Since last year, the last week of March has been designated as "China Anesthesia Week". On the occasion of careful anesthesia this year, I visited many hospitals in Hang Cheng, and listened to the anesthesiologist talk about the worldly wisdom in the delivery room and the race against time in the operating room, and learned the important role of anesthesia in modern medicine, and also witnessed the hard work and difficulty of the anesthesiologist.
Postoperative anesthesia resuscitation room is another battlefield for anesthesiologists.
The story in the delivery room
The pain grade is the pain grade classified by medical specialty, usually 10. "Generally speaking, the pain experienced during natural childbirth can reach 10," said Xiao Chun, director of anesthesia department of Hangzhou Obstetrics and Gynecology Hospital.
In order to cope with this kind of pain and let the parturient give birth in a relatively relaxed state, many hospitals have introduced painless delivery (spinal anesthesia for labor analgesia), but many family members often object to "anesthesia" for fear of affecting the fetus.
The parturient in the delivery room is in great pain.
The husband refused to give birth painlessly.
In Hangzhou Obstetrics and Gynecology Hospital, Xiao Chun told reporters about one of his experiences.
26-year-old Chen Xiao (not her real name) has entered the delivery room, with two fingers open at the entrance. Chen Xiao couldn't stand the pain any longer, and proposed painless delivery.
But in the face of his wife's painful death, the husband firmly shook his head and refused to sign the consent form for painless delivery. He said, "Taking anesthetics has an impact on children, but it is not good for adults." No matter how the anesthesiologist explained that the concentration of anesthetic in painless delivery would not affect the mother and fetus, the husband's attitude remained firm.
"I hate you all my life!" Xiao Chen cried and shouted this sentence to her husband.
The anesthesiologist is doing spinal anesthesia for the parturient.
"In production, more than 50% of pregnant women will achieve 10 pain. For example, the degree of pain of directly cutting the flesh with a knife is only 9.2. " Talking about Chen Xiao's motherhood, Xiao Chun was full of heartache.
Painless delivery VS cesarean section
The concentration of narcotic drugs is much lower.
"Finally alive!" ..... After using painless delivery technology in the first stage of labor, parturients often hear similar expressions. But outside the delivery room, mother-in-law, mother and husbands are worried about this technology. They are worried that narcotic drugs will affect the intellectual development of the fetus after birth, and spinal injection will lead to postpartum low back pain.
"The control of cesarean section rate in western countries has been maintained below 15%, but the cesarean section rate in China was as high as 45%, largely because of fear of pain in vaginal delivery." Hu Shuangfei, deputy director of the Anesthesiology Branch of the Provincial Medical Association and director of the Anesthesiology Department of Zhejiang People's Hospital, explained that the concentration of local anesthetics used in cesarean section was 0.5%, while the concentration of pain anesthetics used in painless delivery was only 0. 1.25%.
Moreover, a very small dose of anesthetic is injected into the spinal canal, absorbed by the blood, and then reaches the fetus through the placental barrier.
Anesthesiologists monitor patients' indexes in the operating room.
The story on the operating table
In most hospitals, the anesthesiology department is adjacent to the operating room, and the anesthesiologist's office is located next to the operating room.
In the eyes of many patients and their families, the success of an operation depends on the skill of the surgeon, but I don't know that it is actually the anesthesiologist who accompanies the whole operation from beginning to end.
It can be said that the anesthesiologist is an unsung hero under the shadowless lamp. As the saying goes, "Surgery cures a disease and anesthesia saves lives", an operation can't be done without an anesthesiologist.
On the operating table, the patient's blood pressure rose sharply.
The anesthesiologist solves the crisis.
"Are there any patients and their families who thank the anesthesiologist after the operation?" In this regard, Hu Shuangfei said little, but the slightly better phenomenon is that people have gradually understood the importance of anesthesiologists.
Not long ago, a patient diagnosed as "retroperitoneal tumor" was pushed into the operating room for laparoscopic tumor resection. After all the procedures such as anesthesia and intubation are ready, the surgeon first establishes pneumoperitoneum for the patient, so that there is enough visual field for the operation after the endoscope is inserted. This is the most routine process. Unexpectedly, just as the abdominal cavity expanded, the patient's blood pressure on the operating table suddenly rose, and after the surgeon stopped it, the patient's blood pressure immediately fell back to normal. But when pneumoperitoneum was established again, the patient's blood pressure soared again.
