Nowadays, general anesthesia has become the mainstream method of anesthesia. Every day, we almost have to perform a series of general anesthesia operations such as oxygen inhalation, oxygen and nitrogen removal, and induction of intubation. If you do too much, there must be problems of one kind or another. In general anesthesia, everyone's biggest concern is nothing more than the problem of endotracheal intubation.
However, there are some unexpected situations that are even more unexpected, such as the extravagant infiltration of anesthesia. The so-called extravasation of anesthesia is that the anesthetic does not push into the blood vessels as expected, but runs outside the blood vessels.
When the anesthetic runs out of the blood vessels, although it is not as tense as the problem with the endotracheal intubation, the tension must not be low. This is because most anesthesiologists are very worried about some questions: How should this anesthetic be metabolized? Will it affect the awakening? Some people may even consider that this quasi-intubation dose of anesthetic will enhance the effect of re-administering the anesthetic. There are also some people who are worried, that is, will this anesthetic be successfully absorbed? Will there be any problems?
However, this problem is so difficult to explain. This is because of a key issue, which is the barrier to expertise. For anesthesiologists, although they have a general understanding of some of the processes of nursing work, they are not proficient; for nursing staff, the extravasation of common drugs is not unfamiliar, but the care of anesthesia extravasation is almost blank.
Below, we share a case of extravasation of anesthetic to see how the patient recovers.
Let's start with the process:
The patient, a 50-year-old male, was admitted to the emergency hospital for surgery due to a car accident fracture. Before surgery, the left forearm indwelling needle is given by the emergency observation room. During anesthesia, the anesthesiologist injects dialycent drugs such as propofol, liyuexi, atracurium cisthronium cisylate, and sufentanil sequentially from the venous passage of the left forearm brought in.
However, the anesthesiologist on duty did not find an abnormality. The problem was not discovered until 5 minutes later, when the patient was still not sleeping. At this point, touching the vicinity of the indwelling needle, it is obvious that there is a large hard lump. Subsequently, the indwelling needle was removed.
In view of the fact that the operation had to be performed, the indwelling needle was re-injected in other areas for anesthesia, and the operation proceeded normally. The operation lasted 3 hours and woke up without abnormalities.
On the day after the operation, large blisters of 9 cmx9 cm appeared around the needle puncture point of the original left forearm indwelling needle, epidermal necrosis occurred after 1 week, and necrosis of subcutaneous tissues, muscles, blood vessels and other tissues gradually appeared, and pressure ulcers were excluded through multidisciplinary consultations such as intravenous treatment team, stoma, anesthesia, pharmacy, ultrasound, etc., and treated as extravasation of drugs.
I thought that after systematic treatment, I would heal quickly. However, the process is really too long. It was not until a year later that a basic cure was declared, but the complainant's left palm remained numb.
Neurological consultation is given to consider nerve damage. The next treatment is to go to the neurology, rehabilitation department, and beauty department regularly for further rehabilitation and functional exercise.
After that, the patient enters an even longer process of rehabilitation. It is said that after 3 years, the function of the left forearm and palm is basically restored, and it can be normally engaged in work and labor.
The consequences of a small indwelling needle accident are shocking. Almost everyone would not believe that such an accident could put a person on the road to recovery for several years.
Share the treatment process (this treatment process is for reference only, different cases should have individualized treatment and rehabilitation plans):
First, the first step must be to find the cause accurately. This aspect is particularly important, with etiology being key and treatment secondary. In other words, finding the right direction can be targeted; the wrong direction may not only delay the timing, but also lead to the opposite effect.
The judgment of drug extravasation is mainly based on the patient's clinical manifestations and the reason for the occurrence of the event:
1. Bring indwelling needles in the left forearm before surgery, which is obviously a hidden danger. The hidden danger is whether the indwelling needle is strictly handed over? In addition, particularly thin needles may not have blood returns on their own, so it is difficult to distinguish whether the indwelling needle is in the blood vessel;
2. There is a process of bolus of propofol, liyuexi, atracurium cisthroammonium cisylate, sufentanil and other drugs, and at that time it has been confirmed that drug extravasation has occurred.
3. Causes such as pressure ulcers, coagulation, clotting spots, and thrombosis have been ruled out.
The next step is the process:
A few months after surgery, dry necrotic tissue was debridement and disinfected with ann iodine and washed with normal saline. After drying, use an amorphous, stylized flake hydrogel dressing.
After a few months, surgical debridement, autolytic debridement, conservative sharp debridement, and negative pressure drainage continued. After washing and drying with iodine disinfection and normal saline, remove the liquefied and separated necrotic tissues in batches and multiple times to avoid bleeding and causing pain in patients; use alginate and foam dressings to absorb exudate and promote the growth of granulation tissue.
After that, doctors advised him to graft his skin, but it did not happen for a variety of reasons.
Until nearly three years later, the patient was basically cured, complained of hand anesthesia, continued to give rehabilitation function training, and recovered the function of the affected limb and arm.
The road to recovery for patients is long, tortuous, and a kind of physical and mental torture for patients. However, the medical staff involved in this accident are also very distressed. If the patient is not good for a day, this pressure will always exist.
Looking back at the whole case, there are a few points that deserve our consideration and warning:
1. Patients can bring indwelling needles into the operating room, and they are also welcome to play indwelling needles in the ward, which will save time and increase the turnover rate of the operating room. However, it is important to ensure that the indwelling needle is unobstructed and free of extravasation.
2. When the indwelling needle is found to be thinner, promptly ask the nursing colleague to inject a thicker indwelling needle.
3. This one is very critical: the administration must be withdrawn. No blood is seen, no medicine can be administered! When administering the drug, it is necessary to observe whether there is an abnormality in the local area and whether the resistance on the hand is abnormal. Also, try to avoid pouring administration. The dosing is too fast and the cycle cannot be carried!
【Warm tips】Point to pay attention, here is a lot of professional medical science, for you to reveal the secret of surgical anesthesia those things ~ ~
![Because of the war, in the absence of anesthesia, the general was sawn three times in half a month[fig]](data:image/gif;base64,R0lGODlhAQABAIAAAP///wAAACwAAAAAAQABAAACAkQBADs=)