With the rapid development of China’s economy in the past 20 years, medicine has also developed rapidly. With the rapid development of medicine, our medical concepts and medical knowledge are constantly evolving. Update, change.
This year, our department has recruited a few freshly graduated medical undergraduates. Since they have just graduated, the director asked us senior doctors to teach in person. A few days ago, you asked me a question, why do you always tell the patient’s family members that you can let the patient sleep for a while when you send a patient after general anesthesia? And when we used to practice, how often did nurses and doctors not let patients go back to the ward to sleep?
This question is a good question. Regarding this issue, I would like to share some of my views over the years. This thread should start from the past.
my country’s anesthesia career developed relatively late. It was not until 1987 that Xuzhou Medical College recruited its first undergraduate anesthesia students. It took 5 years to really go to the clinic. At that time, it was mostly elite education, and too few people were recruited. These graduates have basically stayed in the most well-known tertiary hospitals in the country, and many of them are well-known directors of anesthesiology departments, but almost none of them actually went to grassroots hospitals. Until the expansion of enrollment in 1999, this situation gradually get better.
At that time, the methods of anesthesia were basically local anesthesia, cervical plexus, brachial plexus, epidural anesthesia, spinal anesthesia, combined spinal-epidural anesthesia, etc.; General anesthesia drugs are also very few and imperfect, resulting in very, very few general anesthesia at that time. Due to the limitations of general anesthesia drugs and concepts, general anesthesia is considered unsafe by everyone.
In the past, it was mostly anesthesia drugs such as “Flufen Mixture”, “Dufen Mixture”, “Hercules”, etc. The old anesthesiologists knew that the analgesic and sedative effects of these drugs are very good. It belongs to the kind of drug of 1+1=3 or 4, 5, and there is no antagonist, it can only wait for the metabolism of its own drug, and there was no current monitoring equipment before, so there were many accidents in patients at that time. At that time, nurses and doctors would try their best not to let patients sleep, and keep family members calling the patients.
After nearly 20 years of rapid development in the anesthesia industry, a large number of products such as remifentanil, medium- and long-chain propofol, midazolam, dextromethorphan, and short-acting muscle relaxants have come out. Medicines like Mikuloku, Shunben, Roku and other excellent medicines. These drugs not only wake up the patient quickly, the recovery is also perfect, but also have antagonists, and our anesthesia machine, anesthesia monitoring equipment, and anesthesia tools are getting better and better, and general anesthesia is becoming more and more safe. It is gradually accepted by people, and with the opening of the resuscitation room, patients after general anesthesia become safer and safer, but the concept of not allowing general anesthesia patients to sleep after surgery has not changed.
Therefore, I would like to express my personal suggestions and opinions on whether patients can sleep after anesthesia surgery. After general anesthesia, the patient is resuscitated. Most of our anesthesiologists wait until the patient’s consciousness and muscle relaxation recover before extubation. Usually, they will be sent to the resuscitation room for observation for more than half an hour, and deoxygenation for 5 minutes to observe the oxygenation. It will be sent back to the ward only when it is very safe.
I personally think that after the patient responds well, bring a breathing bag and, if possible, a portable pulse oxygen on the way back to the ward. Call the patient frequently on the road, do not let the patient fall asleep (if the patient is obese, or has a history of snoring, or a history of apnea, you need to bring an oxygen bag, pulse oxygen, and the head of the bed is elevated).
After being sent to the ward, general anesthesia patients routinely inhale oxygen, ECG monitoring, blood pressure, SpO2, (personally believe that surgery is also a kind of damage to the human body, and the body also needs sleep to repair), If the patient is not allowed to sleep and rest, it may not be conducive to the recovery of the patient’s body. After monitoring, pay attention to the drop of SpO2 and call the patient, nurse and doctor in time.
This is some of my personal suggestions and opinions, I hope colleagues can exchange and discuss with each other.
Author: Zhejiang Xin’an International Hospital, Tang Huadong (Jiaxin Tang)
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