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deleted9493
I'm not on anesthesia this month but did a peds consult for ENT today in the PACU and was just curious as to everyone's opinions.
Four year old girl apparently presents for preop today with a resolving URI that she's had going for 1.5 weeks on top of underlying asthma. She's got albuterol PRN (mother says she's not needed it) and also singulair, daily. Parents are smokers but both "make sure that she's not around when they do." She's to have bilateral tubes and T&A but the anesthesiologist isn't satisfied with her respiratory status, as she is actively wheezing. Mother flips out when she hears that he wants to cancel the case and basically ends up (somehow) getting him to go ahead with the case anyway. Myringotomies go fine but when the ETT is placed for the T&A, they get about two breaths in and the girl goes into bronchospasm. From what I could tell, they dosed her up with rocuronium, propofol, and albuterol to try to turn things around. I think they were giving sevo throughout, as well?
She was about 2.5 hours in the OR before they sent her to the PACU where I saw her. She was pretty well obtunded, wheezing throughout and was saturating in low 90's on 5L. Only one dose of albuterol had been given in the OR, almost 3 hours prior to my arriving.
From what I could piece together, everything about this case just seemed jacked up to me. I know that the information is limited here but I'm wondering how some of you guys would have managed this girl, assuming you did choose to clear her for surgery.
Four year old girl apparently presents for preop today with a resolving URI that she's had going for 1.5 weeks on top of underlying asthma. She's got albuterol PRN (mother says she's not needed it) and also singulair, daily. Parents are smokers but both "make sure that she's not around when they do." She's to have bilateral tubes and T&A but the anesthesiologist isn't satisfied with her respiratory status, as she is actively wheezing. Mother flips out when she hears that he wants to cancel the case and basically ends up (somehow) getting him to go ahead with the case anyway. Myringotomies go fine but when the ETT is placed for the T&A, they get about two breaths in and the girl goes into bronchospasm. From what I could tell, they dosed her up with rocuronium, propofol, and albuterol to try to turn things around. I think they were giving sevo throughout, as well?
She was about 2.5 hours in the OR before they sent her to the PACU where I saw her. She was pretty well obtunded, wheezing throughout and was saturating in low 90's on 5L. Only one dose of albuterol had been given in the OR, almost 3 hours prior to my arriving.
From what I could piece together, everything about this case just seemed jacked up to me. I know that the information is limited here but I'm wondering how some of you guys would have managed this girl, assuming you did choose to clear her for surgery.