Female / 46 , C / O Hoarseness of Voice 3 days, H / O ingestion of chicken bone 5 days back. CT scan showed FB in Esophagus. Reports normal, but WBC count 17000. Posted for Rigid Esophagoscopy. Standard induction with Fentanyl, Medaz, Propofol, Scoline, O2, IPPV, Tube 6.5 with difficulty. Maintained on Propofol, Vecuronium, Gas Oxygen, IPPV. Over in 20 mins. Reversal started on attempts of breathing. Inadequate reversal picture. Extubated on struggles. SpO2 drops to 80. Reintubated and
? pink liquid noted in throat. May be froath may be blood stained saliva.
At that moment some one informed that actual printed report of CT has now come and it showed a rent in esophagus.
Pt given Medaz and O2 and shifted to Recovery for observation. ABG showed pH 7.2 and PCO2 70.Connected to venti and Vecuronium given. CXR showed pulm edema pattern.
OK by evening but not sustaining BP. Dopamin and Dobut given. 2D Echo 30% LVEF, WBC 24000.
Imporved over 24 hours and discharged in 2 days. and ok.
Question is was it a picture of early sepsis due to mediastinal infection which can spread rapidly or was it an improperly managed reversal? Later picture is of clear cut septic shock and septic cardiomyopathy.
I am putting this case for discussion tomorrow in society meet.
Let me many opinions.
The anaesthesiologist feels that it was her fault. I feel it was sepsis. Is it that uptill now the society used to say that it was over dose of anaesthesia, and now we have also started feeling the same!!!!!