Wednesday, October 22, 2008
We had a 16 year old girl for Op today. She had lymphoma and with it a big mass inside her chest cavity ( mediastinal mass ) . It is compressing one of her lungs which impairs her respiratory function. Thus; the very visible shortness of breath and bad oxygen saturation. On top of that , her pleural effusion which needed regular tapping is not helping the situation. She CANNOT lie flat at all and needed to sit up and crouch her body to make herself comfortable.
She was due for excisional biopsy of her big cervical nodes ( along her neck ). If it was assymptomatic , I don't think the surgeon would have called for our help. She was very breathless and cannot sit still ; more over to lie her down and do the excision. As fast as any surgeon can do , it would take more than 10 minutes. Having a patient who moves because of breathlessness will slow things down and mistakes are due to happen !
Of course ,General anaesthesia was out of the question as her mediastinal mass was compressiong 50% of her airway( the big pipe !! ) and shifted her heart to the right side of the chest. It is her muscle tone which is sustaining her and obtunding this will result catastrophy and that maybe the last time we'll see her alive !
Of course , SI-FU LING ; was the person to consult ! Our regional block master concurred with my plan to block her superficial cervical plexus. We had one advantage , the girl was very co-operative and that was really helpful to make this procedure succesful and avoiding GA.On top of that , she would be pain free ! The only risk is , her "good" lung was the right side and the surgeon was keen on taking out the nodes on her right side of the neck. If my block is too deep , then I will be blocking the phrenic nerves and that may impair her breathing effort some more !
We had to perform the procedure with the patient 60 degrees propped up becuase that was her most comfortable position.
" MAfeitz ahh.. u better make sure it works ! "
Yeah right.. Thanx for the encouragement !! Hahahaha
The girl was very brave as I gently performed the block. She did not cry nor sulk eventhough she was just 16 , I guess she was suffering so much that "simple" things like this doesn't affect her at all.
Alhamdulillah , the block worked well and the biopsy was done with the patient pain free. She smiled at me when I brought her to recovery area.
"Ada sakit tak ? "
She said no... " Thank you Doctor.. " she smiled , eventhough she was still breathless.