Xiao Zhang, 30 years old, finally got pregnant after several efforts. However, it seems that Heaven and she had made a big joke: at 20 weeks of pregnancy, she inadvertently found that she had a hard nodule on her right breast.
At first, she reassured herself that the nodule was not painful at all, it would not be a serious illness, it might be caused by a fire. However, as she looked up information online, she felt that the nodule might not be ordinary. So she went to the hospital.
Preliminary examination results: symmetrical bilateral breast size, no orange peel-like appearance, no dimple signs, no nipple depression, no discharge; palpable mass in the outer upper quadrant of the right breast, about 2 cm by 3.5 cm in size, unclear boundaries, hard texture, poor range of motion, no tenderness; bilateral axillary lymph nodes are not touched and enlarged.
Despite her repeated reminders that it didn't hurt at all, the doctor told her it wasn't a good thing. The doctor explained that this type of disease generally has no symptoms in the early and middle stages. Once there are symptoms, most of them are not early.
Suddenly, Xiao Zhang fell into a deep contradiction: if surgery is done, anesthetics or chemotherapy drugs may hurt the child; without surgery, the condition may develop.
Just when the doctor once thought that Xiao Zhang would choose to save his life, she chose to be discharged. Because she consulted an obstetrician-gynecologist, as long as she persisted until 28 weeks, the child had more chances of survival. At that time, it is decided according to the growth of the child and the condition of the breast nodules.
During the time she returned home, her parents and relatives and friends also tried many times to persuade her to induce labor, but she still insisted on her decision.
In order to let the child grow up healthy, she even forced herself to forget about the disease.
Two months passed, and Xiao Zhang came to the hospital.
At this time, although the nodule is slightly larger, the operation is not difficult, and the biggest difficulty is how to anesthetize. The family's biggest concern is that the anesthetic will hurt the child.
At this point, the focus is on the anesthesiology department.
For this case, the anesthesiology department also felt very tricky. The key is that there are no particularly high gold-content guidelines around the world for questions such as when to anesthetize, how to anesthetize, and even whether to anesthetize. All that is left is experience or theoretical thinking.
If this aspect is not easy to understand, let's start with one aspect: this is a question about anesthesia in pregnant women. Ask what pregnant woman would want to expose her child to an anesthetic in her stomach. If it is not a very critical condition, it is generally insisted on until after giving birth before surgery.
Not to mention that there is no more data reference during pregnancy, and the anesthesia medication data for children younger than three years old is also quite small. Most anesthetic drug instructions generally write that the risk of the drug being used in children is unknown.
However, she couldn't wait any longer. After the doctor's assessment, this operation must be completed as soon as possible.
Obstetrics and pediatrics, do not dare to say that children will be able to live when they are born. Suddenly, there was another stalemate.
Faced with such a condition, the anesthesiology department immediately began to discuss. Doing it is definitely to be done, but how to be safer on anesthesia is the focus of everyone's discussion.
During the two-hour discussion, it was agreed that it was more appropriate to take a combination of anesthesia, that is, nerve block compound general anesthesia.
The basic role of anesthesia is to control pain. The pain is transmitted by the nervous system. The breast is a special location with complex nerve distribution. If it is not complicated, it is possible to rely on a simple nerve block to solve the problem. Therefore, it is considered that compound anesthesia is needed. It is to solve this problem well through the nerve block of local anesthesia and the auxiliary analgesia of general anesthesia.
The intercostal nerve is the main innervation nerve of the skin sensation of the breast, specifically the anterior and posterior branch innervation of the intercostal nerve of the chest 3-6. The posterior branch of the intercostal nerve innervates the lateral half of the breast, and its medial branch innervates the medial half of the breast.
The lateral skin sensation of the breast is innervated by the posterior branch of the intercostal nerve, the inner skin sensation is innervated by the medial branch of the intercostal nerve, the skin sensation in the lower part is also innervated by the intercostal nerve, and the upper sensation is innervated by the anterior branch of the 3rd and 4th cervical nerves.
The lateral branch of the second intercostal nerve is relatively large, and after the extrusion of the anterior serratus, it fuses with the medial cutaneous nerve of the arm to form the intercostal brachial nerve, walking along the lower edge of the axillary vein, innervating the sensation of the skin on the inside of the upper arm.
Obviously, as long as the nerves are distributed in the surgical area, they must be blocked.
Considering that a large number of anesthetics may also have an effect on fetal development, the anesthesiology department decided to use ultrasound to guide the parathracic nerve block. In this way, not only the problem of drug overdose is solved, but also the risk of local anesthetic poisoning is avoided to a certain extent.
In terms of general anesthesia, the anesthesiology department also strives for excellence. In order to reduce the "fearless" increase in general anesthesia that tracheal intubation stimulates the airway, the anesthesiology department decided to use a laryngeal mask to establish an artificial airway.
After making plans, Xiao Zhang was pushed onto the operating table.
Fetal heart rate monitoring is performed intermittently during surgery, monitoring every 5 to 10 minutes, and fetal heart rate monitoring is strengthened during the induction and awakening periods of anesthesia. Intraoperative vital signs are stable and the fetal heart rate is normal. The operation lasted an hour and a half. After completing the operation, Xiao Zhang quickly woke up and recovered well from spontaneous breathing. After successful removal of the laryngeal mask, fetal heart rate monitoring continues.
After the postoperative follow-up, Xiao Zhang gave birth to a healthy baby boy at 35 weeks of pregnancy, weighing 3.5 kg.
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