A few days ago, anesthesia from an appendicitis procedure became the subject of a case discussion in the department.
There is nothing special about the anesthesia method, just an epidural anesthesia. In terms of anesthesia effect alone, it is decent and can be regarded as a qualified anesthesia. However, one of the "episodes" that occurred during this period is worth pondering.
After the patient enters the operating room, he is particularly nervous. I couldn't stop muttering in my mouth, but I couldn't hear what it was.
Dr. Li, who was in charge of anesthesia, asked her what was wrong, and answered: The first time I entered the operating room, I was nervous.
Dr. Li comforted: Most people are first-time, don't be nervous. After saying that, quickly put her in the shape of a "big shrimp" needed for anesthesia.
The shape of the "prawn" is a position required for puncture in the spinal canal. The patient lies on his side on the operating table, his entire body curled up as much as possible. It's similar to holding your knees with both hands, but you don't really need to hold a posture with both hands.
Since several surgeries were lined up in the back, Dr. Li stepped up operations: disinfection, towel laying, local anesthesia...
After a while, the anesthesia puncture is completed.
At this time, everyone noticed that the patient's whole body was shaking.
Seeing this scene, everyone thought that something unexpected had happened.
When Dr. Li made it clear that he had not yet pushed the anesthetic and could rule out the anesthesia accident, everyone was relieved to go their separate ways.
During the conversation, everyone had reached out together to put the patient's position back into a lying position. (During appendix surgery, lying flat on the operating table is required.) ）
After seeing that everything was normal on the monitor, Dr. Li pushed the local anesthetic into a plastic tube buried in the patient's back.
Who knows, just push the patient and shout "ah" shouted.
Dr. Li asked her what was wrong, and answered: I felt something pass through my back.
Hurriedly comforted: it is pushing anesthesia.
Seeing the patient whose tension had not decreased at all, Dr. Li noticed at this time that her feelings were ignored the whole time. Such a nervous patient, even if there is any abnormality during the puncture process, may not be able to accurately express it.
Thinking of this, Dr. Li was afraid after a meal.
After a patient explanation, the patient's trembling body gradually returned to calm. However, blood pressure and heart rate remain in a "nervous" state.
Yes, people have just experienced such tension, and they will not calm down so easily.
The next "plane test" link can be said to be a lot of effort. The reason is that patients with high levels of stress simply can't figure out what pain is and what touch is.
The plane test is a key in spinal canal anesthesia. Since the effect of spinal anesthesia is almost entirely dependent on the anesthesiologist observing the patient's response to determine whether it works, the patient's cooperation is crucial. Assuming that the patient is too nervous to help himself, it is difficult to accurately judge whether it is effective.
During the procedure, the anesthesiologist may use a cotton swab to draw the boundaries of the site of possible anesthesia. Of course, some anesthesiologists are gentle and may dip a cotton swab into the alcohol test. The dividing point of the anesthesia site is called the anesthesia plane. When the anesthesia plane completely covers the surgical area, both anesthesia is considered successful.
Because of the neglect of the patient's nervousness, the test of the effect of this anesthesia was extremely difficult.
Fortunately, Dr. Li has a wealth of experience and judged the anesthesia effect through the subtle changes in the circulation indicators on the monitor. The doctor on the stage then tested it with forceps and finally determined the success of the anesthesia.
At first, everyone thought that the case discussion seemed less necessary. However, spinal anesthesia is something that every anesthesiologist is worried about.
It can be said that no anesthesiologist can stop the water in this anesthesia center. All kinds of worries: worry about the effect of anesthesia is not good, worry about the traction reflex during surgery, worry about local anesthetic poisoning...
After this case discussion, everyone formed a consensus: no matter how busy you are, you must communicate with patients more. Empathetic thinking, lying on the gas table, perhaps more nervous.
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