Sudden cerebral infarction during surgery is something that every anesthesiologist is very worried about. Once it happens, almost all of the fingers are pointed at the anesthesiology department.
This doesn't seem to be a problem: after all, surgery really doesn't affect the cerebral blood vessels, except for brain surgery.
It is precisely because of this problem that anesthesiology often becomes the backstabber.
However, in a recent case, it was proved that this time it had nothing to do with anesthesia.
The patient is a young woman who loves beauty, and it is precisely because of Aimei that she eventually lost her life!
At the time of onset, the patient had just undergone bilateral temporal limb fat grafting. During the recovery period from anesthesia, although the endotracheal tube is removed, the patient's consciousness is obviously abnormal, and there is a suspected neurological abnormality. At the strong request of the patient's family, he was transferred to a strong local hospital.
Emergency examination found that the patient was unconscious, occasionally spontaneous speech, bilateral pupils were equal to large and equal circles, light reflex was present, frontal lines were symmetrical, and the left nasolabial fold became shallow. The muscle strength examination of the limbs is not cooperative, there is no obvious movement of the left limb, the whiplash sign of the left upper limb is positive, the abduction and external rotation of the left lower limb is unable to support the bed, the movement of the right upper and lower limbs is visible, the muscle tone of the left limb is reduced, the muscle tone of the right limb is not increased or decreased, the tendon reflexes of the left limb are dull, the tendon reflexes of the right limb are normal, the left Babinski sign is positive, and the right Babinski sign is negative.
Whiplash sign: In patients with complete paralysis, the affected limb is passively lifted, and in cases of organic paralysis, the limb falls rapidly, while in patients with hysteria, it falls slowly.
Urgent CT of the brain showed hypodense opacities in the right middle cerebral artery running area. Carotid ultrasound showed solid echogenicity in the right internal carotid artery and external carotid artery. Combined with the medical history and clinical manifestations, the admission diagnosis: (1) cerebral infarction (right cerebral hemisphere); (2) Fat embolism.
To diagnose cerebral infarction, time is of the essence, and the emergency green channel is opened.
Soon, the patient is wheeled into the interventional operating room. During the operation, a large number of foreign bodies were entwined around the stent, the guide catheter was withdrawn, and a large amount of lumpy fat was flushed out with normal saline, and the re-imaging showed that the anterior blood flow of the right internal carotid artery, middle cerebral artery, and anterior cerebral artery was restored, and the anterior blood flow was grade 3, and the right external carotid artery was occluded.
After the operation, the anesthesia was not awake, the bilateral pupils were unequal, the left side was 3mm, the light reflex was lost, the right side was 4mm, the light reflex was lost, the tracheal intubation was connected to the ventilator to assist ventilation, the muscle strength test was not cooperative, the left limb was not moved, the right limb was visible, the left Babinski sign was positive, and the right Babinski sign was negative.
Seeing the patient's situation, everyone felt faintly uneasy. Especially when I saw the face that was supposed to look quite handsome, I had mixed tastes.
A few days later, the tragic news came from the intensive care unit that the patient had passed away due to complications such as massive cerebral infarction, cerebral edema, and an infection in the lungs.
At this time, the anesthesiology department's mood was heavy, and it did not gloat because it was not his own reason this time. After all, life does not allow a stain on our minds.
Some people will be curious: can facial fat injections cause cerebral infarction?
Let's take a look at the reasons for this:
The possible pathogenesis may be twofold or both: (1) Fat particles enter the blood vessels directly from the injection site. (2) Fat particles enter the cerebral blood vessels through the reserve communication branch: Under normal circumstances, the internal carotid artery and the external carotid artery communication branch of the facial blood supply are in a functionally closed state. High-pressure injection can cause an increase in local pressure, the reserve branch opens, and the fat emboli wanders through the anastomosis intracranial and intracranial vessels, causing cerebral embolism.
Intravascular injection has occurred, isn't it withdrawn?
This is a key issue: to ensure uniform fat filling, autologous fat grafting requires multi-layered, multi-point dispersed injections in the recipient area, and injection of fat particles at the same time as needle withdrawal. If the injection needle fails to accurately enter the periosteum and the myometrium, and is not withdrawn before injection to observe whether it has accidentally entered the blood vessels, it can cause fat particles to enter the craniofacial blood vessels and cause acute cerebral infarction.
Hopefully, such a tragedy will never happen again. At the same time, I also advise those female friends who "never feel that they are not beautiful enough": plastic surgery is risky, cherish life!
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