I lied. I am going to respond. Yes, taking the TROLL bait... can't help myself here....
sure....especially when for the surgeon is a must to retract the peritoneum in order to perform his procedure. U gonna stop him all the time..."let the patient to bleed a little - stop whatever you do because he has a vagal reaction".LOL
First off, easy to sound intelligent... okay, maybe not in your case... when you move the goalposts and change the argument. Who was talking about a bleeding patient anyway? Did you feel the need to interject that because you know you're wrong? I can only hope so.
The depths of what you do not understand are amply illustrated in your attempt to flame me. Other posters, med students, junior residents, do not read his posts and think you are taking any meaningful information away with you. He knows not of what he speaks.
You
absolutely do ask the surgeon to stop what they are doing. That, as I said before, is the
first step. Often, this is during peritoneal traction, and
if the patient is bleeding uncontrollably at this point - instead you should do whatever you can to fix that first.
IF the patient is bleeding uncontrollable at this point, the surgeon has much bigger problems (i.e., competency) than vagal reflex, as most of the major vessels that will bleed are
inside the peritoneum, which is what he is outside of when he is putting traction on and when the reflex occurs. You better be reaching for atropine, epinephrine, blood products, etc.
SECONDLY, as
every competent anesthesiologist knows, this reflex rapidly extinguishes with repeated stimulation. That is, the first time they "vagal" on you will probably be the worst. The second time is not as bad. The third time becomes less and less noticeable. Etc.
AND THAT IS USUALLY IT. After that point, you don't have to
usually worry about any potentially dangerous vagal response.
Next, if the patient is repeatedly having a potent vagal response, you try to identify the cause first and foremost. Sometimes a retractor is placed too tightly against a viscera, muscle, etc. and it can be moved slightly. This does
not inconvenience the surgeon, especially if you tell them that the patient is having a sustained vagal response. Now - read this carefully 2win - this is often
far more effective than treating it pharmacologically. Read that again, 2win.
MORE EFFECTIVE than treating it pharmacologically.
Absolutely finally, you can give anticholinergic drugs (glyco, atropine) if the patient continues to have significant, meaningful bradycardia during the case.
THIS IS THE LAST THING that the vast majority of
COMPETENT PRACTICING ANESTHESIOLOGISTS will do.
NO one in common, day-to-day practice reaches for these drugs as a
first choice except
apparently you.
I will, again, state the following so it is clear to everyone reading this thread, which is what I believe:
(1) You are
not actually an attending anesthesiologist (or, if you indeed are, the program that graduated you should be embarrassed and/or you clearly are not Board Certified by the ABA),
(2) You are only here to TROLL,
(3) You have proven, with your short track record, that you don't really have anything of value to add to this forum.
Given the above,
please go away.
Thank you.
-copro
