The patient's sudden throat edema was suffocated after surgery. Which link was wrong?

It is said that the surgeon is a dancer on the tip of the knife. The anesthesiologist must be the one with the wire rope at all times. Anesthesia doctors need to be responsible for managing the cycle, breathing, internal environment, etc. of the patient's technique. The most important thing is breathing and cycle. If the management is not good, the problem is in minutes!

It is another night shift, eating dinner, and the call on duty sounds. The urology calls that there is an emergency gravel patient who needs emergency surgery. The time for fasting water is enough. Let us arrange anesthesia and surgery. After half an hour, we arrive at the operating room. Intersection

We thought it was an ordinary gravel surgery, so I didn't take it attentively, and then I dinner (what are the need for emergency surgery with this gravel surgery? This month's surgical indicators cannot be completed, so as long as the patient has emergency surgery needs, it will be met. As a comrade -in -arms, it is naturally understood. After all, our business volume depends on the surgical volume of surgeons)!

After entering the surgery room, I prepared anesthesia -related supplies, and the surgeon brought the patient to the door of the operating room. We went to the patient channel to talk to the patient's history and asked the medical history to explain the risk and sign the anesthesia consent.

This patient is a patient with a stones in the upper section of the urethra. About a year ago, oral malignant tumor surgery was performed in a foreign hospital, chemotherapy was distributed after surgery. After the neck was cut into the scar tissue, there was no problem with the fastening mask. The patient's neck CT and magnetic resonance examination did not do it.

Biochemical creatinine value is slightly high, and other examinations are unique. ECG prompts 58 sinus/cents, and has a history of hypertension. The blood pressure of the room is about 160/90mmHg, and the heart rate is 60 times/minute.

Considering that patients have a history of malignant tumor disease, and general digestive systems and respiratory malignant tumors are likely to be metastasized in the spinal canal (although this oral malignant tumor does not clearly pointed out, it is unlucky in case of unlucky steps).

So discuss with the surgeon, or let the patient improve the magnetic resonance examination to eliminate the intra -spinal dysentery and do the internal anesthesia in the spinal canal, or improve the cad CT to eliminate the pneumatic obstruction. After checking and wanting to discharge, the surgeon re -talked and promised to do CT. After all, compared with magnetic resonance, CT saves money and time).

After the CT of the neck is completed, the airway is unobstructed and there is no narrowness, so it is arranged to enter the operating room to implement a general anesthesia.

The patient is 180cm tall, weighs 70kg, induces 140 mg of propyol, 0.2 mg of fentini, Rolu 50 mg, tin alkane 3mg, Changtuo Ning 0.3mg, Mi'an 1mg Certainly). After that, the ventilation of the cover is normal. First, the 4.0 throat is used, but the air leakage is very serious. After repeated adjustment, it is still leaking, so give up!

The rectification of the tracheal tube 7.5 is a lot of boring mirror. It can be very tired of the visual laryngeal mirror. It is a little bit hypertrophic at the door. There is no danger, and finally inserted into the trachea!

Polyols and Ryfen maintain surgery, and the operation ended about forty minutes. During this period, he did not add muscle pine and other drugs, and his life signs were stable.

After surgery, the phlegm and the medicine were stopped plus fluorosani, and the head is high and low. The patient woke up for about six or seven minutes, no cough, clear consciousness, instruction cooperation, and the volume of autonomous breathing more than 500ml. Give muscle pine antagonist, and the pipe is smooth. Patients breathe normally, and their cooperation is normal. Patients suck pure oxygen 5L/min, and then write anesthesia record forms and continue to monitor patients.

After about five or six minutes, the patient was suddenly restless, and told me not comfortable with his throat with his fingers (he was not talking about his tongue because he was cut half and fixed, so he could not clearly express the meaning). Immediately after the restlessness, his face flushed.

I asked him if he couldn't breathe, he nodded and responded. I quickly gave the mandibular jacket cover and have resistance.

Immediately after the mask's ventilation resistance, the patient's resistance was strong. ECG monitoring reminder pulse oxygen is low and continued to drop to 70%, so the assistant directly pushed the propylene phenol 100mg and Rocci was 50mg.

The small two ribbon of the secondary intubation is about 1/3 of the exposed sound door, and you can see the swelling of the door. Fortunately, the secondary intubation smoothly, from the push to the inserted pipe ventilation process for about 3 minutes, the minimum pulse oxygen was reduced to 50%.

The ventilation is normal after the intubation. Pure oxygen ventilation is given 10mg of dexamethasone, and then communicate with the surgeon and family members to send the ICU, and then slowly extract the tube after the throat edema is eliminated!

Go to the ICU to visit the next day, the patient is awake, and the back tube is smooth. The brain does not have substantial damage caused by short -term hypoxia! However, the patient's family has a lot of opinions. He believes that he has to live in an ICU and complain about us!

Recalling the entire process of this case of anesthesia, there is still a lot of heart.

Should I give up the anesthesia in the spinal canal and choose a systemic anesthesia. It remains to be discussed: no considering the tissue structure and edema caused by the patient's malignant tumor tumor surgery; there is no prevention of hormonal segemon in the anesthesia;The stimulation of the cover and repeated adjustment of the throat has increased the throat edema; it has not predicted the relevant risks and communicated with the family members in place, resulting in great opinions and complaints!Eating a long one, hoping to learn lessons in this anesthesia. Fortunately, the patient's prognosis is good!

The details determine the success or failure. If you want to be a qualified anesthesiologist, you must not only be bold in clinical practice, but also always charging and learning!When you encounter problems, we must repeatedly consider and learn from experience, so as not to make similar errors.

Author: Chen Jiajia, Zhejiang Xin'an International Hospital

[Reminder] Pay attention, there are a large number of professional science sciences here to reveal those things about surgical anesthesia ~

- END -