Cobweb subcavity blocking delay cardiac arrest rescue 1 successful case

1General informationpatients, male, 65 years old, height 168 cm, weight 82 kgDue to the recurrence of the left groin, the cavity blocking the underside anaesthetic under the cobweb seisfa is patched down the single-sided groinDenyhistory of hypertension,diabetes, coronary heart disease, etc., preoperative examination did not show obvious abnormalitiesNo medication was taken prior to surgeryPatients lie flat after entering the chamber to absorb oxygen, monitoring vital signs heart rate (HR): 69 times/min, oxygen saturation (SpO2): 98%, non-invasive blood pressure (NBP): 137/81mmHgthe right side of the patient lying, in the L2 to 3 gap cobweb membrane undercavity puncture smooth (Humpman company production batch number: 1704008), see clear cerebrospinal fluid reflux to give 0.75% bubicain original liquid 2.2ml, pushing speed of about 1ml/5sAsk the patient to take oxygen 3L/min from the flat mask and measure the anaesthetic plane to T10 (needle tingmethod)Patients complain of chest tightness discomfort, monitoring signHR: 32 times / min, NBP: 80/40mmHg, SpO2:90%, immediately accelerate the infusion at the same time static push atropine 0.5mg, ephedrine 30mg, and then the patient call should not, autobreath disappear, monitoring warning, HR:0 time/ min, blood pressure not measured, SpO2:70%immediately press the chest and chest, while the mask is pressurized to oxygenThe patient's heart rate recovers after pressing about 30s, HR: 120 times/min, NBP:155/100mmHg, SpO2:100% Subsequently the patient's consciousness recovers, intravenous injection of semysone 10 mg, intravenous drip sodium phosphonate 1g, continue to mask oxygen After 5min HR gradually decreased and remained at about 80 times /min, NBP110/65mmHg, SpO2: 98% to 100% Test the anaesthetic plane T6 again and continue the operation The vital signs were stable during surgery, and there were no abnormalities in follow-up after surgery Asked about the medical history, the patient informed 1 year ago when the laparoscopic groin groin repair after urinating out of bed when there was a brief history of fainting 2 Discussion of this case of patients in the sub-cobweb cavity resistance lag occurred cardiac arrest, the analysis of the cause may be the result of the following factors On the one hand, the patient measured anaesthetic plane to T6, because the block plane of the autonomic nerve is 2 to 3 sections higher than the sensory plane, perhaps the patient's actual blockplane is higher than T4, high plane blocking cardiac palsy nerve fiber (from T1 to 4 levels), weakening the heart replacement function caused serious cardiac retarding and even cardiac arrest On the other hand, it may be that insufficient blood capacity produces the result of blood vessels reflexes and hyper-excitement of the vagus nerve studies have shown that when venous reflux is reduced, bainbridge and Bezold-Jarisch reflexes at the heart can be activated, which can cause a slower heart rate The internal blockage lag, especially when the patient's circulating blood capacity is insufficient, the amount of venous backheart loss, the front load is reduced, the cavity vein, right atrium and left ventricular pressure receptor excitement, through the above 2 reflections, can be serious heart palpitations, and even cardiac arrest patients in this case have a number of reasons for the lack of blood strength: preoperative fasting forbidden drinking capacity is insufficient, before anesthesia did not appropriate expansion In the vertebral tube blocking lag lower extremities blood vessels dilating, the amount of blood and blood is reduced Turning over exacerbates the sudden change in hemodynamics and the blood volume drops sharply In the event of cardiac arrest during anesthesia, the application of epinephrine is an inevitable choice for CPR, and early chest pressure is also indispensable This case patient rescues timely, successful recovery, thanks to close monitoring and teamwork The first time found cardiac arrest, immediate chest compression, mask to oxygen, timely veins to give rescue drugs At the same time, the case also gives everyone a warning, the intravertebral anesthesia can not relax the vigilance, to closely monitor and observe, and immediately effective treatment of related complications