I was in charge of orthopaedic surgery again today, and the first surgery made me difficult. The operation was performed on an 82-year-old patient with a fracture of the left humeral neck. The patient had a history of Parkinson’s disease, Alzheimer’s disease, hypertension, and diabetes.
The patient could not fully cooperate, so the doctor prescribed brachial plexus anesthesia with open and internal fixation for left humerus surgical neck fracture. (There are always 1-2 surgeons in each hospital who think they are awesome , Everyone should listen to me. This doctor has just returned from a training in a top-grade tertiary hospital in a well-known hospital in Shanghai. He is quite arrogant. He once boasted to Haikou that there is no surgery that he cannot do in orthopaedic surgery. This machine requires brachial plexus anesthesia.
This patient made me feel difficult at the time, and it was quite difficult to perform a surgical neck operation on the humerus to beat the brachial plexus:
(1) Brachial plexus block itself has great uncertainty, especially for patients with surgical neck fracture of the humerus, anesthesia requirements are higher and more difficult, and the effect of anesthesia may be Poor, the effect cannot be guaranteed.
(2) Old age, senile dementia and Parkinson’s disease, usually unable to communicate with people normally for a long time, and may not be able to cooperate during the operation. After careful consideration, general anesthesia is safer and more reliable.
After negotiating with family members and orthopaedic surgeons, and after further discussions, family members and orthopedic surgeons still strongly demanded brachial plexus anesthesia. The reason is that family members and orthopaedic surgeons consider that the patient already has Alzheimer’s, and that Parkinson’s is afraid of aggravating Alzheimer’s after returning home, and delirium may occur. After the patient returned to the ward, it was not easy to manage. The doctor and family members were very firm and did not agree with general anesthesia.
In the end, I discussed and communicated with the doctor’s family again and again, and finally decided to perform anesthesia of the brachial plexus first. The effect is good, and the operation will be done. God bless, I didn’t expect that the effect of brachial plexus anesthesia was surprisingly good that day. After brachial plexus anesthesia, intravenous dexamethasone was pumped, sterilized, draped, and skin cut, everything went smoothly.
When the operation is performed for an hour, the patient may be a little irritable due to the long time in one position, or the stimulation of the periosteum, and the dose of dexamethas is also increased. , and as time goes on, the patient becomes more and more restless and unable to control himself. Completely unable to cooperate with surgery. The doctor was sweating profusely on the operating table, and it was extremely painful, and there was nothing he could do. Finally, the orthopaedic doctor couldn’t bear it any longer, and suddenly came out and said, Lao Tang, give us general anesthesia, otherwise there is really no way to do this operation. …
At this time, it was my turn to speak, “I started to put you under general anesthesia, you are not under general anesthesia, but you don’t believe it, you insist on brachial plexus, and now you know that you need to change the general anesthesia, you need to change the whole anesthesia. Ma, you go out and communicate with your family. If you communicate well, I will sign and change to general anesthesia. If you do not communicate well, just do it…
How to say it, comrades orthopedic surgeons will formulate anesthesia plans according to their care and needs for patients. Heli (in anesthesia), they know very little about the concept of “same anesthesia, different patients; same patient, different individual differences”.
Fortunately, the surgeon went out to communicate relatively smoothly. The patient’s family was actually reluctant and unhappy, but there was no other way. The patient was still on the operating table. I took the signed form and re-explained it, signed it, and re-intubated the general anesthesia. After the general anesthesia, the doctor felt more comfortable after the operation… Fortunately, the operation went smoothly and ended soon after the drug was stopped. The patient woke up. It was also fast, and there was no delirium after returning to the ward.
Different patients may be anesthetized the same way, but because of their different procedures, the anesthesia regimen will vary. For the same operation, and based on the individual differences of different patients’ own conditions, each person’s anesthesia plan is also different. Therefore, it is not the same surgery, and the same anesthesia can be applied to every patient. It should be based on the patient’s condition, taking into account the entire operation, and a specific analysis of the possible situations.
Therefore, every line is like a mountain, we often say that professional things are left to professional people to do. One sword for ten years is a manifestation of the skills of our anesthesiologists. It lies in the overall and careful consideration of these, seemingly simple anesthesia, but in fact, it is not simple. Therefore, orthopedic partners can have their own thoughts on the anesthesia of patients, but they should still seriously consider listening to the advice of the anesthesiologist. After all, “professional things should be left to professional people to do”.
Author: Zhejiang Xin’an International Hospital, Tang Huadong (Jiaxin Tang)
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~