A laparoscopic uterine fibroid surgery is under anesthesia at 9 am. The person in charge of anesthesia is Dr. Pang, who has been working for more than ten years.
The patient has no special circumstances: he is in his 30s, and he has a regular physical examination, and there is no obvious abnormality in various examinations.
General anesthesia under general anesthesia. It is planned to complete laparoscopic enucleation of uterine fibroids under general anesthesia.
This is a very low-risk procedure, in principle. Although many people think that this is still a major operation and an operation that requires general anesthesia, with the rapid popularization of anesthesia technology, general anesthesia technology has become a routine technique in first-level hospitals in townships and villages.
With ease, the nurse takes the patient to the operating room, checks the information with three parties, and makes a drip…; on the anesthesia side, connect the monitor, give the patient oxygen, and draw medicine…, Everything is proceeding in an orderly manner.
Because there were several larger operations in other operating rooms, the director of anesthesiology asked the nurse to help Dr. Pang with the medicine and then walked away.
Dr. Pang, while instructing the nurses to push the medicine, manually controlled breathing, and used a mask to pressurize the patient with oxygen. After the anesthesia was fully effective, I looked up at my blood pressure and heart rate: my blood pressure was over 90 and my heart rate was over 80. Very good, he muttered to himself.
Because there was no indication of difficult intubation, the intubation was also very smooth, and it was inserted with a “swoosh”. Looked up again at blood pressure and heart rate: not much changed.
After auscultation confirmed that the intubation was correct, Dr. Pang firmly fixed the tracheal tube with tape. Look at the monitor again: there is something unusual, but what is unusual, he can’t figure out for a while. After that, let the surgeon take the time to wash his hands and go to the stage, thinking about this problem.
After a while, the surgeon came in humming a ditty: Today is a good day…
Yes, when encountering an easy operation, everyone’s psychological pressure is small. Working under high pressure every day, anyone has to break down. Hearing the surgeon humming a little tune, everyone felt relieved.
However, Dr. Pang remained silent and frowned.
The surgeon who was about to hum the next sentence seems to have noticed something wrong and asked Dr. Pang: Are you all right?
The highly focused Dr. Pang ignored him and pressed the blood pressure button again.
Meanwhile, almost trotting back toward the emergency medicine cart.
The surgeon who was standing on Dr. Pang’s path jumped off.
Dr. Pang opened a medicine with only a click.
Before the next blood pressure measurement came out, the drug was injected.
Everyone wondered: The blood pressure is a little lower, but it’s not so nervous, right?
We all know that anesthesiology is notoriously big heart. When a small situation occurs, it is basically dealt with between talking and laughing. Treating with a serious look and quick action like this can only show one problem – the patient has a serious condition!
For a while, time and space in the operating room stood still.
At this time, the systolic blood pressure on the blood pressure measurement interface popped out an 85. Seeing this situation, Dr. Pang hurriedly shouted: Help me call someone here.
Those who have been in the operating room all the year round, of course, know who to call: the director of the anesthesiology department is the first choice, and any anesthesiologist will do. Because, in the operating room, the most powerful rescue ability is the anesthesiologist.
In the blink of an eye, the operating room was full of people.
The people who came in later didn’t know what was going on, and were busy asking what was going on.
The director of the anesthesiology department, who arrived first, agreed with Dr. Pang’s judgment of “patient allergy” through simple communication. So, start anti-allergic treatments immediately:
In one go, the IV anesthetic was removed from the infusion pump.
Some people say: emulsions may indeed be the source of allergies, but they shouldn’t be taken down, right? Can’t you just press pause?
The director of anesthesiology, who has worked in anesthesia for many years, also wants to just hit the pause button. However, the painful lessons of the past told him:It is only safe to remove it completely.
I remember one time when the infusion pump was on muscle relaxants. The muscle relaxant that had been stopped was accidentally hit by a colleague. It doesn’t matter this bump. Unbiased, the syringe still on the pump was knocked in by a few milliliters. At this point, the surgery was almost finished. As a result, the balance of analgesia, sedation, and muscle relaxation is disrupted. According to the patient after the operation, he seemed to be able to hear everyone talking, but he couldn’t move. Fortunately, the surgery was done by then. If you don’t finish it and your body hurts so badly you can’t move, what kind of feeling is that?
