Working in operation theaters, sometimes things do not go as planned. As such we have to write something about the sequence of events. I have just made a template of how I presented my critical incidence in the department.
2. A CASE OF POST OP RESPIRATORY DEPRESSION
• A MALE PATIENT OF 35 YEARS WAS ON LIST. HE HAD NASAL POLYPS WITH INTRACRANIAL
EXTENSION. HE WAS REVIEWED IN THE PREOP BY THE RESIDENT. HE HAD NO CO MORBIDS AND HAS
NO CENTRAL PRESSURE SYMPTOMS. PATIENT WAS DISCUSSED WITH OT INCHARGE WHO
COMMUNICATED WITH ENT SURGEONS THAT NEUROSURGICAL ASSESSMENT WAS NECESSARY FOR
THE CASE AS THERE WAS RISK OF RAISED ICP.
• THE FOLLOWING DAY, PATIENT PRESENTED FOR THE SURGERY. SURGEONS PLANNED ONLY TO
REDUCE THE SIZE OF THE POLYP AS NEUROSURGICAL OPINION AND ASSISTANCE WAS NOT
SOUGHT.
• IT WAS DECIDED TO PROCEED WITH THE SURGERY WITHOUT NEUROSURGEONS. PLAN WAS TO
REMOVE SOME POLYP AND REDUCE THE SIZE WITHOUT PULLING OUT THE PART EXTENDING INTO
THE CRANIUM.
3. • PATIENT WAS PREPARED. ANESTHESIA WAS INDUCED BY TAKING PRECAUTIONS FOR POSSIBLE
RASIED ICP. PATIENT REMAINED VITALLY STABLE THOUGH OUT THE PROCEDURE. PATIENT WAS
EXTUBATED. HE WAS SHIFTED TO PACU WHEN HE WAS RESPONDING TO VERBAL COMMANDS.
• PATIENT WAS CONSCIOUS IN PACU WHEN PULSE OXIMETER WAS ATTACHED.
• AFTER FIFTEEN MINUTES, ANESTHESIA TEAM RECEIVED A CALL FOR HELP. ON ARRIVAL IN THE PACU,
THE PATIENT WAS IN LEFT LATERAL POSITION, CYANOSED AND NOT RESPONDING TO VERBAL
COMMANDS. PULSE OXIMETER READ 60 % WITH POOR WAVE FORM.
• IMMEDIATELY PATIENT WAS TURNED SUPINE AND CAROTID PULSE WAS SOUGHT. SINCE CAROTID
WASN’T PALPABLE CPR WAS STARTED AND CALL FOR HELP SENT FOR MORE TRAINED ASSISTANCE.
4. • PATIENT WAS INTUBATED AND RESPIRATION MAINTAINED VIA AMBU BAG AND LATER BY T
PIECE. ONE SHOT OF ADRENALINE GIVEN. PATIENT HAD ROSC AFTER THREE MINUTES. ABGS
SENT AND PATIENT’S ATTENDANTS WERE COUNSELLED ABOUT THE EVENT. POST CARDIAC
ARREST WAS CONTINUED IN THE ICU.
• OUTCOME: PATIENT EXPIRED IN ICU ON SIXTH DAY.
5. A CASE OF SCOLIOSIS
• A SEVENTY YEARS OLD FEMALE PATIENT PRESENTED TO US FOR THE EXCISION OF PAROTID
SWELLING ON HER RIGHT SIDE. HER PRE OP ASSESSMENT WAS DONE. SHE HAD NO CO MORBIDS
AND METS >4. ECHO WAS DONE WHICH WAS NORMAL. AIRWAY WAS DIFFICULT DUE TO ABSENT
DENCTURES.
• ON OT TABLE DURING REASSESSMENT, HER X RAY WAS REVIEWED WHICH SHOWED DEFORMED
TUBULAR HEART. HER SPINE WAS ASSESSED. PATIENT HAD SCOLIOSIS.
• THE RESIDENT FAILED TO IDENTIFY HER AS A CASE OF SCOLIOSIS PREOPERATIVELY.
• IN THE OT HER VITALS WERE WITHIN NORMAL LIMITS. CHEST WAS CLEAR ON AUSCULTATION AND
METS WERE ACCEPTABLE.
• MOREOVER PATIENT WAS ON OPERATION TABLE AND HOOKED UP TO ALL MONITORS. IT WAS
DECIDED TO PROCEED WITH THE SURGERY.
6. • AFTER INDUCTION, PATIENT DEVELOPED SEVERE HYPOTENSION AND BRADYCARDIA.
• ISO VALUE WAS REDUCED TO 0.4 TO 0.6%.
• PRESSURES WERE MAINTAINED BY ADDING 3 MLS OF 1:10000 EPINEPHRINE IN 1000 ML OF
LACTATED RINGER. INFUSION WAS TITRATED TO MAINTAIN MAP >65 MMHG.
• SEDDATION WAS ASSURED VIA DORMICUM 3MG AND KETAMINE IN INCREMENTS.
• SURGEONS WERE IONFORMED OF THE CRITICAL CONDITION. THEIR CONSULTANT PROCEEDED
WITH THE SURGERY HIMSELF. THE SWELLING WAS BENIGN AND HENCE, SURGERY CONCLUDED
WITHIN FORTY FIVE MINUTES.
7. • AFTER CONCLUSION OF SURGERY, NMB WAS REVERSED VIA NEOSTIGMINE. TRACHEA WAS
EXTUBATED AFTER PATIENT RESPONDED TO VERBAL COMMANDS. SHE WAS PROPPED UP AND
NEBULIZED WITH ATROVENT.
• IN PACU, SHE WAS MONITORED FOR HYPOTENSION AND DESATURATION. AFTER THIRTY
MINUTES AND WITH OUT A SINGLE EPISODE OF HYPOTENSION PATIENT WAS SHIFTED TO THE
WARD.
