Aunt Zhang was recently hospitalized, and after examination and diagnosis, the doctor diagnosed it as "uterine fibroids". According to Aunt Zhang's condition, age and other factors, the doctor decided to perform "laparoscopic total hysterectomy" for her, which is a minimally invasive procedure. Originally from admission, examination to surgery everything went smoothly, the whole operation process did not know anything, like a beautiful sleep, as if she also had a dream, after the operation anesthesiologist also installed an analgesic pump for her, did not feel pain at all.
However, the day after the operation, when the one-day list was sent down, Aunt Zhang was confused. Only to see the above charging items are: general anesthesia, the number of 1, the number of nerve block anesthesia 0.3. How can there be two anesthesias after one surgery? Obviously there was only one anesthesia, so I only slept. Besides, they are all under general anesthesia, so why do you need other anesthesia? And how is nerve block anesthesia 0.3? Can anesthesia still only hit 0.3? Will it be indiscriminate charging? Aunt Zhang muttered in her heart.
Just in time, the tube bed nurse came to inspect the ward, Aunt Zhang quickly asked her what was going on, the tube bed nurse looked at it and shook her head and said that she didn't understand, and asked him to ask his attending doctor. Aunt Zhang went to ask the attending doctor, and the attending doctor saw that he did not understand, saying that he had to ask her anesthesiologist.
So the attending doctor helped her call the anesthesiologist. After a while, the anesthesiologist came and gave her a full and detailed explanation.
It turns out that although this laparoscopic total hysterectomy is a minimally invasive operation, anesthesia is not "small anesthesia"! Because the entire surgical process needs to be continuously filled with carbon dioxide gas in the patient's abdominal cavity, maintaining a certain pressure, so that the inside of the abdominal cavity forms a space, and then with the help of lighting equipment and video transmission equipment, the image inside the abdominal cavity can be clearly transmitted to a dedicated video screen. In this way, the surgeon can clearly see the specific location of the lesion, the situation and the operation of the operation. However, this has a great impact on the patient's own physiology and internal environment. For example, the stretching of the peritoneum by the abdominal bulge, the compression of carbon dioxide on the diaphragm, abdominal organs, blood vessels, and the absorption of carbon dioxide may lead to a decrease in the amount of blood returned to the heart, obstruction of heart drainage, circulatory fluctuations, dyspnea, hypercapnia, etc., which cannot be tolerated by awake patients at all. This requires the need for general anesthesia.
However, any method of anesthesia has its advantages and disadvantages, indications, contraindications. Nerve block anesthesia or spinal anesthesia, which is commonly known as "semi-anesthesia", has the disadvantages of incomplete block, intraoperative patients may be awake with fear, anxiety, and special patients can not cooperate, can not meet all types of surgery and other shortcomings, but the circulation is relatively stable, postoperative analgesia effect is good. General anesthesia can meet all types of surgery, and endotracheal intubation can also ensure good respiratory management, but the use of a large number of sedation, analgesia, muscle relaxants may lead to postoperative nausea, vomiting, respiratory depression, delayed awakening and other adverse reactions. Thus, compound anesthesia came into being.
Compound anesthesia is a combination of two or more anesthesia methods, such as general anesthesia and nerve block anesthesia at the same time, for surgery or treatment, the application of their respective advantages, to achieve the advantages of the addition, disadvantages to offset the complementary effect. The advantages of compound anesthesia are mainly to meet the depth of anesthesia required for various operations, greatly reducing the dosage of general anesthesia drugs and reducing the use of opioids, while nerve block anesthesia is also conducive to postoperative analgesia, avoiding restlessness and pain during the awakening period of general anesthesia, and promoting patient recovery.
Aunt Zhang's surgery was performed by the anesthesiologist after performing general anesthesia, and then performed an ultrasound to guide the lower abdominal transverse fascial block (TAP) in Aunt Zhang's abdomen. This not only greatly reduces the dosage of general anesthesia drugs, ensures early postoperative wake-up, reduces the incidence of postoperative nausea, vomiting and agitation, but also facilitates postoperative analgesia, early discommunication activities, and promotes recovery.
According to the "Henan Provincial Medical Institution Service Project Charging Standards", two anesthesia methods are applied at the same time, and the second anesthesia method can only charge 0.3 of the standard fee, so Aunt Zhang's one-day list will have a "nerve block anesthesia, quantity 0.3" charging item.
Listening to the anesthesiologist say this, Aunt Zhang suddenly understood! Thinking about it again, having an operation is like sleeping, and I don't feel pain after the operation. Aunt Zhang gave a thumbs up and praised the anesthesiologist: The numbness is so good!
About author:Wang Wenjiang, Deputy Director of the Department of Anesthesiology, Yichuan County People's Hospital. Graduated from Xinxiang Medical College, bachelor's degree in anesthesia, engaged in clinical anesthesia work for 15 years, studied anesthesia in Zhongshan Hospital affiliated to Fudan University for one year, and loves anesthesia. Personal hobbies are poetry, songwriting, writing.
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