The relevance of additional method of observation — video bronchoscope in modern anesthesia practice
The article pays attention to the use of video bronchoscope in anesthetic practice in the ICU. The paper describes the main advantages: precise visualization of the vocal cords, followed by the introduction of the tube into the trachea under direct vision; no need for general anesthesia intubation; opportunity for both irrigation and nasotracheal intubation; safety against tracheal or pharyngeal perforation; full autonomy, which allows the use of the device at any time and in any place; large screen for easy operation plus a successful intubation by a doctor always on the first try. There are identified the main stages of bronchoscopic monitoring: determining the elements of lung root and the formation of bronchial stump; transillumination, after repeated operations, atypical structure of the bronchial tree, with bleeding, when switching to one-lung ventilation, intraoperative control of bronchial resection margins, removing mucus and clots. The paper describes the indications for sanation bronchoscopy: obturation of the bronchi thick viscous sputum, atelectasis of various localization, aspiration of gastric content, pneumonia, including destructive, prolonged mechanical ventilation, purulent bronchitis, performed bronchoalveolar lavage to obtain material for cytology and microbiological studies. The main problems of the use of modern methods for additional anesthesiologist on the basis of multidisciplinary clinic include difficult intubation, anesthetic management of surgery patients at the Center for Head and Neck Pathology, patients in the departments of endocrine surgery; patients in the departments of thoracic surgery; remedial bronchoscopy in patients in intensive care units for the recovery of respiratory drainage in cases of overproduction of mucous secretion, no cough reflex, possible aspiration of gastric contents.
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