A 95-year-old man had an urgent fracture surgery, and letting the anesthetic float up solved the anesthesia problem

On Monday morning, just after the morning meeting ended, the director of orthopedics came knocking on the door.

As soon as he entered the door, he said: We have a patient with a fractured femoral neck. The lower hospital refused to operate on him, saying that his lungs are not in good condition. Can you take a look?

When faced with a problem, we took the lead. Over the years, it is precisely because of this mutual support that both the Department of Surgery and the Department of Anesthesiology have developed rapidly. It is just as the saying goes, "If you trust me, I will do my best." Then, we went to the ward.

(The picture and text are unrelated)

"Focused Eyes"

The photo is from the 2nd "Renxin Cup Most Beautiful Angels in White Photo Collection Competition"

Photographer: Miaomiao

When we saw the patient, we were still a little surprised: the old man was very weak and lying flat on his back. From a distance, it looked like there was nothing on the bed. The weak voice made our hearts sink.

After asking, we learned that the old man had been lying at home for a day after being injured. After discussing it, the family decided to send him to the hospital for treatment.

From this, we can see the attitude of the family members: this may mean that the elderly are too old to be bothered anymore.

However, their "no trouble" caused the old man's condition to take a sharp turn for the worse. When he arrived at the hospital, he had developed aspiration pneumonia. His blood test was also messy.

Considering that the patient could not receive general anesthesia, we developed two plans: first, try intraspinal light-weight spinal anesthesia. In this way, the anesthesia is concentrated on one lower limb, which can reduce circulatory fluctuations; the second plan is to perform nerve block.

Although nerve block is the general trend, it also has disadvantages. For elderly people like this, who are not sensitive to pain and have communication problems, no one dares to guarantee perfect results. If the effect is not good and general anesthesia is not possible, it will be difficult to back down.

During the operation, water for injection (also known as distilled water) is added to the local anesthetic. The purpose of adding water for injection is to control the anesthesia plane as much as possible on the affected side.

Some people may ask: Why not use heavy specific gravity?

The effect of high specific gravity is certainly good, but there are two major disadvantages: when puncturing, the affected side is at the bottom, and the patient will feel very painful. At least, it will be very painful before the anesthesia takes effect; in addition, after the anesthesia takes effect, the affected side must be turned over to the top.

There is one more thing that must be said: Studies have shown that even if the patient has been in a one-sided position for dozens of minutes with spinal anesthesia, the anesthetic will still spread to the other leg when the body is turned over. This means that blood pressure during surgery will also fluctuate due to this turn.

For a 95-year-old man, every detail should be taken seriously to ensure the success of the operation.

Although the old man had bone calcification, it was not difficult for our experienced anesthesiologist and the puncture was successful in just a few minutes.

As the light-weight spinal anesthetic was pushed in, the old man's pain was significantly reduced.

The benefit of this anesthesia is that once it takes effect, you can feel the pain reduction almost instantly.

Seeing the anesthesiologist's technique of "pointing and shooting", the orthopedic surgeon complimented: It's amazing, how did you do that?

The anesthesiologist was not polite: It floated up.

A difficult problem was solved "easily" just like that.

[Warm Tips] Follow us, there are a lot of professional medical knowledge here to help you understand the anesthesia issues in surgery~