A patient about to undergo total knee revision, was administered spinal anesthesia prior to the case.However, the spinal failed, and the patient went on to have general regional anesthesia.Notes from the procedural report: 08:42 - spinal performed by certified registered nurse anesthetist (crna).08:42 - sterile prep with chloraprep and draped.08:45 - vertebral interspace l3/4 located by palpation.08:45 - skin anesthetized with lidocaine 1%.08:45 - 25 g whitacre needle advanced to subarachnoid space using midline approach with introducer.Positive cerebrospinal fluid (csf).08:45 - spinal bupivacaine 0.75% 1.5 ml spinal.08:45 - number of attempts: 1.08:45 - patient did not report paresthesias.08:46 - patient positioned supine.08:49 - propofol bolus 50 mg iv.08:49 - temperature monitoring utilized: skin.08:49 - lidocaine 2% 60 mg iv.08:50 - cefazolin 2 g iv.08:52 - propofol infusion 60 mcg/kg/min (1000 mg per 100 ml) started.08:56 - informed medical doctor of anesthesiology (mda) that patient was still able to move her leg and could feel some pain if her right knee was bent.08:58 - patient safety: patient position supine; arms bilateral less than 90deg abducted; pressure points padded; eyes taped closed; 08:58 - anesthesia type: general, regional.08:58 - convective warmer placed on upper body set at 43 with high fan speed.08:58 - propofol infusion 90 mcg/kg/min (1000 mg per 100 ml) dose change.08:59 - induction presence.08:59 - per mda.Convert to general ¿ laryngeal mask airway (lma).As patient was able to wiggle her toes on right foot.The operative note indicates: "the patient was taken to the operating theater where spinal was performed.She still had some pain and therefore general anesthesia was induced." the procedure was carried out with no complications.
|