I was involved in a long surgery with the ENT team yesterday. We kind of expected it , as the surgeons told us that it would take 7 hours and we estimated to add another 2. We were right. We started off at 12 pm and ended at about 9.30 pm with the patient extubated and responding well.
The day started in a panicky manner when we had problems with our first patient. A 72 year old chinese man who had bilateral enlarged infected tonsils with matted cervical lymph nodes. HIs airway looked ok on assessment ; and we were confident that we initiated nasal intubation. After induction , my senior gave the full dose of muscle relaxant and i laryngoscoped the patient. ALAMAK... The anatomy was distorted and i could hardly see the epiglottis.THe so called tonsils were blocking my view ; not to add the truama I caused when inserting the tube through the nose. Cormack Lehane IV tu !! Luckily his saturation was maintained at 99-100 % all the time ; showing us that it was more of a can't intubate can ventilate scenario. He tried a few times but was unsuccessful.
Called for help and Prof Lucy came to the rescue. It was indeed difficult and of course i had to take the rap ! Well , I've informed my senior colleagues and on their assessment did not anticipate this problem. We managed to intubate the patient and the Op went well. With the removal of his tonsils which were damn BIG .. I think it would be not that problematic to intubate him. But i suggest SUX should be the first drug to use..
Then we proceeded to the next case. 40 year old Malay man with a right parotid growth , a lump as big as a size 3 football ( YES IT WAS THAT BIG ! ) on his right side of the neck. Kind of reminded me of this one Malay actor. The NET team planned to excise the tumour and then re construct the neck using the chest muscle. ( something like the picture above ). I could not imagine if it was the plastic team who would take i reckon more than 24 hours to settle this. One thing though , we were lucky that there was no mass encroachment to the airway. But we were more careful this time ; we used SUX and we were OK this time around .COrmack Lehane 1.
We prepared the patient with all the invasive lines; My triple lumen was spot on on his left subclavian eventhough his size looked like a big challenge.We had problems ventilating him initially but managed to get good lung volumes after some time while altering his settings. The surgery started on time and went on..and on... and on.. and on..
The op was uneventful except for this one time when he desaturated to about 70%. The surgeons pressed on his long circuit connection and accidentally disconnected it. In the beginning I failed to bag the patient and he looked bad that i called for help. SOmehow , I managed to sort out the problem and when Vas and Yoga came in.. His saturation was already 99%.The Op was interesting and i should have brought my camera . Next time... next time..
It was long.. but not long enough as there will be times when surgery can go up to 24 hours. And being UM , there is no shift system ; so one has to stay on all the way till the end. Haks.. I'll write about it when i'm there.. don;t worry..
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