I know that this word can dilate our sphincters.
I had a case of Fistula in ano under GA with LMA.
Standard induction with Fentanyl, Medazolam, Glycopyrolate, Pre oxygenation, Propofol, Vecuronium, and intubation with LMA. All parameters normal till at about 20 mins after starting surgery things started happening.
I have group of 4 qualified anaesthesiologists. One of them was on the pulse. Multi paramonitor was connected. Second anaesthesiologist was writing notes and drug list etc. I was just around in the OT.
First assistant started making movements. ON inquiring she said " No Radial"
Monitor took next NIBP reading:50/20mmBP.
SpO2 started dropping. N2O stopped. Quickly LMA removed and endotracheal tube put. 100% O2 with venti given.
No change. SpO2 now 70%. BP not recordable. Vaso Pressures given.
I went to surgeons trolly. Asked the sister about what is in the bowls. She said one is Savlon, Betadine, and Hydrogen Paroxide.
I asked the assistant to auscultate. She said air entry was equal on intubation. I asked for murmur, she said there was no murmur preop.
I asked her to re auscultate. She said there is some funny loud murmur. In a fluke I said this is called a Mill Wheel Murmur. I had never heard it before.
The surgeon had injected 10ml of Hydrogen Paroxide to find the internal opening of the Fistula in ano.
The murmur vanished in about a min and SpO2 was about 52%.
It was not possible to give Durrant's position from lithotomy possision. nor was it possible to put in a central line.
We were just waiting for the fate. Suddenly the SpO2 started rising. BP came up till 120 systolic. And Patient was fully conscious at reversal.
Was discharged on third day and he had no clue about the diagnosis.
Any one can throw some light on this case.
any easier way to manage this crisis.
Any one with a simillar experience?