Crush introduction to anesthesia
Definition[edit | edit source]
- Mode of introduction to general anesthesia at high risk of aspiration.
Indication[edit | edit source]
- Use in high risk of aspiration (fasting patient, ileus etc.).
- The patient is not hungry (suspected abdominal sudden event, trauma) in acute admissions;
- ileus, upper gastrointestinal bleeding;
- gastric atony, pyloric stenosis, hiatal hernia, Gastroesophagic reflux, esophageal diverticula, esophageal atresia;
- pregnant from the 2nd trimester;
- patients under the influence of alcohol, comatose or intoxicated patients;
- uremic patients;
- patient with increased intracranial pressure;
- clinically manifest hypothyroidism.
Preparing the patient[edit | edit source]
- If there is time, the patient must be thoroughly prepared for the operation (medication to reduce stomach acidity with drugs such as – proton pump inhibitors, H2 receptor blockers, intestinal prokinetics , sodium citrate).
- In case of a very high risk of aspiration (pylostenosis or ileus of the small intestine and at the same time the patient is not fasting), we must introduce a gastric tube and aspirate the contents of the stomach before starting anesthesia - the tube is then removed again, as it can serve as a guide for gastric secretions (however, some authors recommend leaving the tube ).
- If vomiting occurs during intubation, we immediately place the patient in the Trendelenburg position to prevent gastric contents from leaking into the airway.
Procedure[edit | edit source]
- Reliable intravenous access.
- Insertion of a gastric tube and suction of the stomach (subsequent removal or pulling out of the gastric tube).
- After thorough preoxygenation (minimum 5 minutes).
- Constantly ready suction.
- We will perform an introduction to anesthesia (CAVE: WE DO NOT BREATHE THE PATIENT WITH THE MASK!) using a fast-onset muscle relaxant (Succinylcholine or Rocuronium).
- The assistant applies the Selick maneuver (by pressing on the annular cartilage, we compress the esophagus).
- After the onset of relaxation (with succinylcholine after the onset of muscle fasciculations) we intubate ALWAYS A TUBE WITH AN INSTALLED CONDUCTOR'.
- Breathing through the mask and verifying the position of the tube only after inflating the cuff of the tube.
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