For the first time, Dr. Wang was excited and nervous without the command of a superior doctor. Excited that he could finally hold up the sky from now on; nervously, he was really afraid of what happened during the anesthesia process.
Seven years of study in anesthesia and several years of internship training made him know that anesthesia is an extremely high-risk major. Although he was not sure when he would encounter risks, he knew that this day would come sooner or later. After the patient entered the room, he immediately connected the patient with a full set of anesthesia monitoring.
Seeing that the patient's vital signs were normal, he began to induce anesthesia.
With the injection of drugs, the young man quickly entered the unconscious state of . After the muscle relaxation medicine took effect, Dr. Wang picked up the laryngoscopy and . Somehow, my hands that were intubated almost every day were shaking a little.
tremblingly, he inserted his laryngoscope into the right lingual root of the patient. He tried hard to control his tension, but his hands were still shaking. Maybe this was the awe of life.
Finally saw the laryngoscopy, and a warm current seemed to pass through the scalp behind the head.
With excitement, he was about to insert the tracheal catheter. But at this moment, the monitor called the alarm. The moment he called the alarm, he felt his eyes blurred. But behavioral memory tells him that the heart rate on the monitor is falling! The heart rate of
40 was obviously abnormal, and he immediately realized that the patient was in danger. So, he did not continue to intubate, and he wanted to find the reason.
In fact, putting down the laryngoscope is also a subconscious guide from his professional knowledge. Various brain knowledge that infused with the brain during school and after work told him: This may be a vagus reflex, and it should not be a heart disease. Because the patient is very young and has no history of heart disease. During the induction of anesthesia, no hypoxia occurred. The blood pressure I just tested did not show major circulation problems. There is no problem with breathing and circulation, and no cardiac events should occur.
Sure enough, after taking out the laryngoscopy, the patient's heart rate slowly rose. The consistent regular sinus rhythm , the re-risen heart rate and laryngoscope lifting movements prove that this is a vagus reflex.
At this time, someone will ask, don’t you give atropine before anesthesia? This should effectively avoid vagus reflex!
In fact, most hospitals have abolished the routine preoperative atropine process. This is because most patients cannot benefit from such a general treatment. On the contrary, patients will feel very uncomfortable after the operation. Some patients with hidden heart disease or Sjogren's syndrome may also bring additional risks.
Seeing that the patient had a vagus reflex, Dr. Wang decisively injected atropine into the patient. At this time, whether it is comfortable can only rank second. First of all, patient safety is still the safety of the patient. After the intubation after
administration, the previous vagu reflex no longer appeared.
So, what is vagu reflex?
refers to various stimulations that mediate reflexes through vagus nerve , transmit impulses into the vascular movement center, inhibit sympathetic nerve or activate parasympathetic efferential fibers, causing sudden dilation of small blood vessels in the visceral and muscles to decrease heart rate, and the effective circulating blood volume of and heart rate decrease, and then a series of clinical manifestations of increased vagus nerve tone.
The clinical manifestations of increased vagus nerve tone include decreased blood pressure, slowed heart rate, short-term heart and cerebral ischemia and even fainting, so it is also called neuromediated syncope or vascular inhibitory (vagus) syncope.
Within a few minutes, Dr. Wang completed the complete process of discovering the situation, analyzing the situation, making judgments and processing it. And these are just a small node in the entire anesthesia process. Anesthesia work is like walking on thin ice, and there is a long way to go!
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