On Monday morning, Dr. Liu, who was in charge of anesthesia on duty in the painless gastroscope room, came to the gastroscope room early. He knew that this must be another busy day, and dozens of gastroscopes were indispensable.
I was thinking about one gastroscope for a few minutes, but it got stuck on the second.
The second patient, lying on the examination bed, was found abnormal by Dr. Liu. The patient weighed nearly 200 pounds, a typical obese physique. The electrocardiogram showed a marked left deviation of the electrical axis.
The cardiac axis generally refers to the average QRS axis, which is the synthesis of all instantaneous vectors during ventricular depolarization.
There are many reasons for the left deviation of the ECG axis: first, the body type, the ECG axis of the short and fat people is prone to left deviation; the other is age, the elderly are prone to left deviation; , the position of the heart in the chest cavity also affects the cardiac electrical axis.
If the heart is moved to the right, the axis will be to the right, and vice versa.
In addition, the weight ratio of the left and right ventricles of the heart also affects the cardiac axis: if the right ventricle is hypertrophic, the cardiac axis is deviated to the right; if the left ventricle is hypertrophic, there may be cardiac The electric axis is deviated to the left.
Combining with the patient’s flushing cheeks, Dr. Liu immediately became alert: It doesn’t make sense! Why does this patient look like he has high blood pressure? But why is the blood pressure measured by the monitor only around 110?
Dr. Liu, full of doubts, measured the other arm. However, blood pressure was not high either.
Ask the patient if they have high blood pressure. Answer: No.
While thinking about it, Dr. Zhang from the internal medicine department came in with a smile on his face. When he came in, he said: “It’s hard work, this is the father of a friend of mine.”
I thought my colleagues in my hospital would know the real situation, but Dr. Zhang kept hesitating about it.
Faced with this situation, Dr. Liu is even more convinced that there is a problem here. Although it is only a seemingly small examination, the anesthesia is not small and must not be taken lightly.
After further questioning, the patient finally stated that he usually had high blood pressure. Consult with Dr. Zhang before the examination. On Dr. Zhang’s side, he naturally knows that the anesthesiology department is more strict. Therefore, patients must take medicine to control their blood pressure. Moreover, this antihypertensive drug is also prescribed by him.
After learning that it was enalapril, Dr. Liu couldn’t help but worry: this drug can indeed reduce blood pressure, but it may lead to intractable hypotension during the operation.
Why are you worried about this medicine? Let’s get familiar with this medicine together.
Angiotensin-converting enzyme inhibitor drugs commonly used in clinic include the following: captopril, enalapril, perindopril, benazepril, mida Puli, Fosin Puli, etc.
The mechanism of action is to inhibit the conversion of angiotensin I to angiotensin II, thereby inhibiting the activation of the RAS system in vivo.
The truth is simple: when blood vessel tension is low, blood pressure must be low.
At present, most of the anesthetics have inhibitory effects on the cardiovascular system. The effects of antihypertensive drugs and anesthetics are superimposed, and the consequences cannot be controlled.
Thinking of this, Dr. Liu has made up his mind: this anesthesia must not be done!
Despite Dr. Zhang’s repeated attempts to accommodate Dr. Liu, Dr. Liu eventually dismissed them.
Looking at the back of the two leaving, Dr. Liu seemed to have heard their dissatisfied conversation. However, the principle must be adhered to. Perhaps, they will never understand the stubbornness of the anesthesiologist, but the anesthesiologist is very clear about the reasons for doing so.
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~