The application of airway exchange catheter in patients undergoing tracheotomy after head and neck free flap transfer

QIU Baojun; ZHANG Tiecheng; WU Long; LI Xiaoying; WANG Wei

doi:10.3969/j.issn.2096-2681.2017.03.005

Abstract：Objective To observe the application of airway exchange catheter in patients undergoing tracheotomy after head and neck free flap transfer.Methods During the tracheotomy, anesthesiologists inserted an airway exchange catheter into the endotracheal tube through the right-angle connector of the breathing circuit.The position of the exchange catheter was secured and the endotracheal tube was subsequently slowly removed.Then the surgeon opened the tracheal wall and inserted the metal tracheostomy tube when the exchange catheter was exposed.An endotracheal tube(5.0#or 4.5#) was then connected to the tracheostomy tube.The exchange catheter, the right-angle connector of the screwed tube, and the endotracheal tube were removed after continuous and stable PETCO2 was detected.The heart rate (HR) and mean arterial pressure (MAP) was recorded every 5 minutes after tracheotomy T0-T3.The patient's satisfactory and cough response during tracheotomy was observed and recorded to evaluate the toleration of the tracheotomy.Results The transition procedure of endotracheal intubation to tracheotomy has been successfully finished in all the 30 patients.Compared to T0, variations of MAP were not significant in T1-T3 (P>0.05).Variations of HR were not significant in T1-T2, compared to T0 (P>0.05).However, HR in T3 was significantly increased(P<0.05).During the whole process, no significant hemodynamic changes were detected.86.67% of the patients had no facial expression change, 10% had subtle changes, while 3.33% of the patients had expressions of distress.None of the serious unexpected response like head movement were observed.76.67%of the patients had no cough reflex, 20% had mild cough reflex, and 3.33% had moderate cough reflex respectively.No severe cough reflex was observed.None of the patients received a second operation due to the wound bleeding or failure of the anastomosis.Conclusion The airway exchange catheter could effectively keep the airway safe and hemodynamic stability during a tracheotomy in patients undergoing head and neck free flap transfer.