Yesterday was an achievement for me during my on call as we went where no men went before !!! The usual practice for reimplantation of hand / fingers in Malaysia would be to put patient under general anaesthesia ; period. The surgery is known to occupy the OT for long hours ; 8-10 hours . Our patient was 27 years of age, fit young man and suffered a massive slash wound on his right hand when attacked by men with parang . After a fair discussion , he was agreeable for regional anaesthesia .
We gave brachial plexus block via the infraclavicular approach. I have no problems doing the block bcoz I've been doing it a lot. I can elicit my twitch and finish the job within minutes. However , it was the first time for me to insert a catheter in that space and crossed my finger that it works.
I was initially sceptic myself whether it was possible to retain the patient in his current state without converting to GA during the procedure. I cannot imagine lying down on a flat hard bed for 10-12 hours where it can be tiring and cause agitation and discomfort.But of course , with a damn good sedation it was possible. And guess what ? manage to reimplant the hand all the way for 10 hours with regional anaesthesia !! He was well asleep and never under GA ! When i woke him up he was amazed that it had been more than 10 hours and he could eat straight away !!! He was very hungry by then !!! No post GA complications !!! The best part for the patient is that he was never in pain after the block and he will be so as long as the infusion runs ..
*******************************************
We had to give GA for a 14 month old baby at 2am as he had suffered bad lacerations over his scalp. Scalp bleeding can be torrential and one has to attain it fast as it can really serious. I really dunno how he fell having such suspicious wound but of course ; it was secured. There was no problem with GA and we extubated him well. Now the baby will have a C.I. scare on his head !!
No comments:
Post a Comment