Chapter 205: 【205】Back pain before anesthesia
The nurse connected the patient to the monitor, adjusted the oxygen supply, and hung a saline drip for resuscitation before walking away. Now, only the anesthesiologist was left to proceed with the operation.
The anesthesiologist needed to administer anesthesia to the patient. For surgeries one, specifically noted as an anal surgery, general anesthesia was usually not required. Whenever possible, surgeries would avoid general anesthesia, which carries a higher risk and is more expensive; both of which are reasons why neither anesthesiologists nor surgeons prefer it, and not something the general public needs to worry about.
Her supervising physician had previously instructed her to perform spinal anesthesia on the patient, which was a type of neuraxial block.
Following the teacher’s instructions, the intern acted according to the orders given. As an intern, Lau Jingyun was even more cautious, first checking that the resuscitation equipment, such as intubation tools and the defibrillator, were in place.
She opened the anesthesia puncture pack to ensure that all the items were present and used syringes to draw up the anesthetic and saline solution.
Engaged in these tasks, Lau Jingyun’s mind had completely forgotten about her junior by her side—her focus was entirely on what steps to take next.
The patient needed to lie on their side for the spinal anesthesia, and Xie Wanying helped her senior adjust the patient’s position, since she had come to lend a hand.
The patient’s head needed to be lowered, and their hands wrapped around their knees to open the spaces between the lumbar vertebrae, aligning the back with the edge of the operating table to facilitate the anesthesiologist’s work.
However, the anesthesia had not yet been administered to the patient, and simply asking her to lower her head made her complain of discomfort. Asking her to wrap her hands around her knees only caused her more distress, as she exclaimed, “My back is killing me!”
Upon hearing this, anyone with medical knowledge would know that something was amiss.
“Senior sister,” Xie Wanying called to her senior.
Lau Jingyun had indeed heard the patient cry out in pain, and her heart sank to the bottom of the sea.
Dr. Zhang abhorred being called upon by interns asking for advice.
Lau Jingyun was in an eight-year program, which included an extended period of practical training compared to the five-year undergraduate program. Thus, she was essentially able to perform procedures independently now, with her teacher only coming by to check and supervise.
For a simple spinal anesthesia, which wasn’t even a combined spinal-epidural anesthesia or a more complex epidural catheterization, as long as the needle accurately penetrated the two layers of the dura mater and arachnoid membrane to reach the subarachnoid space and inject the anesthetic, it was considered relatively straightforward neuraxial anesthesia.
Subarachnoid block anesthesia took effect very quickly, and the anesthesiologist could easily gauge its success. In the eyes of a teacher, it was not a difficult procedure.
With an increasing variety of anesthesia methods to complement advanced surgical techniques, neuraxial blocks were widely utilized. For anesthesia students, this was a threshold to cross; but for practicing anesthesiologists, especially those at top-tier tertiary hospitals, it was a routine task, as easy as eating.
Interning in the Anesthesiology Department at a top-tier tertiary hospital and not being able to perform a simple spinal block would be unacceptable.
Gathering her composure, Lau Jingyun turned back around, approached the patient, and asked, “Where does it hurt? Tell me?”
“I can’t bend my back,” said the patient.
Unable to bend at the waist—was it a lumbar disc herniation?
With modern life’s fast pace, many suffer from various minor ailments, and lumbar disc herniation is quite common. If such a condition were a contraindication for spinal anesthesia, then it would have long been abandoned by anesthesiologists. Therefore, a herniated disc is not the key factor in deciding whether spinal anesthesia is possible.
Spinal anesthesia is generally performed between the second and third lumbar vertebrae, whereas common disc herniations occur between the fourth and fifth lumbar vertebrae, so there shouldn’t be much of a problem.