The patient is full, and the doctor’s careful persistence avoids a potential risk

Today’s duty is really a busy day. In the morning, three inpatient operations were anesthetized, and when I went to work in the afternoon, I first performed three anesthesia in the outpatient operating room, and then went to the delivery room for two no-shows. Painful childbirth. Just after returning to the office to take a sip of water, I heard the urgent bell of the operating room door.

Opening the door of the operating room, I saw a young mother holding a six- or seven-year-old girl (pseudonym Xiao Li) hurriedly saying that Xiao Li had a straddle injury at school. After examination, the outpatient doctor said that the wound needs to be sutured. Considering that Xiao Li was young, she could not cooperate with the suture of the wound under local anesthesia, and asked her to go to the operating room for inspection and suture under general anesthesia.

Inquire about Xiao Li’s basic information immediately: Xiao Li is seven years old, weighs 22 kg, and has no history of anesthesia and surgery, and history of drug and food allergies. I ate rice three hours ago and drank milk an hour ago.

When I heard Xiao Li’s diet, I immediately realized that because Xiao Li’s fasting time was too short, if general anesthesia was used, the food was likely to be inhaled into the lungs by mistake, which is a contraindication to general anesthesia Symptoms, it is necessary to adopt an anesthesia method that makes the child awake and the swallowing reflex is not inhibited to avoid vomiting and aspiration. After comprehensive consideration, it is determined that spinal anesthesia (subarachnoid anesthesia) is a better choice for anesthesia.

When talking to Xiao Li’s mother, she said that she planned to sew the wound under spinal anesthesia. Xiao Li’s mother was worried that Xiao Li would be nervous and cry when she was awake, and would not cooperate with the suture.

I explained patiently: Before anesthesia, solid food should be fasted for more than 6~8 hours, milk should be fasted for more than 6 hours, and clear drinks and water should be fasted. more than 2 hours. Because Xiao Li’s fasting time was too short, after the general anesthesia-induced consciousness disappeared, the throat reflex disappeared. Once the food is vomited and refluxed, it can be inhaled into the trachea and lungs by mistake, causing tracheal obstruction and aspiration pneumonia, which can be life-threatening. Therefore, the use of spinal anesthesia is safer, and can fully meet the requirements of suture surgery.

Xiao Li’s mother then agreed to the proposed method of anesthesia and signed the informed consent form for anesthesia.

When the obstetrician and gynecologist entered the operating room, she said that she was an acquaintance of Xiaoli’s mother. She was worried that the spinal anesthesia would cause back pain, headache, and would require hospitalization for observation. She requested general anesthesia.

Explain to colleagues the risk of vomiting and aspiration under general anesthesia with full stomach, and that patients with spinal anesthesia are conscious and do not lose the throat reflex. Even if there is food vomiting during surgery, reflux aspiration is less likely. Headache after spinal anesthesia is more common in the previously used large spinal anesthesia needle, which is very likely to cause cerebrospinal fluid leakage, resulting in headache caused by decreased intracranial pressure. At present, the pen-point fine spinal needle is used, and the probability of causing headache is very small. As for low back pain, especially long-term low back pain, it has nothing to do with spinal anesthesia puncture. Colleagues immediately expressed the use of spinal anesthesia with higher safety.

The spinal anesthesia was successfully performed with low-concentration local anesthetic (ropivacaine) during the operation. The anesthesia effect was good, and the vital signs of the child were stable. The patient was sent to the ward after the operation, and there was no anesthesia complication in the postoperative follow-up.

In hindsight, any medical operation should strictly abide by the operating rules and avoid contraindications for illegal operations. This will not only cause harm to patients, but also bring unnecessary trouble to themselves.

Author: Ren Xintao, Department of Anesthesiology, Maternal and Child Health Hospital, Luanchuan County, Luoyang City, Henan Province