管(HFNC)充氧和氧储备指数(ORi)监测麻醉。一位33岁的孕妇,6个月前接受了插管,经历了声音嘶哑,最终被诊断为双侧肉芽肿。由于明显的气道阻塞,插管和通气都不可行,因此需要手术干预。手术切除前,采用HFNC氧合保证患者氧合。在确认患者氧合充足(ORi为0.38)后,开始手术,由于手术持续约3分钟,患者能够忍受短暂的无额外氧供应。术后切除,面罩袋敷,恢复HFNC充氧,ORi为0.39;然后,恢复操作。在整个过程中,SpO2保持在98以上。HFNC和ORi的结合确保了充足的氧合,并允许在手术过程中早期发现低氧血症。这种方法可能是治疗肉芽肿的一个很好的选择。
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Anesthetic Management for a Pregnant Patient with Bilateral Vocal Cord Granuloma Using High-Flow Nasal Cannula Oxygenation with Oxygen Reserve Index Monitoring: A Case Report
Anesthetic management for pregnant patients suffering from airway pathology poses unique challenges. The presence of a bilateral vocal cord granuloma adds further complexity to anesthetic management as it can potentially cause a compromised airway and respiratory distress. This case presents a pregnant patient with a bilateral vocal cord granuloma who underwent anesthesia using high-flow nasal cannula (HFNC) oxygenation and oxygen reserve index (ORi) monitoring. A 33-year-old pregnant woman, who underwent intubation six months ago, experienced hoarseness and was ultimately diagnosed with a bilateral granuloma. Due to the significant airway obstruction, neither intubation nor ventilation was feasible, thereby requiring a surgical intervention. Before the surgical removal, the patient’s oxygenation was ensured using HFNC oxygenation. After confirming the sufficient oxygenation of the patient with an ORi of 0.38, the operation commenced, and as it lasted approximately 3 min, the patient was able to tolerate the brief period without additional oxygen supply. Post-surgical excision, mask bagging, and HFNC oxygenation was resumed, driving the ORi to 0.39; then, the operation was resumed. Throughout the procedure, the SpO2 remained above 98. The combination of HFNC and ORi ensured adequate oxygenation and allowed for the early detection of hypoxemia during the procedure. This approach may be a good option for managing granulomas.
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