At 9 a.m., an abdominal mirror uterine fibroid surgery was under anesthesia. In charge of anesthesia is Dr. Pang, who has been working for more than a decade.
The patient has no special situation: more than 30 years old, usually physical examination, there is no obvious abnormality in various examinations.
Anesthesia is general anesthesia, and the removal of laparoscopic uterine fibroids is planned to be completed under general anesthesia.
Logically, this is a very low-risk surgery. Although many people think that this is still a major operation, a surgery that requires general anesthesia, with the rapid popularization of anesthesia technology, general anesthesia technology has become a routine technology throughout township hospitals.
With ease, the nurse takes the patient to the operating room, checks the information three times, and plays a drip... Anesthesia, connecting the monitor, giving oxygen to the patient, drawing drugs, etc., everything is proceeding in an orderly manner.
Since there were several larger surgeries in the other operating rooms, the head of the anesthesiology department asked the nurse to help Dr. Pang finish the medicine and walk away.
Dr. Pang, while directing the nurse to push the medicine, while controlling breathing by hand, uses a mask to pressure the patient to inhale oxygen. After the anesthetic was fully effective, I looked up at the blood pressure and heart rate: blood pressure was more than 90, and heart rate was more than 80. Very good, he muttered in his heart.
Since there is no indication of difficult intubation, the intubation is also unusually smooth, and it is inserted with a "whirl". Look up again at blood pressure and heart rate: not much has changed.
After auscultation confirmed that the intubation was correct, Dr. Pang firmly fixed the endotracheal catheter with tape. Look at the monitor again: there was a hint of unusualness, but where it was unusual, he was not clear for a moment. After that, while asking the surgeon to seize the time to wash his hands and go to the stage, he thought about this problem.
After a while, the surgeon came in humming a little song: Today is a good day...
Yes, when encountering surgery that is not difficult, everyone's psychological pressure is small. Working under high pressure every day, anyone has to collapse. Hearing the surgeon humming a little song, everyone's heart also relaxed.
However, Dr. Pang did not say a word here, and his brow frowned.
The surgeon who was just about to hum the next sentence seemed to realize that something was wrong and asked Dr. Pang: Is it all right?
Dr. Pang, who was highly concentrated, ignored him and pressed the button to measure blood pressure again.
At the same time, it was almost a quick retreat to the emergency medicine truck.
The surgeon, who was standing on Dr. Pang's walking route, jumped away.
Just listening to the "pop", Dr. Pang opened a medicine.
Before the next blood pressure measurement came out, the drug had already been injected.
Everyone wondered: blood pressure is a little lower, but not so nervous, right?
On weekdays, everyone knows that the anesthesiology department is notoriously big heart. When small situations arise, they are basically coped with between talk and laughter. Dealing with such a serious look and quick action can only explain one problem - the patient has a serious condition!
For a moment, space-time in the operating room stood still.
At this time, the systolic blood pressure of the blood pressure measurement interface jumped out of an 85. Seeing this, Dr. Pang shouted urgently: "Help me call someone over."
Perennial in the operating room, of course, know who to shout: the first choice of anesthesiology director, no longer any anesthesiologist can do. Because, in the operating room, the strongest rescue ability is the anesthesiologist.
In the blink of an eye, the operating room was packed with people.
The people who came in behind, not yet aware of the situation, were busy asking what the situation was.
The director of the anesthesiology department, who arrived first, agreed with Dr. Pang's judgment that the patient was allergic through a simple exchange. Therefore, immediately start the various treatments of anti-allergy:
As soon as I put it, I removed the intravenous anesthetic that was being put on the infusion pump.
Some people say: emulsions may indeed be the source of allergies, but they will not be removed, right? Isn't it okay to press Pause?
The director of the anesthesia department, who has been doing anesthesia work for many years, also wants to press the pause button only. But the bitter lessons of the past taught him that it was safe only if it was completely withdrawn.
I remember one time, the infusion pump was muscle relaxant. The muscle relaxing medicine that had been stopped was accidentally bumped by a colleague. It doesn't matter. Unbiased, the syringe still on the pump was knocked into a few milliliters. At this point, the surgery is almost finished. In this way, the balance of analgesia, sedation, and muscle relaxation is disrupted. According to the patient's postoperative words, it seems that everyone can be heard talking, but they can't move. Fortunately, the surgery was done by then. If you don't finish it, your body hurts so much that you can't move, what is that feeling?
