When the patient doesn’t breathe…

Inhalation anaesthesia rebreathing system

Today’s Diary Entry is sponsored by Chart Stables

 So today my patient stopped breathing…

Just like that, one minute fine, the next nothing…

I had known this patient was going be a pain as it stopped breathing during prep as well with the doctor, even though it started breathing again then I was on my toes. I’m not even sure how I ended up doing this anaesthesia, one minute there were loads of people in the room watching, the next I was alone. Anyway the surgery here was essential so had to continue, however was going be short I hoped.

Running anaesthesia is a balancing act, you need to keep the patient under deep enough to stop them feeling any pain, but you need to make sure it isn’t so deep that they are dead. Sometimes it is a fine line, and today especially it felt like a mountain ridge.

So it is going well for a while, however I did not know the induction protocol that has been used, or what has already been given so when the patient starts getting really light I am getting very little response on the inhalation anaesthesia (cold room affects the gas vaporisation) so give a little propofol as it is faster acting. Maybe not the best idea but better than the patient waking up completely during surgery I think. And propofol is really fast acting so just buys me a period of time in which to stabilise the inhalation anaesthesia.

So patient goes back to a surgical level of sleep, I start to balance my gas anaesthesia, and then the patient stops breathing.

A load of words went through my brain at this time, however randomly another doctor decides to walk into the room at this time to ask a question of the dr doing the surgery so I grab them to help me. I start manually ventilating the patient, and we try this for a minute or so to see if we can stimulate breathing like this. However it fails to start any breathing so the doctor with me vanishes and returns with a needle.

The light bulb goes on as I remember the theory of the stimulation of the nasal philtrum (groove in the middle of the nose) stimulating a breathing response. It’s some kind of acupressure point which until now I have never had to use, however using the needle to stimulate this point the patient starts breathing again. There are loads of techniques out there but sometimes it’s the simplest that are best and now I’ve seen it work I have a new tool in my anaesthesia toolkit… A simple needle. After this I managed to keep anaesthesia well balanced and the patient recovered well and went home.

After this patient was finished in surgery and had recovered we had an emergency patient in with a fracture of the mandible (lower jaw). It was a little Chihuahua who was very cute, however as it was a delicate surgery the doctor asked me to scrub in and assist in the procedure. This involved opening the skin over the fracture, drilling into the mandible, and then wiring the two halves together. This was pretty cool as it was the first time I’ve got to handle living bone myself without someone else placing the instruments for me. This surgery went well and the patient recovered very quickly and looked pretty cute once confined to the cone of shame.

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