The operation is over, but the patient still cannot breathe. Beware of myasthenia gravis

When it was almost time to get off work, an emergency case of appendicitis suddenly came in. So I changed into the surgical isolation gown I had just taken off and trotted into the operating room.

When we arrived at the operating room, the patient had already come in. So I instructed the doctor on duty to perform anesthesia in an orderly manner.

After the operation started, everything seemed normal. So I whispered to him: You do it yourself, I'll leave early.

At that time, I was going to leave work early and spend the weekend because I thought that it was just a small operation and would be over in a short time. Besides, the patient was young and there shouldn't be any big problems.

However, an hour later, the doctor on duty called urgently. After I answered the phone, the doctor said: The patient has been unable to breathe. He is definitely conscious, but his muscles cannot relax. He asked me to return to the hospital as soon as possible.

After hanging up the phone, I felt a little upset, thinking to myself: Can’t you even handle such a small operation?

Angry, I rushed into the operating room again.

At this time, surgeons, nurses, and caregivers waiting to get off work were all gathered around the operating table. The doctor on duty, pretending to be calm, was holding the ball and trying to feel the patient's breathing.

Although he appeared relaxed, I knew he must be very anxious, because I had also been through that period when I was young.

This was not the time to blame him. The most urgent thing was to find out what had happened to the patient.

Since it was an emergency surgery, it was too difficult to figure out the few examination items. All of a sudden, everyone turned their eyes to me. Instantly, I felt the pressure doubled. Although no one wanted to rush me, I could feel that they were thinking: hurry up and wake the patient up so that we can get off work.

The medical record didn't give me any clues, so I could only look for the cause from the anesthesia and the patient: After reading the anesthesia record in detail again, there was no possibility that the patient could not wake up.

What is the reason? I wondered.

Could it be that the patient had a special physique? This question popped into my mind quickly.

However, the patient was unable to open his mouth and his eyes were closed, so I couldn't ask him anything. I went to the operating room door to ask his family, but there was only an old man who didn't know his health condition at all. I had no choice but to go back and look for the reason from the patient.

Logically speaking, with this amount of medicine used during the anesthesia process, it shouldn't be impossible to wake up. Could it be that he is allergic to the muscle relaxant?

With doubts, I carefully opened the patient's eyelids. The completely normal pupils and eyeballs moving back and forth reminded me that he was fully conscious and only needed to restore muscle tone.

After a series of examinations, I looked back at the blood pressure on the monitor and it had already soared to over 160.

After determining that it was a sensitivity to the muscle relaxant, I thought: I can wait a little longer, until the muscle relaxant is completely metabolized, and maybe I will recover.

However, after waiting for another half an hour, his muscle tension was still as low. And the time from the last administration of muscle relaxants had exceeded the normal metabolism time of muscle relaxants by several times. This means that it is very likely that the patient's own physical condition has caused sensitivity to muscle relaxants.

During this period, the doctor on duty discussed with me whether to use some antagonists to see the effect, but I refused. I told him that if the patient has special physical conditions such as myasthenia, even if the antagonists are effective, problems may occur after the antagonists lose their effect. The safest way is to send the patient to the intensive care unit and delay extubation.

After that, we sent the patient directly to the intensive care unit.

The next day, we went to the intensive care unit early to remove the tracheal tube from him. After he was able to speak, we asked him if he knew if he had any muscle weakness. He replied that he often had no strength. When it was serious, he couldn't even lift his eyelids.

Later, after special tests, it was confirmed that he was indeed suffering from myasthenia gravis.

Although it was an emergency surgery and we did not have time to ask for a detailed medical history, this incident also sounded a warning to us: with such a large patient base, there must be various physical conditions. In future work, we must be more cautious and meticulous.