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Anesthesia mind map for bronchoscopy diagnosis and treatment
An anesthesia mind map for bronchoscopy diagnosis and treatment is compiled. The content is divided into medical knowledge points such as pre-anesthesia assessment, pre-anesthesia preparation, anesthesia methods, respiratory management, complications and treatment, and there are more test points that can be supplemented by yourself.
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Anesthesia mind map for bronchoscopy diagnosis and treatment
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Anesthesia for (bronchial) bronchoscopy diagnosis and treatment
Staging of sedation/anesthesia depth in (bronchial) bronchoscopy diagnosis and treatment
mild sedation
Ramsay: 2-3 points
moderate sedation
Ramsay: 4 points
deep sedation
Ramsay: 5-6 points
general anesthesia
Pre-anesthesia assessment
Determine the location, nature, proximity and scope of surgery of the lesion
Assess the respiratory system
Is there hoarseness, stridor, difficulty breathing, difficulty swallowing?
Do you have asthma or COPD?
Smoking or not
Assess the circulatory system
Do you have high blood pressure?
Whether there is arrhythmia
Whether there is heart failure
Fasting, gastrointestinal retention, reflux or obstruction, etc.
Preparation before anesthesia
Fast for 6 hours and water for 2 hours before surgery. If there is gastric emptying dysfunction or gastric retention, the time should be appropriately extended. Ultrasound was used to evaluate gastric contents and gastric emptying when necessary.
Routine use of anticholinergic drugs is not recommended
Asthma patients: prophylactic bronchodilators
People with chronic obstructive pulmonary disease: testing lung function. If FEV1<40% of predicted value or SpO2<93%, arterial blood gas should be measured. The decision to use prophylactic bronchodilators should be made on a case-by-case basis.
Use sedative and analgesic medications with caution
Anesthesia method
topical anesthesia
1-4% lidocaine: spray method, atomized inhalation method, intratracheal instillation method, gargle method, cricothyroid membrane puncture method
mild to moderate sedation
Sedation: midazolam 0.03~0.05mg/kg, or remazolam 5.0~7.5mg
Analgesia: fentanyl 1~2μg/kg or sufentanil 0.1~0.2μg/kg,
deep sedation
calm
Dexmedetomidine is injected intravenously at 0.2 to 1 μg/kg within 10 to 15 minutes, followed by maintenance at 0.2 to 0.8 μg·kg-1·h-1
Midazolam 0.03~0.05mg/kg
Propofol 1~1.5mg/kg, maintain (1.5~4.5)mg·kg-1·h-1, or target control effect chamber concentration 3~5μg/ml
Etomidate 0.2~0.3mg/kg
1:2 mixture (etomidate 20mg/10ml mixed with propofol 200mg/20ml), the first dose is 0.15~0.2ml/kg slow intravenous injection
The first dose of cyclopofol is 0.3~0.4mg/kg
analgesia
Fentanyl 1~2μg/kg
Sufentanil 0.1~0.2μg/kg
Remifentanil 0.5~1.0μg/kg, followed by continuous infusion of 0.05~0.1μg·kg-1·min-1, or target controlled effect chamber concentration: 1.5~3ng/ml
Oxycodone 0.05~0.1mg/kg
general anesthesia
respiratory management
Oxygen and nitrogen removal (8-10L/min, 3-5min)
nasal cannula
mask ventilation
high frequency ventilation
high frequency jet ventilation
high frequency positive pressure ventilation
high frequency oscillation ventilation
summary
oxygenation parameters
Inhaled oxygen concentration FiO2
mean airway pressure MAP
ventilation parameters
Inspiratory time I-Time%
Amplitude DR
Frequency Hz
Bias Flow
Piston CenteringPiston Centering
laryngeal mask ventilation
Bronchial/tracheal tube ventilation
Complications and treatment
Respiratory depression
Pause operation
Increase inspired oxygen concentration
mask ventilation, endotracheal tube ventilation
If it is caused by benzodiazepines, flumazenil can be used to antagonize it
bronchus/tracheospasm
Adequate topical anesthesia
deepen anesthesia
Use a mask to pressurize oxygen, and if necessary, intubate the trachea
bronchodilator
Glucocorticoids
Reflux and aspiration
Strictly fasting from water
Lie on your side, pat your back, and clean your mouth and throat
Severe tracheal intubation, bronchoscopy and suction
airway burns
Immediately stop all gases and remove equipment including endotracheal tubes, etc.
After clearing the airway debris, inject normal saline to cool down
Reestablish airway and provide oxygen
Bleeding
pneumothorax
flexible bronchoscope
fiberoptic bronchoscope
electronic bronchoscope
electromagnetic navigation bronchoscopy
Endoscopic ultrasound
rigid bronchoscope