The patient's description of "not being able to breathe" made the doctor reflect on his own skills

A few days ago, a seemingly ordinary appendicitis anesthesia made me think deeply. I began to reflect on whether there was something wrong with my technique.

Here’s what’s going on:

This appendicitis was nothing special, just the most common appendicitis. The special thing was that there was a very big operation afterwards. And this big operation would conservatively take six hours. Therefore, I decided to speed up all the steps to save time. As for the slowness of the surgeon, I couldn't do anything about it.

So, when I saw the patient coming in, I was anxious to find the surgeon. This is because without the surgeon present, the three-party verification of "surgeon, anesthesiologist and nurse" cannot be carried out.

In the process of connecting monitoring wires to patients, we have completed the necessary three-party verification.

In order to save time, I put the oxygen mask on the patient's face in advance and told him to breathe deeply. Only when he breathes more oxygen and has a larger oxygen reserve in his body can the subsequent anesthesia intubation be safe. If the intubation fails, there will be enough time to deal with it.

After increasing the oxygen flow, I went to draw the medicine.

All of this seems reasonable. However, I was very surprised by a statement made by the patient after the operation: I think that the patient should not have any memory of the anesthesia intubation, but he clearly remembered it. Although he just said "I can't breathe", I know it is true. Because this feeling can be explained from the anesthesia link. The key to this feeling is that the patient's disappearance of consciousness lags behind muscle relaxation.

During general anesthesia, we usually use sedatives, analgesics, muscle relaxants and intravenous general anesthetics. For intubation, perfect sedation and muscle relaxant effects are very important. From the onset time, the muscle relaxant I used that day took about 3 minutes to take effect, so I decided to inject a certain amount of muscle relaxant first.

Theoretically, muscle relaxation with a TOF value below 25% does not affect a person's normal breathing movements, that is, the patient will not feel suffocated.

However, after I did this, he should have had breathing difficulties, but this difficulty was quickly covered up by my operation of fastening the mask, so it was not discovered.

In fact, it is difficult to find out unless the patient speaks out. But in that case, how can the patient have the opportunity to speak out?

Administering medication, inserting the tube, confirming that the intubation is successful... while these actions are completed in one go, the doctor also comes on stage to start disinfection and laying the towel.

The operation was quick, taking less than an hour, and since only the initial dose was given, the patient woke up as expected.

However, when the patient clearly expressed the feeling of "not being able to breathe" before, I felt guilty. I knew clearly that I was a little anxious this time. If I could routinely give a large amount of sedatives, analgesics and intravenous general anesthetics first, and then inject muscle relaxants for the patient, the patient should not have this feeling of suffocation.

Although no one can guarantee that intraoperative awareness will not occur, at least every detail should be paid attention to. Although the amount of medication used during the intubation phase is considered to be one of the largest during the entire operation, the order of medication should also be optimized.

For us, this may just be part of the job, but once it happens to a patient, it may be a lifetime bad memory.

If you have any unpleasant experiences in the past, you can share them with us to answer your questions and solve your problems. This will not only improve our technical level, but also save future generations from suffering.