Brief information on the anatomy and physiology of the trachea and bronchi. The trachea is a continuation of the larynx and consists of an average of 16 rings connected by a fibrous cords. The length of the trachea 11-13 see the Larynx and trachea have great mobility due to the presence around them significant amounts of soft tissue. The beginning of the trachea corresponds to the interval between the sixth and seventh cervical vertebrae. Level V thoracic vertebra trachea divides into two main bronchus. Right bronchus is more steeply than the left, and he wider left. The right main bronchus is divided into 3 bronchus of the first order, and the left one - on 2 bronchus of the same order. The trachea is in front of the esophagus and behind the aortic arch. Bifurcation with a deep breath makes a move in two directions: one down for approximately 1 cm, the other - from back 0.75 see If a strong jerky exhale (cough) is a short-time decrease the clearance of a breathing tube. Children change clearance breathing tube in breathing, especially when coughing, are much more. In addition to respiratory movements, there are still pulsating movement of the trachea. Ripple, trachea (especially on the right) is explained by the proximity of the aortic arch and other large vessels. The intensity pulsing motion increases during the breathing pauses. Their absence indicates abnormal tissues around bifurcation.
The Toolkit. For the production of bronchoscopy and ezofagoskopia there are special sets: Brunings, Jackson, Friedel and other
Anesthesia. Traheobronhite in adults can be performed under local anesthesia (cocaine, dikain)and under General anesthesia with the use of muscle relaxants. Local anesthesia lower divisions of the pharynx and larynx is usually.
General anesthesia is done using intravenous anesthesia (thiopental, geksenal, Apostol). For anaesthesia with the protracted interventions apply inhalation drugs: nitrous oxide, halothane (narkoman) and their combinations. Muscle tension is removed by relaxants short type actions. In the application of thiopental, nitrous oxide, halothane patients after 1.5-2 hours after anesthesia fully oriented in your state in the environment and able to move independently. When using apetala patients reach this state after a 10-1,5 minutes Complications from the use of such methods of General anesthesia is usually not the case.
The position of the patient at bronchoscopy. At bronchoscopy patient may be in a sitting or lying (on the back, chest and side) provisions. Easier orientation in tracheobronchomalacia painting is carried out in a sitting position of the patient.
There are "upper" and "lower" tracheobroncheal. At the top bronchoscopy tube is introduced into the respiratory tract through the mouth. Under certain conditions (foreign body in small children, large foreign body in adults, the narrowing of larynx, the presence of
tracheostomy and others) handset does not enter through the mouth, and a tracheostomy (lower traheobronhite).
The method of upper bronchoscopy (in a sitting position of the patient). The position of the doctor ahead of the patient and somewhat to the right of him. The head of the patient is fixed by the hands of the assistant, which is located behind the patient (Fig. 8). The index finger of the left hand, the doctor lifts the upper lip, protecting it from damage tube. The patient with his hand pulls language as at laryngoscopy (Fig. 9), and found the epiglottis. Tube esophagoscope wound in his guttural surface, the language of the patient is released. By the end of the tube is pushed through the root of the tongue forward, and is made visible all the glottis. In order to better determine the glottis patient is forced to tonirovat. Having ascertained the presence of the glottis before the end of the tube, the patient is forced deep, but exactly to breathe, then the glottis maximum expanding, and the end of the tube is slowly sliding through her deep throat (Fig. 10,a, b). Tube penetrates into the trachea, and becomes a prominent bifurcation (Fig. 11).
A deeper study of the bronchi is possible only when using "false" tube, which is a pre-lubricated with vaseline oil.
During the inspection of the right main bronchus head of the patient turns to the left, and when viewed from the left main bronchus - right.
At loss of orientation in tracheobronchomalacia picture you want to return to the previous stage of the study. Mucus from the trachea and bronchi removed by wiping with a cotton swab or a special odesilatele.
Traheobronhite in the horizontal position of the patient (Fig. 12). To manipulate in the trachea and bronchi in the horizontal position of the patient is much easier, as the doctor while sitting, mucus does not close clearance breathing tube, foreign body move less and not go in depth.
The lower traheobronhite. Lower bronchoscopy is preceded by a tracheotomy. Lower bronchoscopy may be made at a sitting, and supine positions of the patient. Anesthesia is the same as when the top bronchoscopy. Tracheotomies hole obkladyvaetsja sterile cloths.
Tracheobronchomalacia tube is carried out through tracheotomies hole (Fig. 13). The order of examination of the trachea and bronchi corresponds to the top bronchoscopy.
In Fig. 14 shows the moment of approach forceps bronchoscope to the foreign body.
Traheobronhite in children. Traheobronhite in children is much more difficult than in adults, and is performed under General anesthesia and local anesthesia (cocaine, dikain). General anesthesia is usually stops after the pipe is already entered into the trachea further use local anesthesia. Head and body of a child are fixed by the hands of the assistant.