Today, general anesthesia has become the mainstream form of anesthesia. Every day, we almost have to perform a series of general anesthesia operations such as oxygen inhalation, oxygen and nitrogen removal, and induction intubation. If you do too much, there must be problems of one kind or another. In general anesthesia, everyone is most worried about the problem of endotracheal intubation.
However, there are some unexpected events that are more unexpected, such as extravasation of anesthesia. The so-called extravasation of anesthetic means that the anesthetic did not advance into the blood vessel as expected, but went outside the blood vessel.
When the anesthetic goes out of the blood vessels, although it will not be as tense as a problem with tracheal intubation, the degree of tension must not be low. This is because most anesthesiologists are very worried about some questions: how should this anesthesia be metabolized? Will it affect awakening? Some people even consider that this quasi-intubation dose of anesthetic will enhance the effect of re-administration of the anesthetic. Some people worry about whether this anesthetic will be absorbed smoothly? Will there be any problems?
However, the problem is so inexplicable. This is because of a key issue, which is the barriers to expertise. For anesthesiologists, although they have a general understanding of some nursing processes, they are not proficient; for nursing staff, the extravasation of common drugs is not unfamiliar, but the nursing of extravasation of anesthetics is almost blank.
Below, we share a case of extravasation of anesthetic and see how this patient survived.
Introduce what happened first:
The patient, a 50-year-old male, was admitted to the hospital for emergency surgery with a fracture in a car accident. Before surgery, the left forearm indwelling needle was placed in the emergency observation room. During the anesthesia, the anesthesiologist sequentially injected propofol, Liyuexi, atracurium cissulfonate, sufentanil and other permeabilization drugs from the left hand forearm venous channel.
However, the anesthesiologist on duty found nothing unusual. The problem was not discovered until the patient still did not sleep after 5 minutes. At this point, when you touch the vicinity of the indwelling needle, you can clearly feel a large lump. Immediately, the indwelling needle was removed.
In view of the necessity of the operation, the indwelling needle was re-inserted in other parts for anesthesia, and the operation was carried out normally. The operation lasted 3 hours, and the recovery was normal.
On the day after the operation, a large blister of 9 cm x 9 cm appeared around the venipuncture point of the left forearm indwelling needle. One week later, epidermal necrosis occurred, and necrosis of subcutaneous tissue, muscles, blood vessels and other tissues gradually appeared. The treatment team, stoma, anesthesia, pharmacy, ultrasound and other multidisciplinary consultations excluded pressure ulcers and treated them according to drug extravasation.
I thought it would heal quickly with systemic treatment. However, this process is really too long. It was not until a year later that he was declared basically cured, but he complained that the left palm was still numb.
Consult with neurology to consider nerve injury. The next treatment is to go to the neurology department, rehabilitation department, and beauty department on a regular basis for further rehabilitation and functional exercise.
After that, the patient went into a longer recovery process. It is said that after 3 years, the function of the left forearm and the palm of the left hand has basically recovered, and he can work and labor normally.
The consequences of a small indwelling needle accident are shocking. Almost everyone would not believe that such an accident could put a person on the road to recovery for several years.
Share the treatment process (this treatment process is for reference only, different cases should have individualized treatment and rehabilitation plans):
First, the first step must be to pinpoint the cause. This aspect is particularly important, the cause is the key, and the treatment is the second. That is to say, only by looking for the right direction can you be targeted; if the direction is wrong, it may not only delay the opportunity, but also lead to the opposite effect.
The judgment of drug extravasation is mainly based on the clinical manifestations of the patient and the cause of the event:
1. The left forearm indwelling needle was brought into the left hand before surgery, which is obviously a hidden danger. The hidden danger is, is the indwelling needle strictly handed over? In addition, very thin needles may not return blood, so it is difficult to identify whether the indwelling needle is in the blood vessel;
2. There is a process of bolus injection of propofol, Liyuexi, atracurium cissilate, sufentanil and other drugs, and drug extravasation has been confirmed at that time .
3. Causes such as pressure ulcers, coagulation, coagulation plaques, and thrombus have been excluded.
Next is the process:
A few months after the operation, the dry necrotic tissue was debridement, disinfected with Aner’s iodine, and washed with normal saline. Once dry, apply a shapeless, shapeable sheet hydrogel dressing.
After several months, surgical debridement, autolytic debridement, conservative sharp debridement, and negative pressure drainage were continued. Use iodine to disinfect and wash with normal saline to dry, remove the liquefied and separated necrotic tissue in stages and multiple times, so as not to cause bleeding and cause pain to the patient; use alginate and foam dressings to absorb exudate and promote the growth of granulation tissue .
Afterwards, doctors tried to persuade him to get a skin graft, but it didn’t happen for a variety of reasons.
Until nearly three years later, the patient was basically cured and complained of numbness in his hand. He continued to give rehabilitation training, and the arm function of the affected limb recovered.
The patient’s road to recovery is long and tortuous, and it is a physical and psychological torture for the patient. However, the medical staff involved in this accident are also very worried. If the patient is not well for one day, the pressure will always exist.
Looking back at the entire case, there are a few points worth considering and cautioning:
1. Patients can bring indwelling needles into the operating room, and they are also welcome to put indwelling needles in the ward, which will save time and increase the turnover rate of the operating room. However, it is important to ensure that the indwelling needle is unobstructed and that there is no extravasation.
2. When the indwelling needle is found to be thinner, promptly ask the nursing colleague to make a thicker indwelling needle.
3. This item is very critical: the drug must be withdrawn. No blood return, no medication! When administering the drug, observe whether there is any abnormality in the local area and whether the resistance on the hand is abnormal. Also, try to avoid pour-on dosing. Dosing is too fast, and the cycle can’t hold it!
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~