Geisz-Everson Marjorie A, Wren Kathleen, Kennedy Latosha
Louisiana State University Health Science Center, School of Nursing, New Orleans, USA.
AANA J. 2008 Feb;76(1):25-7.
A 53-year-old woman presented to the operating room for surgical correction of pericardial and pleural effusions. Her history included stage IV breast cancer, well-controlled hypertension, and diverticulitis. Although her baseline blood pressure, heart rate, and respirations were normal, she was short of breath with diminished breath sounds on the left side of the lungs and required oxygen, 2 L/min via nasal cannula. The nurse anesthesia student, under the direction of the Certified Registered Nurse Anesthetist (CRNA) and anesthesiologist, induced general anesthesia with etomidate, fentanyl, lidocaine, and succinylcholine. During placement of a double-lumen endotracheal tube, the patient became asystolic. The nurse anesthesia student immediately withdrew the laryngoscope, and the patient returned to normal sinus rhythm. A second attempt at laryngoscopy produced asystole as well. Again, the laryngoscope was withdrawn, and the patient returned to normal sinus rhythm. After resuming ventilation with 100% oxygen and administering atropine, 0.4 mg, the next intubation was successful, producing no untoward effects. Reintubation at the end of the case with a single lumen endotracheal tube was uneventful. The patient was transported to the intensive care unit and mechanically ventilated overnight. The next morning, she was extubated with no further anesthetic complications.
一名53岁女性被送至手术室，准备接受心包和胸腔积液的外科矫正手术。她的病史包括IV期乳腺癌、控制良好的高血压和憩室炎。尽管她的基础血压、心率和呼吸正常，但她呼吸急促，左侧肺部呼吸音减弱，需要通过鼻导管吸氧，流量为每分钟2升。护士麻醉专业学生在注册护士麻醉师（CRNA）和麻醉医师的指导下，使用依托咪酯、芬太尼、利多卡因和琥珀酰胆碱诱导全身麻醉。在插入双腔气管导管时，患者出现心脏停搏。护士麻醉专业学生立即拔出喉镜，患者恢复正常窦性心律。第二次喉镜检查尝试也导致心脏停搏。喉镜再次被拔出，患者再次恢复正常窦性心律。在恢复100%氧气通气并给予0.4毫克阿托品后，下一次插管成功，未产生不良影响。手术结束时更换为单腔气管导管再次插管过程顺利。患者被转运至重症监护病房并接受了一夜的机械通气。第二天早上，她顺利拔管，未出现进一步的麻醉并发症。
