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    Home > Active Ingredient News > Anesthesia Topics > 1 successful rescue of respiratory inhibition caused by star-like nerve blocking

    1 successful rescue of respiratory inhibition caused by star-like nerve blocking

    • Last Update: 2020-06-21
    • Source: Internet
    • Author: User
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    IN 1883, LIVERPOOL AND ALEXANDER MISTAKENLY INJURED THE NECK SYMPATHETIC NERVE IN THE TREATMENT OF VERTEBRAL ARTERY CANCER, BUT ACHIEVED OBVIOUS RESULTS, IN 1920 BEGAN TO PROMOTE NON-SURGICAL TRANSDERMAL NEURORHYTHMIA THERAPY, SOON BECAME A WIDELY USED THERAPY, AS A BASIC TREATMENT OF PAIN, THE SCOPE OF THE SAME SIDE HEAD, NECK, UPPER LIMBS AND UPPER CHEST, OFTEN USED IN CERVICAL VERTEBRAL DISEASE, MIGRAINE, SHOULDER INFLAMMATION TREATMENTThe hospital began to carry out astro-neuro-rhyest surgery in January 2008, the most common complications are the larynx reflux nerve block lag appeared hissand and bleeding, no other complications, relatively safeHowever, this seemingly simple clinical diagnosis and treatment technology, there are a lot of mechanisms and risksThe hospital has been carrying out this technology for 10 years, planetary nerve hydrate blocking surgery about 10,000 times, the occurrence of misentering the vertebral artery local anaesthetic (bureau hemp) drug poisoning led to respiratory suppression 1 case, is reported below1ClinicalPatient, female, 48 years old, 165 cm tall, weighing 58.5kgSuffering from neck pain with left shoulder blade area, left upper limb pain, numbness january 24, 2017Past: "tuberculosis" has been curedAllergy to "Benault tablets, ibuprofen capsules"Nothing specialadmission: body temperature 36.6 degrees C, pulse 80 times / minute, breathing rate 20 times / minute, blood pressure 124/84mmHg (1mmHg - 0.133kPa)There were no obvious abnormalities in the heart, lungs and abdomenSpecialist body: spine, limbs no deformities, neck front flexo 30 degrees, back stretch 30 degrees, left flex30 degrees, right flex45 degrees, left rear spin 30 degrees, right rear-rotation 50 degrees, top test negative, intervertebral hole extrusion test positive, neck test positive, neck 3 to 7 ratchet pressure test, left arm pull test, Hoffmann signs, double limb upper muscle force 5 positive, no obviousPain visual simulation score 6 points during onset, relief time 0cervical vertebral quadrator scan: cervical degenerative change CT examination: neck 2 to 3, 3 to 4, 4 to 5, 5 to 6, 6 to 7 disc protruding, cervical degenerative change Magnetic resonance imaging examination: cervical physiological curvature straightened, vertebral vertebral hyperplasia, neck 4 to 5 vertebral disc protruding, neck 5 to 6 intervertebral disc right rear protrusion, neck 6 to 7 intervertebral disc left rear protruding, cervical 3 to 4 vertebral disc puffing out, epidural sac pressure, part of the intervertebral stenosis, cervical myelin form and signal did not see significant abnormality electrocardiogram and chest, blood, urine, clotting routine, biochemical, rheumatic 3, infectious disease markers and other examinations did not see significant abnormalities The hospital was diagnosed with cervical vertebral disease The third day of admission to the hospital by the Bureau of Massachusetts CT guided by the dermal puncture neck 4 to 5, 5 to 6 vertebral disc ozone myelin ablation combined collagen enzyme chemical dissolution, after surgery to improve microcirculation, nutritional nerves and other treatment The pain in the neck and left upper limb of the patient was relieved, and the pain visual simulation score was reduced to 2 to 4 points In order to further relieve the pain in the neck and left upper limb, the left side of the astrocyte block starts on the 6th day after surgery, 1 time per day, 10 times for 1 course of treatment patients 1st and 2nd planetary nerve blockdid no abnormal, the third left left star-like nerve block operation is smooth, but after the injection of the drug patient complained of hand hemp, dizziness discomfort, then have breathing difficulties, immediately establish edion channels, and give the mask oxygen absorption, electrocardiogram pulse: 58 times / minute, Blood pressure 100/53mmHg, pulse blood oxygen saturation 84%, then appeared to call should not, breathing stopped, pulse oxygen saturation continued to drop to 60% to 70%, pupil-to-light shot disappeared, double-sided pupils and other large equivalent circle about 5mm, limb muscle strength 0 level Immediately line breathing sac artificial assisted breathing, and then transferred to the intensive care unit tracheostomy intubation, ventilator-assisted breathing, to rehydration, urine, warmth, etc , emergency blood routine, liver, kidney function, electrolyte, blood gas analysis, etc have not seen significant abnormalities patients breathing stopped about 40min after the call can open their eyes, pupil reflection of light insensitive, two sides such as large circle about 4 mm, limb muscle strength 0 level; The patient is fully aware of 30min after the quadriplegic muscle strength recovery level 5, feel normal plane, continue to monitor 30min no special circumstances and then returned to the ward The ward continues to monitor vital signs by means of oxygen absorption (3L/min) in the nasal catheter The next morning the room patient complained of dizziness discomfort, continue low flow oxygen absorption (3L/min), at 17:30 on the same day the patient self-confessed dizziness discomfort significantly alleviated, to stop oxygen absorption, pull out the urethra Observe no special after 2d discharge After 1 week after discharge, 1, 2, 6 months call back, patients self-complaining pain, numbness symptoms completely alleviated, did not complain of other discomfort 2 Discussion