Anesthesiologists monitor patients' indexes in the operating room.
After Hu Shuangfei came to the operating room to ask, he suspected that this "retroperitoneal tumor" was a pheochromocytoma. The popular understanding is that this tumor grows on the adrenal gland and has no special symptoms. It belongs to the silent type, but touching or squeezing the tumor will cause blood pressure to soar. The operation group immediately adjusted the operation plan, and the anesthesia group also controlled the patient's blood pressure to maintain a stable state through strict drug dosage on the operating table.
"Usually, we will prepare positive and negative drugs before surgery. Use positive medicine when blood pressure drops, and use negative medicine when blood pressure soars. The overall purpose is to ensure the patient's blood pressure is stable and provide conditions for surgery. " Hu Shuangfei said.
A routine operation became irregular, and the atmosphere in the operating room suddenly became tense. After surgical tumor resection, rapid pathological biopsy found that Hu Shuangfei judged that it was a pheochromocytoma of adrenal medulla growing retroperitoneum. After the operation, when the patients and their families thanked the surgeon, they realized that if it were not for the escort of the anesthesiologist, the consequences might be unimaginable.
Not only did they watch the patient "fall asleep"
Wait for the patient to wake up
In fact, the anesthesiologist plays such a role in every operation. Hu Shuangfei said that it is precisely because more and more surgeons mentioned the importance of cooperation with anesthesiologists before operation that patients and their families gradually got a new understanding of anesthesiologists.
If the preoperative blood pressure control is not stable, the stimulation of the wound during the operation, the stress response of the human body, the stimulation of anesthetics and blood loss may all lead to a sharp increase in blood pressure, and even induce fatal lesions such as intraoperative cerebral hemorrhage. If the blood pressure control is not good, it will also cause problems such as postoperative wound bleeding.
Therefore, any severe stimulation during operation requires the anesthesiologist to adjust the depth of anesthesia in time to avoid adverse events. During the operation, once the anesthesiologist finds something wrong, he needs to respond quickly and adjust the patient's vital signs to the normal range through drugs and other means to ensure the smooth operation of the surgeon.
Meng Li, an anesthesia nurse, is holding a child who has just finished surgery. He is recovering from anesthesia.
Under normal circumstances, after anesthesia intubation, anesthesiologists need to use various drugs to maintain the depth of anesthesia, so as to avoid patients waking up prematurely or suffocating with limb movements. After the operation, while waiting for the patient to wake up, there is also the possibility of danger, and the anesthesiologist must never leave.
"On one occasion, a patient said to me before anesthesia, what if I can't wake up from this sleep? I comforted her and will always be by her side until she wakes up. " Xiao Chun told reporters that patients are not required to have a deep understanding of anesthesiologists, as long as they know that they have been guarded when they are asleep.
● About anesthesiologists
The Historical Contribution of Anesthesiologists
★ 1842 On March 30th, Dr. Lang from Georgia, USA successfully performed the world's first ether anesthesia, which laid the foundation for the development of modern anesthesiology and was also a milestone in the history of modern medicine.
★ Apgar score is a rapid method to evaluate the health status of newborns, which was invented by American doctor virginia apgar in 1952. Apgar was an American anesthesiologist. In order to evaluate the effect of anesthesia on newborns during delivery, he designed a scoring method. This method is the most widely used neonatal health assessment method in the world.
Why is there such a shortage of anesthesiologists in China?
It is reported that there are only 0.5 anesthesiologists per 10,000 population in China, compared with 2.8 in Britain and 3.0 in the United States. In Europe and America, the ratio of anesthesiologists to surgeons in operating departments is about 1∶3, and in China it is about 1∶8.
According to the data recently reported by Zhejiang Clinical Anesthesia Quality Control Center, as of 20 17, there are more than 4,600 anesthesia practitioners in Zhejiang Province, including more than 4,200 anesthesiologists and more than 400 anesthesiologists. The ratio of anesthesiologists to surgeons in the operation department is about 1∶6.
