"Thinking about Anesthesia Disputes" Reading Notes 4

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"Every day anesthesiologists are overloaded with work, just like in a storm, pulling a kite string between life and death.
I keep reminding myself that no matter how tired I am, I must stay awake".
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Maybe Some people have seen this drama, "Anesthesia Storm" is a true portrayal of today's anesthesiologists
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Every Tuesday, we share "Judicial Judgments and Medical Reflections on Anesthesia Dispute Cases" one case per week.
Welcome everyone to discuss the fourth episode of epidural anesthesia with abdominal muscle tightening and muscle loosening to cause disaster.
Spinal anesthesia is commonly known as "half anesthesia".
It is an anesthesia method that preserves the patient's consciousness and spontaneous breathing, and achieves the anesthesia effect of regional block by blocking the conduction of spinal nerves through local anesthesia
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But some people regard the epidural as a 🚮 trash can, a laboratory 🧪, which has improved significantly in the past 20 years
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1 Basic case 21-year-old male college student with appendicitis underwent exploratory laparotomy 18:30 Epidural anesthesia 20:00 End of operation 20:40 Sent to the ward, blood pressure 65/35mmHg oxygen and undetectable cardiopulmonary resuscitation intubation 21:15 ICU Vegetative Person 2 Litigation and Judicial Judgment Appraisal Opinions 1.
The anesthesia effect is not good.
The additional anesthetic is succinylcholine chloride, and the measures are inappropriate.
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The anesthesiology department, surgery and health personnel should escort the transfer after the operation, and the anesthesiologist should stand at the head of the patient.
The department is responsible for observing the condition, detecting and treating it in a timely manner
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3 Thoughts on judicial judgments Discussing the remedial measures of epidural anesthesia As a blind exploratory operation technique, there may be cases of poor anesthesia such as incomplete block, poor muscle relaxation, and block lateralization
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In this case, the effect of epidural block was not good, mainly because the block of the anterior root motor nerve was not enough, resulting in tight abdominal muscles and difficult surgical operation
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The motor branch of the anterior root of the spinal nerve is high, and the sensory branch of the posterior root is low.
When encountering a patient with a large epidural space, the injected local anesthetic spreads horizontally, blocking the sensory nerve but not the motor nerve, resulting in no pain but lack of muscle relaxation good
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Remedial measures: additional local anesthesia, additional adjuvant drugs (low-dose propofol, dexamethasone, ketamine), but the anesthesiologist should be clearly aware that the nature of anesthesia has fundamentally changed at this time, from excessive intraspinal anesthesia to rigidity.
The compound anesthesia of epimembrane and general anesthesia is no longer a simple half anesthesia
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It is necessary to change your anesthesia thinking and anesthesia management accordingly, redefine risk assessment and other preparations, strengthen monitoring, prepare ventilation masks, suction devices and intubation tools, and the anesthesia machine is in working condition
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Otherwise, once the scene gets out of control, it will lead to serious consequences
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Risk assessment of adjuvant drugs for epidural anesthesia 1.
The key to the problem is not what adjuvant drugs are used, but whether to conduct risk assessment and strengthen anesthesia management
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2.
It is strictly forbidden to use scoline when there is no control or assisted breathing condition, and it is also contraindicated to give it when the patient is awake.
At the same time, one of the adverse reactions of scoline is that it can cause an increase in intragastric pressure, up to 40cmH2O, and Causing reflux and aspiration of gastric contents in patients with full stomach
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3.
It is extremely important to strengthen airway management
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There are three difficulties or confusion in thinking about the safety and quality control of epidural anesthesia; manual pain and temperature measurement is highly subjective; the standard of resuscitation for epidural anesthesia patients; the problem of postoperative analgesia for epidural anesthesia, epidural administration Medicine brings many difficult problems
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Problems such as delayed respiratory depression are rare but associated risks
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Anesthesia safety and quality is the eternal theme of clinical anesthesia
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On the one hand, they improve their own technology and concepts to reduce technical risks; on the other hand, they constantly regulate their medical behavior and improve their ability to avoid responsibility
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END grateful heart thank you