    Author star-like nerve section block operation process: the patient to take the recital, shoulder pad thin pillow, the operator is located on the patient side, the operator with the middle finger of the left hand finger close to the upper edge of the chest lock joint, in the chest lock joint above 2.5 cm along the trachea wall side gently down, the chest lock breast augmentation muscle and its deep neck artery to the outside side Fingertip pressure, can touch the 7th cervical vertebral transverse, right hand holding 3.5 cm long 7 puncture needle, along the middle finger of the left hand tip vertical into the skin, into the needle until the bone, that is, the 7th cervical vertebral transtrusion Slightly back needle, bloodless, no cerebrospinal fluid, injected (0.9% sodium chloride injection 5mL, 2% Lidocain 5mL with 1% Lidocain injection) 10mL complications of astral nerve hydrating: (1) hemp poisoning; (2) whole spinal cord anesthesia; (3) throat reflux nerve blocking; (4) thoracic nerve blockor or spasm; (5) bleeding, hematoma formation; (6) gas chest The misentering of the vertebral artery and the whole spinal anaesthetic are dangerous, both of which will have a heartbeat and respiratory arrest But the whole spinal anaesthetic is a punctured cobweb membrane, the liquid mis-entered the subcavity of the cobweb membrane, the main feature is the rapid development of the wide range of sensation and motor nerve block after injection Low blood pressure and tachycardia are the most common manifestations of severe blood pressure and tachycardia Breathing stops sometimes occur In this case, the patient's planetary nerve block injection drug immediately after the emergence of hemp, dizziness discomfort, gradual breathing difficulties, 5min after the respiratory cessation, loss of consciousness, blood pressure, heart rate is not obvious After the patient's consciousness loss of 40min, the mind recovered, after the mind awake 50min to check the sensation plane and muscle strength are normal And the whole spinal cord anesthesia feel plane and muscle strength are slow recovery, generally need 3 to 6h According to this, the most dangerous complication of astro-neurometorreatic blocking ——— caused by the poisoning of the drug inthetades in the vertebral artery analysis of the cause of the patient's drug misentering the vertebral artery: (1) the overstretching of the patient's head and neck during the operation is not ideal; And the needle tip touched the bone when the needle does not retreat needle, left hand fixed unstable, needle tip continues to slide into a little, resulting in the needle too deep, although the back pumping no blood, cerebrospinal fluid, but the needle tip is too tight, back pumping may not have blood, still can not rule out the possibility of straying into the blood vessels; therefore, lessons should be learned to avoid such complications: (1) generally select the 6th cervical or 7th cervical vertebrae horizontal puncture according to the astrocyte anatomy The 6th cervical vertebral block because of its clear anatomical position, easy to operate, this case patients in the 7th cervical vertebrae level blind wear prone to the complications of respiratory inhibition, so, should try to choose the 6th cervical vertebrae Chassaignac's nodule as a puncture target Compared with the 7th cervical vertebral block, the complications are relatively small and light (2) planetary nerve blocking should pay attention to the needle should not be too deep, the needle tip must be offset to the bone, and then the needle 2 to 4mm, injection drug process repeatedly back pumping; (3) must be given electrocardiogram monitoring before the operation, to observe the patient's blood pressure, heart rate, oxygen saturation and other basic conditions In the event of critical complications, basic information on vital signs can be provided to help doctors make correct judgments quickly In addition to the necessary rescue drugs, oxygen absorption devices, breathing bags, conditional hospitals are best equipped with different models of adult trachea catheters each 1, ordinary laryngoscope or visual laryngoscope 1, ventilator 1, etc., in case of need (4) ultrasonic guidance in the regional block provides real-time image for puncture, improves the patient's comfort, reduces the number of punctures, conditional hospitals can consider the ultrasound-guided planetary nerve block, the entire puncture process can be visually monitored in real time, while avoiding the vertebral artery and cervical artery, injection can see the spread of the drug In the ultrasonic guidance direct vision blocking than through the traditional blocking method through the contact transverse positioning more safe and reliable, not only to avoid vascular damage and stray into blood vessels, but also to reduce the amount of hemp medicine, the traditional method needs 1% Lidoca in 8 to 10mL, ultrasound guidance under 2 to 3mL can be And the effect is faster than the traditional blocking method Small amount of dosage, more secure
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