Sir,
Recently i had anaesthetised a 14 yr old girlfor FESS with seotoplasty with no known medical problems except that she was weighing 65kg.
Premedication was tab Ranitidine150mg the night before surgery and one hour before the scheduled time on the day of surgery.An 20G I.V. started and Ringer's lactate fluid used. Monitors included ECG, NIBP, Pulseoximeter.
After preoxygenation for 3 min she was induced with Inj glycopyrrolate0.2mg, pentazocine 12mg, midazolam2mg, propofol 120mg and suxamethonium 100mg and intubated with size 7.0 cuffed endotracheal tube. Throat pack done. Patient ventilated with 70% nitrous oxide with oxygen and 0.5% halothane. After patient came out of suxamethonium, Inj vecuronium 4mg given.At the same time surgeon had started infiltrating the nose with Inj2% Lignocaine with adrenaline 1 in 100000.(For this reason halothane was turned off).
Suddenly patient had bradycardia and asystole. Patient was resuscitated with inj Atropine 0.6mg & 1 ml of inj Adrenaline 1 in 10,000 and cardiac massage given. Patient's heart picked up in 2 min time. Patient was extubated after 1 hour.
My question is
1. what are the causes for bradycadia and asystole other than inj vecuronium and nasal stimulation?
2.Can the panel give me references for vecuronium induced asystole?
3.Is there any mistake in the anaesthesia technique?
Recently i had anaesthetised a 14 yr old girlfor FESS with seotoplasty with no known medical problems except that she was weighing 65kg.
Premedication was tab Ranitidine150mg the night before surgery and one hour before the scheduled time on the day of surgery.An 20G I.V. started and Ringer's lactate fluid used. Monitors included ECG, NIBP, Pulseoximeter.
After preoxygenation for 3 min she was induced with Inj glycopyrrolate0.2mg, pentazocine 12mg, midazolam2mg, propofol 120mg and suxamethonium 100mg and intubated with size 7.0 cuffed endotracheal tube. Throat pack done. Patient ventilated with 70% nitrous oxide with oxygen and 0.5% halothane. After patient came out of suxamethonium, Inj vecuronium 4mg given.At the same time surgeon had started infiltrating the nose with Inj2% Lignocaine with adrenaline 1 in 100000.(For this reason halothane was turned off).
Suddenly patient had bradycardia and asystole. Patient was resuscitated with inj Atropine 0.6mg & 1 ml of inj Adrenaline 1 in 10,000 and cardiac massage given. Patient's heart picked up in 2 min time. Patient was extubated after 1 hour.
My question is
1. what are the causes for bradycadia and asystole other than inj vecuronium and nasal stimulation?
2.Can the panel give me references for vecuronium induced asystole?
3.Is there any mistake in the anaesthesia technique?