After the IV anesthetic was taken off, he asked the nurse to bring bags of warmed fluids.
Seeing the blood pressure on the screen gave the nurse a presumably an idea of what was going on. So ask: Half crystal, half colloid?
She had no problem asking. In the past, whenever hypotension or shock was encountered, the infusion had to be combined with crystalloids and colloids.
However, this time is different. The colloid, which could have raised blood pressure and anti-shock, may also be one of the factors that caused this abnormal situation.
Here, many of my friends may be at a loss.
Explain: At present, all colloids, including synthetic or natural extracts, have the possibility of allergies. Gelatin has the highest probability of allergic reaction among plasma substitutes, and it can directly act on mast cells and basophils to release histamine, causing allergy-like reactions.
In order to cut off any further entry of allergy-causing substances into the patient’s body, the director of anesthesiology told her to bring only crystals.
See the director of anesthesiology again, and while pressing the blood pressure measurement button again, ask Dr. Pang to quickly pump an epinephrine. Dr. Pang, who has participated in many tough battles in the past, already has a well-stocked adrenaline in his hand. After the director of the anesthesiology department asked about the dosage, a needle was pushed in. A casual word: hormones.
In the operating room, no excessive language is required. Just two words, everyone understands what’s going on. While Dr. Pang was smoking dexamethasone, the nurse also helped to find hydrocortisone.
Measured blood pressure again, more than 110.
Seeing this blood pressure, everyone’s spirits relaxed a little.
At this point, everyone is waiting for the Director of Anesthesiology to analyze the cause. Because, in everyone’s eyes, this is almost unbelievable: the operation has not started, no blood transfusion, and the anesthesia seems to have just begun…
Seeing that the patient’s vital signs were slightly stable, the director of the anesthesiology department said: There is a high probability that the patient is allergic to something or has an allergic-like reaction.
Staring at the slightly lower heart rate on the screen, he commanded: Get a norepinephrine. If it doesn’t work, just pump it.
The surgeon asks: continue or postpone the operation?
The director of anesthesiology said: Wait and see. We look for the reason or we see if it is controllable?
After that, everyone was waiting quietly.
During this period, the director of the Department of Anesthesiology gave you some relevant knowledge points:
Patients are exposed to many foreign substances including latex during the perioperative period, and the anesthesiologist is also responsible for infusion of various preparations such as anesthetics (propofol, esters, etc.) Local anesthetics, etomidate, succinylcholine, rocuronium bromide), blood products, colloids (polygelatin), antibiotics, protamine, etc., all of which have the potential to produce predictable or unpredictable adverse reactions, One of the most severe reactions and even life-threatening reactions is the allergy or allergy-like reaction.
Anaphylactic shock is a severe allergic or allergy-like reaction. The mast cells of the body release a large amount of histamines, resulting in leakage of capillaries, dilation of blood vessels in the systemic circulation, a sharp drop in blood pressure, and venous return to the heart. Insufficient blood pumping of the cardiovascular system occurs. Anaphylactic shock rarely occurs during anesthesia, but when it does, the consequences can be serious.
Fortunately, after nearly half an hour of observation, the patient did not experience serious symptoms again. Crucially, the airway has remained normal. So, the director of the anesthesiology department and the surgeon said: Communicate with the family about the situation. If the family members are firm, the operation will continue; if the family members are hesitant, the operation should be postponed.
Some people will ask: Why does the director of anesthesiology focus on the respiratory tract?
This is because, in addition to causing circulation problems, allergic reactions can also cause respiratory problems, such as increased airway pressure. In some patients, even manual breathing is difficult. In particular, the airway reaction during intubation may lead the anesthesiologist to mistakenly believe that “insertion is wrong”. If the anesthesiologist is inexperienced and pulls out the tracheal tube that has been inserted into the trachea, the consequences are disastrous.
After a while, the surgeon who communicated with the family returned. With a relaxed and slightly excited expression, he said: The patient’s family is very good, he said he trusted us very much, and agreed to continue the operation.
With this “reassurance pill”, everyone rolled up their sleeves and started.
After that, the director of anesthesiology did not leave the operating room until the patient was safely sent out.
[Warm Reminder] Please pay attention, there are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~