A breast fibroid operation just finished, before the patient was fully awake, everyone was lifted off the operating table. As soon as the transfer car went out, the next patient lay on the operating table without delay… This is the daily routine of our operating room.
The nurse was putting in the drip while I was busy connecting the oximeter, blood pressure cuff, and ECG leads. Inadvertently, this patient feels familiar. Suddenly I remembered that it was introduced by an acquaintance. The day before, on the phone, I specifically told me to take good care of me and give me more anesthesia.
When I was on the phone, I was thinking: It’s not just about how much anesthesia is given, it’s not a matter of “more and more”. In anesthesia, the focus is on safety. As for the others, they all have to be ranked at the back.
In the blink of an eye, it was time for anesthesia.
Since they are acquaintances, it is definitely indispensable to ask questions. So, I asked the nurse to push the medicine for me, and I gave her oxygen on the side of the patient’s head.
Seeing that the nurse was going to push medicine, I comforted her and said: Don’t worry, it won’t hurt.
Who knows, as soon as I finished speaking, she shouted “ah”. Then, muttering “pain, pain” in his mouth, he “slept over”.
The nurse gave me a look, but I didn’t say anything.
Afterwards, I inserted the mask into her mouth smoothly.
Because it was a minor operation, it was completed in less than half an hour. Because of this, the total amount of narcotics is not much. Wake up, and wake up as planned.
However, the first time she woke up, she burst into tears. Weeping and crying: Isn’t it good to take anesthesia?
Hearing this, the surgeon who was finishing the last step of the operation, the bandaged surgeon, looked at me nervously. See what that means to ask: Wouldn’t it be known during surgery? Turning his head, he looked at the infusion pump that was pumping the anesthetic. Although he didn’t understand it, he looked at it hard.
I said calmly: It’s okay.
My sentence “it’s okay” may give them the feeling that it is “don’t worry, it’s not a big deal”, or it may be “it’s not that painful, maybe the patient is too sensitive to pain” “.
But I know very well that there will be no pain during the procedure. So, where is the pain?
It suddenly occurred to me that I did not smoke the medicine. Because I was too busy, I asked the nurse to help me smoke the medicine, but she forgot to add the local anesthetic!
Some people will ask: Why add local anesthetic?
Current research shows that drugs such as local anesthetics, opioids or non-steroidal analgesics, and hormones can be effective in reducing injection pain. Among them, local anesthetic is the first choice, and the representative drug is lidocaine. Its principle is to relieve the pain of propofol injection through the dual mechanism of local anesthesia and central analgesia. On the one hand, it blocks sodium ion channels to produce local anesthesia, preventing the direct stimulation of free propofol to the nerve endings in the subintima, and on the other hand. On the one hand, it inhibits the polysynaptic reflex in the dorsal horn of the spinal cord and increases the release of acetylcholine in the spinal canal, thereby enhancing the inhibitory descending pain pathway and exerting a central analgesic mechanism.
I felt very embarrassed for not taking good care of others. This incident reminds me that while paying attention to safety, we must not ignore the patient’s medical experience. Just one flaw can affect your overall impression and even question your level of anesthesia.
Summary: Propofol injection pain is a common clinical problem, and its mechanism is not completely clear. This kind of burning pain along the blood vessels often makes the patient emotionally tense and fearful, leading to fluctuations in hemodynamics. A variety of drugs have been proved to be able to prevent propofol injection carbuncle, and achieved certain effects, but still can not completely eliminate the pain of propofol injection. It is necessary to further explore its mechanism and use drugs to prevent it to increase the comfort and satisfaction of patients during anesthesia.