【Case Discussion】An accidental analysis of anesthesia caused by lidocaine allergy in 1 case

Medical history: the patient has no previous special medical history, no history of drug allergies, no special discomfort at the time of admission, no fever, cough, no palpitations, and no shortness of

After entering the room, the interstitial needle was successfully inserted once, the bolus test volume was 1.

Etomidate 8mg, succincholine 100mg, sodium thiopental 50mg rapid induction intubation, maintenance of anesthesia with propofol plus fentanyl, intraoperative SpO2 progressive decline, change the machine control to manually controlled breathing, airway resistance is extremely large, gas is difficult to press in, it is considered to be tracheal duct obstruction, suction tubes equal in length as the tracheal catheter are used to attract unspired sputum, the resistance to re-insert the airway is still large, the auscultation of the double lung breath sound is weak and there is a little sputum sound, the catheter is pulled out again, and the mask is pressurized to oxygen, Re-intubation confirmed that the catheter entered the glottis, with a soft 50cm long suction tube inserted into the deep part of the catheter suction, aspirate a large amount of turbid fluid, after repeated suction, oxygen, and with 0.

2.

3.

2.

3.

1.
There are 4 kinds of adverse reactions in the application of local anesthetics:

First, local anesthetic overdose, this case can be ruled out, because only 5 ml of bolus 1.
7% lidocaine solution is not enough to cause overdose
.

The second is the problem of low tolerance, which can be ruled out
by asking the medical history and preoperative examination.

The third is a specific reaction, which can be ruled out
by medical history and examination before surgery.

The fourth is allergic reactions, the main symptoms of which are local or systemic urticaria, dermatitis and neuroedema, bronchospasm, decreased blood pressure, glottis edema, anaphylactic shock, according to the symptoms and signs of the patient, considering that the patient in this case belongs to this situation, anesthesiologist treatment is also appropriate
.

2.
Local anesthetic allergy and local anesthetic into the subarachnoid cavity are usually very different, but it is difficult to correctly distinguish between them in critical situations, especially if both have the manifestations of shock and breathing difficulties, which require urgent treatment
.

The above has analyzed the situation of local anesthetic allergy, and when the local anesthetic accidentally enters the subarachnoid space and the amount of local anesthetic exceeds the amount of spinal anesthetic, it will show that all the areas innervated by spinal nerves are painless, hypotensive, loss of consciousness and respiratory arrest
.

In this case, when the patient had a critical situation, his lower limb activity was normal, which could rule out the possibility
of general spinal anesthesia.

3.
In our usual anesthesia work, it is very common
to have "breathing difficulties" during surgery.

First of all, we must correctly judge the cause
of breathing difficulties.

This case of anesthesia accident is due to the chain reaction caused by improper treatment of lidocaine allergy, and respiratory management
should also be taken into account while treating drug allergies.

When a large number of secretions or refluxes are pressurized to oxygen without sufficient suction, they are bound to press into the airway and block the trachea, and the consequences are equivalent to aspiration
.

Aspiration is one of the most serious complications during anesthesia, the mortality rate of aspiration is as high as 70%, aspiration should be carried out immediately after the occurrence of oral and pharyngeal full suction, endotracheal intubation to ensure respiratory tract patency, while giving adequate oxygen, correct hypoxaemia, after a slight improvement in the condition and then repeated lung lavage, and adequate suction
.

This case tells us that in the future, in the anesthesia process, we should think of relevant links when dealing with each problem, so that patients can safely pass the surgical period
.

Recommended reading

【Thursday】Clinical anesthesia and analgesia diagnosis and treatment difficult critical discussion essence and caesarean section 1 case of accident

【Thursday】Clinical anesthesia and analgesia diagnosis and treatment difficult critical discussion essence propofol plus fentanyl painless abortion caused by hearing impairment 1 case

【Thursday】Clinical anesthesia and analgesia diagnosis and treatment of difficult and critical discussion of sperm and cesarean section after total peroneal nerve injury

【Thursday】Clinical anesthesia and analgesia diagnosis and treatment of difficult critical discussion essence and pregnancy combined with cardiomyopathy under general anesthesia emergency cesarean section

【Thursday】Clinical anesthesia and analgesia diagnosis and treatment difficult and critical discussion essence of pregnancy 2 0 weeks of pregnancy, rheumatic heart disease, mitral stenosis, pulmonary hypertension, cardiac function grade III.
~IV.
, quasi-emergency cesarean section

【Thursday】Clinical Anesthesia and Analgesia Diagnosis and Treatment Difficult Critical Discussion Essence • Refractory pain in both lower extremities, buttocks and sacrumcoccy after caesarean section surgery

【Thursday】Clinical anesthesia and analgesia diagnosis and treatment difficult and critical discussion essence, pregnancy combined with type 2 diabetes mellitus, diabetic ketoacidosis secondary to chylomicronemia