Puncture technique and anesthesia points
1. preoperative needle, establishment of intravenous access, prophylactic antibiotics 0.5 to 2 hours before surgery Yunyang County Hospital of Traditional Chinese Medicine pain department Huang Wei
2. lie flat on the CT bed, monitor, connect the negative plate, place the positioning strip next to the corner of the mouth, and require that the positioning strip must cover the puncture site
3. mandibular line perpendicular to the horizon
4. The upper 1/3 of the slope and the maxillary second molar line 1mm layer of continuous scanning 6 to 8 layers
5. Select the puncture path, try to choose away from the corner of the mouth to prevent accidental entry into the mouth; also pay attention to whether the positioning strip under the image is compounded with the actual; record the bed number, puncture depth, and sagittal coronal plane angle
6. Mark out the coronal plane according to the bed number
7. Disinfect the towel, 1% lidocaine local anesthesia
8. Give fentanyl 0.05mg intravenously, heart rate above 90 beats or increase to more than 30% of the base
9. Strictly coronal sagittal plane combined with puncture depth puncture
10. Calculate the distance of the puncture needle according to the mouse positioning in the foramen ovale, and calculate the distance by multiplying the layer thickness by the number of layers to guide the puncture of the two surfaces
11. Patients who reach the foramen ovale often have severe pain, accompanied by a decrease in heart rate
12. Some experts’ opinion: 5-8 mm after entering the foramen is II and III branches, 10 mm is I branch; some experts suggest using the slope as the dividing line; some experts’ opinion is safe within 2 cm after entering the foramen. When the sensorimotor stimulation prevails combined with the impedance value between 290 and 320 is judged. Note that the difference between Ⅲ branch lesion is the root or node, the key to prevent recurrence
13. isoproterenol, fentanyl intravenous anesthesia or 1% lidocaine 0.3ml local anesthesia
14. Turn on 120 seconds, 75 degrees, radiofrequency thermal coagulation mode, and gradually withdraw the needle.
15. Pay attention to the respiratory circulation, pay attention to any abnormal rotation of the eye
16. After the operation, withdraw the needle to the external orifice of the foramen ovale, and inject the compound solution of lidocaine and demi in the needle channel
17. wake up, return to the ward and lie down.
Attention.
1. The puncture should not be too external or internal to prevent intracranial hemorrhage.
2. Prefer internal to external, prefer upper to lower 8 words