At 7:50 in the morning, the anesthesiologist in the Jiangnanxi operating room office is on duty.
“Deputy Chief Physician Liu Xiangyu, the last knee arthroscopy patient in the sports medicine department in Room 2 is very fat, 106kg. He has a history of gout, pharyngitis, bronchitis, rhinitis and gallbladder. History of inflammation; history of herpes zoster in 2010, neuropathic pain in the right lower rib, suspected recurrence of herpes zoster; slight edema in both lower extremities; complained of a history of acute myelitis, which was cured after acupuncture and moxibustion therapy; Subcutaneous lipoma. You can feel a little gap, you can try spinal anesthesia.”
Dr. Li Jing is reporting today’s patient’s condition to the senior physician, Deputy Director Liu Xiangyu.
Deputy Director Liu Xiangyu said: “The patient is obese, and the success rate of a single spinal anesthesia is small. If it fails, use a thick epidural needle. Don’t try too much to avoid injury.”
Today they are dealing with a severely obese patient.
The patient is male, weighing 106kg and height 167cm. Body mass index BMI value as high as 38, belong to severe obesity. At 14:40 in the afternoon, he entered the operating room to prepare for anesthesia. Because the patient’s stomach was too large, there was no way to assume a relatively standard lateral position. Therefore, after fully communicating with the patient, Dr. Li Jing chose the seated anesthesia puncture position to perform intraspinal canal for the patient. anaesthetization.
After receiving routine monitoring for the patient, position the patient, instruct the nurse to safely protect the patient, and then wash hands and disinfect before preparing for puncture.
Because the patient is severely obese, the chance of success of a simple fine-needle spinal anesthesia puncture is small, and a combined spinal-epidural puncture is selected. The epidural needle entered the skin 7cm before reaching the epidural space, and a spinal anesthesia needle was placed, which showed smooth cerebrospinal fluid backflow and no blood. Local anesthesia was injected.
Spinal anesthesia was successful. Once you are in the surgical position, the surgery begins. A small amount of intravenous drugs was given during the operation to make the patient fall asleep peacefully, and the operation cooperation was high. The patient’s blood pressure was stable during the operation, and the operation went smoothly. 16:00 Safe return to the ward.
“Modern anesthesiology and clinical anesthesia textbooks say that the puncture positions for spinal anesthesia include lateral decubitus and sitting. The former is generally used. But I found that the sitting position is very suitable for obese patients with a particularly large belly. It is very friendly, so for obese patients who are difficult to put on their side, I will choose to help them sit for anesthesia.”
Author: Li Jing, The Third Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~