After removing the intravenous anesthetic, he asked the nurse to bring over a few bags of warmed liquid.
After seeing the blood pressure on the screen, the nurse probably knew what was happening. So ask: half crystal, half colloid?
She asked, no problem at all. In the past, whenever hypotension or shock was encountered, the infusion had to be crystalline and colloidal with infusion.
But this time it's different. Colloids, which could have raised blood pressure and resisted shock, may also have been one of the factors that caused this abnormality.
At this point, many friends may be confused.
To explain: At present, all colloids, including synthetic or naturally extracted, have the possibility of allergies. Gelatin has the greatest chance of allergic reactions in plasma substitutes, and it can act directly on mast cells and basophils to release histamine, causing an allergic reaction.
In order to cut off all the substances that may cause allergies to enter the patient's body further, the director of the anesthesia department asked her to take only the crystals.
Looking at the director of the anesthesia department, while pressing the blood pressure measurement button again, dr. Pang quickly smoked an adrenaline. Dr. Pang, who has also participated in many hard battles in the past, already has adrenaline pumped in his hand. After the director of the anesthesiology department asked for a clear dose, a needle was pushed in. Casually said: hormones.
In the operating room, there is no need for too much language. It only takes two words, and everyone understands what's going on. When Dr. Pang smoked dexamethasone, the nurse also helped find the hydrogenated codizone.
Blood pressure was measured again, and blood pressure was more than 110.
Seeing this blood pressure, the spirit of everyone pulling the full bow was slightly relaxed.
At this time, everyone is waiting for the director of the anesthesiology department to analyze the reasons. Because, to everyone, it is almost unbelievable: the operation has not yet begun, there is no blood transfusion, the anesthesia seems to have just begun...
Seeing that the patient's vital signs were slightly stable, the director of the anesthesia department said: There is a high probability that the patient is allergic to something or has an allergic reaction.
Staring at the slightly lower heart rate on the screen, he commanded: Take a norepinephrine. It really doesn't work, just pump.
The surgeon asked: Is the operation continued or postponed?
The head of the anesthesiology department said: Wait and see. Let's look for the reason or let's see if it's manageable?
After that, everyone waited quietly.
During this period, the director of the Department of Anesthesiology told everyone some relevant knowledge points:
Patients are exposed to many foreign substances, including latex, during the perioperative period, and anesthesiologists are also responsible for infusing patients with a variety of preparations such as anesthetics (propofol, ester local anesthetics, etomidate succincholine, rocuronium bromide), blood products, colloids (polygelin peptides), antibiotics, protamines, etc., all of which may produce predictable or unpredictable adverse reactions, of which the highest chance of serious reactions or even life-threatening reactions is metamorphosis or anaphylaxis-like reactions.
Anaphylactic shock is a severe metamorphosis or allergic reaction, the body's mast cells release a large amount of histamine, resulting in capillary leakage, systemic circulation blood vessel dilation, a sharp drop in blood pressure, insufficient venous return to the heart and insufficient pumping of blood from the cardiovascular system. Anaphylactic shock rarely occurs under anesthesia, but the consequences can be severe when they occur.
Fortunately, after nearly half an hour of observation, the patient did not have any more serious conditions. Crucially, the respiratory tract has always been normal. Therefore, the director of the anesthesiology department and the surgeon said: Communicate with the family. If the family is resolute, the operation will continue; if the family is hesitant, the operation will be postponed.
One might ask: Why does the director of anesthesia focus on the respiratory tract?
This is because, in addition to circulatory problems, allergic reactions can also lead to problems with the respiratory tract, such as increased airway pressure. Some patients have difficulty breathing even manually. Especially the airway reactions that occur during intubation can be mistaken by an anesthesiologist for "wrong insertion." If the anesthesiologist is inexperienced and pulls out a tracheal catheter that has already been inserted into the trachea, the consequences are unimaginable.
After a while, the surgeon who communicated with the family returned. With a relaxed and slightly excited expression, he said: The patient's family is very good, saying that they trust us very much and agree to continue the operation.
With this "reassuring pill", everyone rolled up their sleeves and started.
After that, the director of the anesthesiology department did not leave the operation room until the patient was safely sent out.
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