Xiao Li, who has just been working for a few years, can be described as experiencing "big winds and waves" again and again. In the operating room, she experienced patient allergies, experienced patient blood loss, and even experienced a jump stop in the operation center. Every incident would make her break out in a cold sweat.
A few days ago, an appendicitis operation had once again left her in a cold sweat.
This operation, seemingly bland, is a small operation of general surgery, and it is also a selective operation. Therefore, it is almost possible to describe this anesthesia as "very simple". The only variable may be that surgery may be required during surgery.
Some people will say: Appendicitis, is not it done by surgery?
It used to be done by surgery. There is even a period when everyone will compete through whether the knife edge is one finger or two fingers, showing the skill of surgery.
But today's appendicitis surgery, most of them will choose laparoscopic completion. This makes it more minimally invasive. Patients whose skin is well healed may not have anything left on their stomachs.
The reason for this patient's variables is mainly because he has had bowel surgery. As a result, the anatomical position of the intestine in the abdominal cavity along with the appendix is likely to be abnormal. Coupled with the possible adhesions after the last operation, whether the operation can be successfully completed is marked with a question mark.
During the operation, Xiao Li was also unusually concerned about everything on the stage.
If the surgeon decides to do it, what she needs to do is increase the depth of the anesthesia. Also, it is increased before the knife is moved. Once the knife cuts through the skin, it is too late to use analgesics.
Some people may be puzzled by this: patients are generally anesthesia, when to give painkillers is different?
The difference here is big: although general anesthesia is gone, the patient's consciousness does not feel pain. However, if the depth of the anesthesia is not enough, the body can still feel the pain.
Once the pain occurs, a series of changes occur in the body: on the surface, blood pressure or heart rate changes. The internal environment will also cause the release of pain factors due to pain stimulation.
These released factors do not disappear immediately, but take a certain amount of time. During this time, pain factors may continue to affect the circulation indicators of surgical patients, thereby affecting the safety of surgical anesthesia.
Suddenly, she heard the surgeon discussing whether to operate or not. Looking at the surgeon general's eyes and thoughts, eight or nine did not leave ten is agreed. So, Xiao Li immediately smoked a morphine. Considering that the surgery could be quick, she only injected half of it.
Sure enough, the operation was fired after a few minutes.
Seeing the surgical operation, Xiao Li gave himself a little praise for this accurate prediction.
After half an hour, the knife edges are stitched. Xiao Li's side is also doing anesthesia control before the end of the operation.
It was thought that the patient would wake up as soon as the operation was over. And, for this, Xiao Li firmly believes. Because the anesthetic maintenance drugs she uses are short-acting.
The only long-lasting one is morphine, but only half of it is used. But from the pharmacology of this drug, it is almost impossible to cause any effect on adult breathing in such a small dose.
However, the knife edge did not wake up after three minutes of sewing.
Puzzled, Xiao Li opened the patient's eyes with his fingers.
It is said that "the eyes are the window of the soul", and this is true. This is perfectly applicable to anesthesia. By the size of the pupil of the eye, the depth of anesthesia can be roughly judged. This aspect has been defined by previous anesthesiologists since the beginning of the development of modern anesthesiology. In that era, pupillary changes were an important sign of ether anesthesia staging.
In addition, the edema of the bulbous conjunctiva can also determine the amount of fluid, whether it is low in protein, whether it has a lot of blood loss, and intracranial pressure.
However, when she opened her eyelids, she was startled: both of the patient's eyes were the size of pinpoints.
Seeing such pupils, she immediately reacted: this is a morphine hypersensitivity reaction.
Some people will say: it can't be that the depth of anesthesia is too deep, right?
Generally not: first, too many analgesics are not used during surgery, and the circulatory system does not show significant inhibition of analgesics; secondly, the analgesics used for maintenance are a drug that metabolizes very quickly, theoretically metabolizing in a matter of minutes.
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