1 case of intrauterine anaesthetic abnormalwide blocking of trachea intubation

Epidural anesthesia is the preferred method of anesthesia for caesarean section in recent yearsThe pain relief effect is reliable, and the control of anesthesia plane and blood pressure is easyThis paper will be in our hospital in the recent implementation of post section under continuous epidural anesthesia, resulting in abnormalwide blocking of trachea intubation of 1 patient, observe the clinical performance of ecth patients when performing epidural anesthesia abnormal wide-ranging blocking time clinical performance and treatment, explore the epidural anesthesia for clinical cesarean patients leading to abnormal wide-ranging blocking effective prevention methodsThe results are reported below1Case informationthe patient's female, 32 years of age, weighing 62 kg, 37-4 weeks of pregnancy, 4 births 1, scarred uterusIt is proposed to have an emergency caesarean section under continuous epidural anesthesiaRegular preoperative preparation, blood routine, blood clotting function is normal, into the operating room to open the upper limb veins, input balance fluidAnesthesia: L1 to 2 puncture, puncture smooth bloodless and cerebrospinal fluid outflow, placed in the epidural catheter 4 cmConventional non-invasive upper limb blood pressure, electrocardiogram monitoring, pulse oxygen saturation monitoring, mask oxygen absorption 2L/min, patient BP128/78mmHg (1mmHg -0.133kPa), R18 times/min, SpO2 98%, P85 times/minflat position to give 2% Lidoca in 4ml experimental volume of 5min after the test plane in T11, no other adverse reactions, again from the epidural tube to give 0.894% methyl sulfonate ropyrica in 7ml, 5min after no abnormality, measuring plane in T6, blood pressure, pulse, breathing, oxygen saturation normal, the lower limbs can still be lifted off the bed surfaceAfter 10min maternal complaints double upper limb numbness, lifting hand weakness, breathing difficulties, immediately measure the plane in T1, the patient's mind clear, speech powerlessness, irritability, blood pressure reduction, heart rate 67 times / min, blood oxygen saturation 97%, double lower limbs can still lift away from the bed surface, consider the anesthesia drug to the side of the abnormal diffusion of the blocking plane is too high, immediately to the jatropha 6 mg static injection, speed up the filling of the whole tubeGive ketamine 60mg, propofol 60mg, amber choline 100mg static injection, insert ID7.0mm trachea catheter through the mouth, 2min after the fetus delivery, Apgar score 10 points, intraoperative anaesthetic maintenance to riffentani 0.15 mg/kg/min, propofol 6mg /kg (kg)pumping, surgery time 43minafter the end of the operation 38min, the patient appeared to breathe autonomously, observed 10min moisture up to 400 ml, the exhalation of the ability to open eyes, head up, vital signs smoothly after the pull tube into the recovery room observation50min after the test plane in T8 or so, double lower limb activity is OK, normal vital signs, pull out the epidural tube after returning to the wardAfter surgery follow-up 72h, the patient did not have any abnormal conditions2Resultsthis patient's epidural anesthesia caused abnormalwide blocking, after the epidural administration 15 to 20min appearedThe blocking range was segmented, there was no loss of consciousness and pupil change, and surgery was performed under trachea intubation3Discussionthe patient is a typical case of abnormal wide-ranging blocking during continuous epidural anaesthetic section, the patient's full-term pregnancy, lower cavity vein reflux is not smooth, the end of the epidural gap veinplex anger, the effective volume of the epidural cavity is reduced, resulting in the end of the abnormal wide-ranging epidural blocking situation, affecting the patient's life safetyanalysis of the ecth surgery in the continuous epidural anesthesia leading to abnormal wide-ranging blocking causes may be: (1) from the lumbar epidural injection, because the lumbar joint epidural outer cavity becomes narrow, so local anaesthetic is easy to spread to the head(2) Pregnant women's lumbar front convex makes the drug easy to spread to the headTherefore, clinical epidural anesthesia, in order to avoid abnormal wide-ranging blocking situation, first of all, in strict accordance with the operating procedures for anesthesia puncture, emphasizing the importance of giving experimental doses, carefully observe the patient's vital signs after administration, timely detection and treatment of abnormal conditions, both to ensure that the patient anesthesia effect is good and accurate, but also maintain a stable vital signssecondly, for patients with special circumstances (pregnancy, abdominal large lumps, old age, etc.) to be familiar with its physiological changes, the corresponding reduction of the bureau's hemp medicinal quantity, pregnancy should be reduced by 1/3, the elderly should be reduced by 1/3 to 1/2, if the patient has a high hematoline treatment with the whole spinal anaesthetic, in addition to close monitoring, treatment, the important treatment is to assist ventilation and even intubation to ensure oxygen and correction of hypothermia