Author: Xiao Ruzi from the Department of Anesthesiology
Every day, the anesthesia recovery room is like a station. After a short stay, the patient’s various indicators were intact, and then he returned to his ward smoothly. The doctors and nurses in the recovery room are also used to this smooth and fast-paced work.
However, something serious happened in the recovery room that day.
It was a post-thyroidectomy patient who broke the stability of the recovery room.
The patient was a 53-year-old female who underwent radical thyroidectomy and was intubated into the recovery room. Indications for extubation were reached after evaluation after admission, and the patients were extubated immediately after their vital signs were stable.
The patient was irritable and self-reported that the incision was painful, so 5ug sufentanil was statically pushed. Immediately after the static push, the patient became unconscious. The nurse called the patient loudly, but there was no response.
The nurse sees something unusual and calls the anesthesiologist immediately. At the same time, blood oxygen saturation began to drop, 90, 85, 83…
Can’t wait any longer! Fasten the mask and give oxygen under pressure.
After putting on the mask and pressurized oxygen, the patient’s saturation was barely maintained at 90.
However, the anesthesia machine displayed a tidal volume of only about 160 at this time. Combined with the stiffness of the patient’s abdominal muscles and high airway pressure, the anesthesiologist flashed the complication of sufentanil — muscle rigidity.
As soon as the cause was figured out, intubation supplies such as laryngoscope, endotracheal tube, and anesthetics were prepared. Intubation is not difficult, and the intubation is completed in a few seconds.
Fortunately, the patient had stable oxygen saturation and stable vital signs during pressurized oxygen delivery.
As the patient woke up, her consciousness became clear, her breathing became stable, and everyone’s tense hearts gradually relaxed.
Although the patient is fine, he is still a little scared: if it is found not in time, if the effect of pressurized oxygen is not good, if the intubation is difficult… If there is a problem in any link, it is possible put the patient at extreme risk. No matter how good anesthesia for surgery, it will fall short.
After observing the patient for 20 minutes, there was no abnormality, and the patient returned to the ward successfully.
When mentioning the complications of Shufen, everyone can think of respiratory depression, blood pressure drop, itching, urinary retention, etc., but muscle rigidity is rare, even an anesthesiologist who has worked for more than ten years never seen it. This case reminds us that when using opioids such as sufentanil, we must be careful to prevent patients from developing myotonia. Severe rigidity is likely to result in restricted breathing, and it is more likely to affect endotracheal intubation and make it difficult to establish an artificial airway.
Of course, don’t let it go for fear. Many drugs are double-edged swords, as long as they can be mastered. Once muscle rigidity occurs, ensure that the airway can be opened quickly, including the application of muscle relaxants, endotracheal intubation and other measures, and effective ventilation to minimize the risk.
The anesthesia recovery room is the last step in the escort of the anesthesiology department. However, because almost all hospital anesthesia departments are under staffed conditions, the recovery room is often only one anesthesiologist responsible for the recovery of anesthesia for all patients. The fatigue and inability to separate from the wheel battle also laid hidden dangers for the safety of the anesthesia recovery room.
Here, I hope that relevant parties will pay more attention to the construction of anesthesia, so as to ensure the ability of anesthesia to escort.
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~