On Friday, Dr. Zhang's college classmate called her: She had a difficult anesthesia and needed to ask her for help.
Dr. Zhang, who has been practicing in the top three hospitals for many years, agreed without thinking about it. According to her idea: she can be said to have experienced hundreds of battles, and there should be no anesthesia that can embarrass herself.
However, when she rushed to the hospital of her old classmates, she felt that things were not so simple.
In the midst of a hug and a compliment, everyone invited her to the ward where the patient was.
At the first sight of the patient, she was dumbfounded. It turned out that this was no ordinary patient, this was a pregnant woman. Moreover, the petite body against the background of the large belly made her immediately nervous.
If it is an ordinary patient, there is always a way to solve the problem of anesthesia. However, pregnant women can't. It is not only necessary to consider the problem of surgical anesthesia in adults, but also to avoid the impact on the fetus in the abdomen as much as possible.
Before I saw the patient, I only heard the old classmate who was also an anesthesia major say: This patient is not good, and I hope she will help do this anesthesia. Suppose you can't tie it, do general anesthesia.
It can be said that because Dr. Zhang has a wealth of experience in general anesthesia, he mainly hopes to use her general anesthesia to support the bottom.
Dr. Zhang knows that although the current general anesthesia technique for caesarean section is very mature, it is still necessary to try not to use general anesthesia when it is not necessary. So Dr. Zhang asked the pregnant woman to turn sideways and look at her back.
When she saw her back, she, who had a lot of experience, couldn't help but take a breath of cool air. What she saw was not a normal back, but a back with some obvious deformities. The whole body is twisted like a snake.
To her slight reassurance, after she had personally straightened the pregnant woman's back, she saw a spine that seemed to be in a straight line.
At that time, she was thinking: If it were not for the fact that this pregnant woman had basically no meat on her back, she would definitely choose to give up directly.
In this way, she did not dare to pack a ticket and say good to the mother, family and old classmates: try epidural puncture, and once she realized that it was not right, she would immediately give up on changing to general anesthesia.
Before the anesthesia, Dr. Zhang also specially examined the anesthesia machine and equipment such as intubation. In the face of such a patient, she really did not have much confidence.
When she was pierced, she asked her old classmates to help straighten the upper body of the pregnant woman.
Under the gaze of everyone, she methodically disinfected, spread towels, played local anesthesia...
When the piercing needle entered two centimeters, a familiar sense of breakthrough came from the hand. Although this depth is much shallower than three centimeters of normal people, "it is better to believe that it has, not to believe that it is not", in case it has reached the target! So she took a little salt water and began to test the negative pressure of the epidural cavity.
When she flicked the brine in, the feeling of no resistance told her: the tip of the needle was already at the depth of the target!
After careful replacement, verify again that the catheter is in the epidural cavity by dropping the liquid level of the catheter.
When they saw the liquid level drop without hindrance, everyone couldn't help but shout "Good! "The cheers.
At this time, a stone in Dr. Zhang's heart finally landed.
However, this is only the first step to success, depending on the blocking effect of the anesthetic.
After laying the pregnant woman flat, Dr. Zhang began to test the amount of epidural anesthesia.
Given the deformity of the back of pregnant women, structural abnormalities of the spine cannot be completely ruled out. So Dr. Zhang carefully pushed two milliliters of local anesthetic test.
A few minutes later, Dr. Zhang asked the pregnant woman whether her lower body was numb, dizzy, and her eyes were not flowering.
Pregnant women said: the legs are a little numb, the head is not dizzy, the eyes are not flowered.
Just when everyone thought it was okay, Dr. Zhang was nervous and frowned. She thought to herself: There are only two milliliters of local anesthetics, which is impossible. At this time, the anesthesia effect, will it be that the epidural catheter enters the subarachnoid space? If so, wouldn't that be a waist numbness?
Seeing that Dr. Zhang did not say a word, the atmosphere in the operating room became solemn.
The epidural catheter was withdrawn again, completely unable to twitch, which made Dr. Zhang feel a little relieved. But she knew that this did not completely rule out that the catheter was not in the subarachnoid cavity. What if the catheter sticks to the wall? What if the catheter enters the nerve root sheath on one side?
After a few more minutes of observation, the anesthesia effect was still limited to the lower limbs on both sides, which made Dr. Zhang feel more at ease.
At this point, according to her judgment, the epidural catheter is basically unlikely to be in the subarachnoid cavity. If in the subarachnoid cavity, the plane cannot be so low. In addition, pregnant women cannot have only a little numbness on their two legs, but will not be able to move at all.
Is it possible for the hypodural space? A thought flashed through Dr. Zhang's mind.
Unlikely, if the catheter is in the hypodural space, the anesthesia plane will jump high rather than focusing only on both lower extremities.
Since there is an anesthesia effect, it will certainly not be in the blood vessel.
After firming up her judgment, she pushed two milliliters of local anesthetic again.
In a state of trepidation, a few more minutes passed. Dr. Zhang asked the patient again how he was, and the patient said that his belly was tingling.
Hearing such an answer, Dr. Zhang was ecstatic in his heart, but on the surface he could not show it so obviously.
At the sound of an order, the obstetrician brushed his hands on the stage.
During this period, in order to ensure the effect of anesthesia, Dr. Zhang pushed two more ml of local anesthetics in the syringe into it.
It wasn't until the scalpel cut through the skin that Dr. Zhang's dangling heart really let go.
During surgery, the effect of anesthesia is basically the same as usual.
Perhaps, only people who really understand anesthesia can understand what this six-milliliter epidural is.
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