ERCP, the full Chinese name is "transendoscopic retrograde cholangiopancreatography", which refers to the operation technique of inserting the duodenoscopy into the descending part of the duodenum, finding the duodenal nipple, inserting the contrast catheter into the opening of the nipple through the biopsy pipe, and x-ray film after injecting contrast agent, and diagnosing and treating biliary hierarchy or pancreatic diseases.
Because ERCP does not require surgery, the trauma is small, the operation time is short, the pain is small, and the hospital stay is greatly shortened, which is very popular among patients.
In just a few decades of application development, ERCP has achieved great achievements and has become an important treatment method for pancreatic and bile diseases today.
However, the improvement of the operational level of the endoscopist and the improvement of the patient's cognitive level seriously test the technical ability of the anesthesiology department. This is because ERCP is an anesthesia with higher risk outside the operating room. When
ERCP technology just developed, patients were all locally anesthesia. However, patients cannot tolerate prolonged operation and nausea and vomiting, which often forces the operation to be interrupted.
Later, under the "soft grinding and hard bubbles" by the endoscopist, the anesthesia department began to provide support for sedation or intravenous anesthesia. However, complications such as respiratory depression that cannot be completely avoided often lead to passiveness of anesthesiology.
At this time, there was still a harmonious internal medicine and anesthesia department before the operation, but it was silently filled with internal medicine's doubts and dissatisfaction with the level of anesthesia.
Anesthesiology department is also bitter: the kind help has ushered in the dissatisfaction of the endoscopic doctor and the level of doubts. As an outcome like
, many regions have gradually shifted ERCP anesthesia to endotracheal intubation general anesthesia.
From a safety perspective, endotracheal intubation general anesthesiologists provide a safe airway. Although cycle inhibition is still possible, this is not a problem for an anesthesiologist who is good at controlling vital signs.
However, endotracheal intubation general anesthesia is several times more expensive than intravenous anesthesia, which often increases the economic pressure of patients abruptly.
During this period, Dr. Wang's hospital is gradually turning intravenous anesthesia to endotracheal intubation general anesthesia. In other words, there are no special circumstances, ERCP must be performed under tracheal intubation general anesthesia .
However, the endoscopist asked the first ERCP to be performed with previous intravenous anesthesia, because the patient had no money.
Hearing the endoscopic doctor's request, Dr. Wang, who has gradually adapted to and liked general anesthesia intubation, suddenly had an idea: Can the patient still be less than this thousand yuan?
With disbelief, Dr. Wang planned to find the patient to find out the situation: on the one hand, to understand whether the patient's financial situation is as difficult as the endoscopic doctor said; on the other hand, to confirm whether the patient meets the conditions for intravenous anesthesia, this is also the most important thing. After all, without a safe situation, all efforts are in vain.
After seeing the patient, Dr. Wang fell into a tangle. He found that the patient's financial situation was indeed not optimistic: I don't know how many years I have worn the clothes and pants, and my pale face and thin face, and my extremely poor nutritional condition reveal the serious condition.
After inquiring about the family situation, Dr. Wang fell into a tangle: the patient has no children, but he is particularly good. I heard from the neighbors who came with me that patients often help their neighbors do things within their ability. Most importantly, he has also used the money from picking up waste to fund a poor student.
At this time, the balance in Dr. Wang's heart was completely tilted towards this respectable patient, and he wanted to use his own skills to do something within his ability.
In order to ensure the safety of the operation, Dr. Wang found all the items and medicines used for general anesthesia. Once you have to get general anesthesia, you should take general anesthesia immediately.
However, ideals are full, but reality is cruel. During the anesthesia process, the patient's constitution is very unbearable to anesthetics. After using intravenous anesthetics, the body movements disappear while the spontaneous breathing will also disappear. At the same time, the straight-down vital signs also made Dr. Wang very worried.
Considering that the subsequent operation will take a long time, Dr. Wang decisively asked the endoscopy to pull out the mirror and he wanted to intubate the patient.
Seeing that Dr. Wang was going to intubate the patient, the endoscopic doctor reminded him: Can the cost be controlled?
Doctor Wang said: Work first, and I will deal with it later.
, and this ERCP was successfully completed under general anesthesia.
However, at this time, Dr. Wang injured his brain cells: the cost of general anesthesia is far beyond intravenous anesthesia!
In the subsequent charging process, he deliberately changed the cost of general anesthesia to intravenous anesthesia. If someone asks me, you will say you have taken the wrong one. In terms of materials, try not to collect them.
Looking at the charging order with only a few lines, Dr. Wang’s mouth slightly smiled behind the mask.
not only ensures the safety of anesthesia, but also helps the patients. If the hospital finds the charge error, it will inevitably be criticized or even fined. However, this patient is too special and such good things must be done. Do you support
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