Post Your Cases > CRNA
Mike, I'd like very much to speak with you about this case ASAP (i.e., by Nov. 10, 2008. Could you email me if you get this in time?
November 6, 2008 |
Linda Chitwood, CRNA
Linda Chitwood, CRNA
With MDA at the bedside, PT's ID, Procedure, & Consent was verified. The risks and benefits of regional and general anesthesia were discussed. All pt's questions were answered to his satisfaction. Patient wishes to proceed with anesthetic as discussed.
O2 via nasal cannula & standard monitors were applied. Pt reassessed. Vital Signs were stable. Landmarks were identified and the injection site was cleansed with chlorohexadine. Anesthetist wore PPE per protocol.
PSOAS COMPARTMENT BLOCK
Patient was premedicated with Fentanyl 100mcg, Midazolam 1mg, Pepcid 20mg, and Metoclopramide 10mg IV. Patient was placed in a lateral recumbant position. A skin wheal was raised with 1% Lidocaine. A 22g STIMUPLEX needle was inserted and advance lateral to L4 & L5 vertebrae. Distal motor response was elicited in the quadracep with the N. Stimulator @ 1.0mA. The mA was decreased to 0.3mA, twitch
was still brisk. After careful aspiration, RAJ test was not positive until after 4ml. Patient was conversing with staff while the local anesthetic (0.5% Ropivacaine and 0.2% Tetracaine with 1:200,000 epi) was being incrementally injected. Aspiration between each 3-5ml bolus was negative for heme. Heart rate during injection was noted to be 60 BPM. A total of 20ml of LA was injected when patient stopped responding to verbal stimuli and the developed generalized siezure activity.
6mg of Midazolam was administered IV.
Pt maintained spontaneous respirations through out siezure activity. Patients respiratory effort was supported with oropharyngeal airway and BVM. 02 Saturation was maintained between 90 - 100%. Heart rate increased to 130 BPM
during seizure activity.
Interlipid Rescue Protocal was initiated. Siezure activity subsided in 1-3 minutes. Heart rate returned to baseline. All vital signs were stable.
On arrousal patient stated that he was comfortable. He remained in the PACU on monitors and O2 via nasal cannula.
The patient went on to have his procedure later that afternoon.