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You are called to an outpatient surgery center for a post-op patient who needs to go to the hospital.
You arrive, don bunny suits and hats, and are led into one of the OR's. Since there were just a few cases this morning, a sole CRNA is working; there is no anesthesiologist or other anesthetist on site. The CRNA is pretty new and has never seen this before, so she is a little frazzled.
She tells you that the patient is a healthy male in his mid 40's with no medical problems. He has had several surgeries and no history of problems with anesthesia, other than telling the CRNA that "it takes me a long time to wake up from anesthesia". He just had an uneventful shoulder surgery that took about 90 minutes. Now, he won't wake up and breathe adequately. The CRNA is afraid that whatever is going on is not going to resolve soon, so he needs to go to the hospital.
Here are the meds he's gotten:
Pre-op:
20 mg famotidine PO
250 mg alfentanil 2 mg midazolam IV for brachial plexus block sedation
20cc 0.25% bupivacaine with decadron for interscalene brachial plexus block
The patient tolerated the block sedation well.
About 30 minutes after the block was placed, they went to the OR, where the patient was given:
100 mg lidocaine
100 mcg fentanyl
5 mg rocuronium
300 mg propofol
100 mg succinylcholine
Patient was intubated easily with an 8.0 ETT
The case started and anesthesia was maintained with 1.8% sevoflurane in 50% oxygen.
A total of 1500ml of LR was given during the case.
Additional meds given included several boluses of phenylephrine, 2 grams of cefazolin, 4 mg of ondansetron, and 4 mg of dexamethasone.
Now the patient won't wake up or breathe well. When the gas is turned off he breathes very fast and shallow and becomes very hypertensive and won't follow commands, so he is being maintained on a low concentration of sevo and the ventilator. It has been a little over an hour since the surgery ended and wake up was first attempted.
Anything else you might want to know before you begin transport? What might be going on?
You arrive, don bunny suits and hats, and are led into one of the OR's. Since there were just a few cases this morning, a sole CRNA is working; there is no anesthesiologist or other anesthetist on site. The CRNA is pretty new and has never seen this before, so she is a little frazzled.
She tells you that the patient is a healthy male in his mid 40's with no medical problems. He has had several surgeries and no history of problems with anesthesia, other than telling the CRNA that "it takes me a long time to wake up from anesthesia". He just had an uneventful shoulder surgery that took about 90 minutes. Now, he won't wake up and breathe adequately. The CRNA is afraid that whatever is going on is not going to resolve soon, so he needs to go to the hospital.
Here are the meds he's gotten:
Pre-op:
20 mg famotidine PO
250 mg alfentanil 2 mg midazolam IV for brachial plexus block sedation
20cc 0.25% bupivacaine with decadron for interscalene brachial plexus block
The patient tolerated the block sedation well.
About 30 minutes after the block was placed, they went to the OR, where the patient was given:
100 mg lidocaine
100 mcg fentanyl
5 mg rocuronium
300 mg propofol
100 mg succinylcholine
Patient was intubated easily with an 8.0 ETT
The case started and anesthesia was maintained with 1.8% sevoflurane in 50% oxygen.
A total of 1500ml of LR was given during the case.
Additional meds given included several boluses of phenylephrine, 2 grams of cefazolin, 4 mg of ondansetron, and 4 mg of dexamethasone.
Now the patient won't wake up or breathe well. When the gas is turned off he breathes very fast and shallow and becomes very hypertensive and won't follow commands, so he is being maintained on a low concentration of sevo and the ventilator. It has been a little over an hour since the surgery ended and wake up was first attempted.
Anything else you might want to know before you begin transport? What might be going on?
