By John G. Brock-Utne MD PhD FFA(SA)
Residents, fellows, and working towards qualified registered nurse anesthetists will enjoy the retelling of those genuine close to misses, the ideas selected on the time, and a retrospective research of these strategies that comes with suggestions for the way the issues might have been refrained from altogether or resolved in a different way. a great research reduction for the yankee Board of Anesthesiology oral examination and an invaluable instructing device for college, due to the fact close to misses similar to those are fairly infrequent and except analyzing approximately them, there quite is not any technique to be ready to effectively deal with such crises. As such, even skilled anesthesiologists and CRNAs will locate this to be a priceless purchase.
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Extra resources for Clinical Anesthesia: Near Misses and Lessons Learned
34% of patients undergoing endoscopic uterine surgery (2). Excessive intravascular volume manifesting as hemolysis, hyponatremia, and mild disseminated intravascular coagulation and/or pulmonary edema has been reported with glycine (3), dextrose (4), sterile water (5), or dextran 70 (6) when these agents are used as the irrigating solutions. The factors that inﬂuence the degree of ﬂuid absorption include injection pressure, extent of tissue trauma, and amount of ﬂuid and duration of infusion. This case shows that the aforementioned complications can also occur during nonuterine endoscopic surgery when crystalloid solution is used as irrigating ﬂuid.
His past medical history and physical exam is unremarkable. He is classiﬁed as American Society of Anesthesiologists physical status 1. He has a full beard and speaks English very well. He requests a regional block, but unfortunately it proves to be inadequate for the surgery. General anesthesia is decided upon. After preoxygenation, general anesthesia is induced with intravenous thiopental 250 mg, followed by succinylcholine 120 mg. Ventilation is easily accomplished by mask. At laryngoscopy, the patient’s jaw is found not to be relaxed.
Much to your surprise, you ﬁnd the patient somewhat incoherent and sweating. You take blood for blood glucose estimation while you call for 50% glucose. When the 50% glucose ampoule arrives, you don’t wait for the blood sugar result, but give the patient 50 ml of 50% glucose IV with good effect. You are wondering how only 12 U of the above insulin could have caused this hypoglycemia. The nurse now tells you that the AccuChek shows blood glucose of 320 mg/dl. 60 mmol/liter). You ask the lab to run the venous blood glucose estimation again.