What is the reason for the shortage of anesthesiologists? The reporter interviewed Yan Min, director of the Anesthesiology Department of the Second Affiliated Hospital of Zhejiang University School of Medicine. She is also the director of Zhejiang Clinical Anesthesiology Quality Control Center and a member of Zhejiang Provincial Political Consultative Conference.
Anesthesiologists have a heavy workload.
Supervision should be carried out before, during and after operation.
Zhejiang Second Hospital actually opened more than 3,000 beds, with more than 6,543,800 hospitalizations+5,000 person-times. There are 38 central operating rooms in Jiefang Road Hospital, 654.38+0.5 in Ophthalmic Hospital and 25 in Binjiang Hospital. Together with the endoscopy centers and interventional centers of the two hospitals, the Second Hospital of Zhejiang Medical University ranks third in the country and first in the province with an annual total of nearly 6.5438+0.3 million operations.
Yan Min told reporters that some hospitals at home and abroad have renamed "Anesthesiology Department" as "Perioperative Medicine Department", which is not difficult to understand literally and is a more comprehensive description of the work of anesthesiologists. In fact, the anesthesiologist's job is not only to make the patient feel painless during the operation, but also to monitor the patient's vital signs at all times to ensure the patient's life safety. Their work also includes preoperative evaluation, adjustment and postoperative follow-up.
From the beginning of the operation, the anesthesiologist should participate in the preparation work together with the surgeon, and sometimes combine multiple disciplines to adjust the patient's state to the best. During the operation, in addition to helping the patient to relieve the pain, it is also necessary to ensure that the patient's organ function is protected so that all organs are not damaged and the operation is safe.
For anesthesiologists, the string should be tightened after operation. In the Second Hospital of Zhejiang Medical University, the recovery room after anesthesia is fully equipped according to the standard of intensive care unit. Patients should be monitored by the anesthesia medical team during the recovery period to prevent postoperative pain, postoperative bleeding, possible infection caused by open surgery and respiratory depression and arrhythmia caused by anesthesia. Until the patient wakes up slowly and realizes functional recovery, he can be sent back to the ward from the recovery room after anesthesia. Even after the patient is discharged from the hospital, the anesthesiologist will pay attention to the long-term cardiovascular and cerebrovascular conditions of the patient to ensure that the operation does not destroy the good hemodynamics.
Anesthesiologists are understaffed.
The aging population and the rapid development of internal medicine and surgery are the reasons.
The aging population in China makes it difficult for anesthesiologists to carry out their work. "The elderly have a high risk of onset, and each elderly person has a different risk of anesthesia, and it requires long-term follow-up after surgery, which is a heavy workload for anesthesiologists." Yan Min said.
In addition, the application of anesthesia goes far beyond the scope of surgery, and the demand for internal anesthesiologists is also high. Yan Min told reporters that the diagnosis and treatment under painless gastrointestinal endoscopy, painless fiberoptic bronchoscopy and interventional diagnosis and treatment of cardiovascular and cerebrovascular diseases all need the cooperation of anesthesiologists. Some hospitals also have pain clinics and anesthesiologists.
"Now more and more disciplines require comfortable treatment, and the construction of anesthesiologists can't keep up with clinical development. We feel a lot of pressure, but the standards of anesthesiologists cannot be lowered. " Yan Min said that it is not easy to train an anesthesiologist. Only five years of undergraduate medical education, three years of postgraduate medical education and five years of clinical experience can we train anesthesiologists with the level of attending doctors. In addition, in order to be independently responsible for surgical anesthesia, it is necessary to pass the examination in the hospital.
Call for improving the treatment of anesthesiologists
Rotation residents receive anesthesia training.
Yan Min, who is rooted in clinical practice, knows the working environment of anesthesiologists too well. As a member of CPPCC, she has been campaigning for her partners.
"Unlike other doctors who have the opportunity to sit in the clinic, anesthesiologists work under high pressure in a closed and sunless environment all the year round. They enter the operating room early in the morning and come out at night, with no rest time at noon. Due to high-intensity work, anesthesiologists have always been a high-risk group of overwork. " Yan Min said frankly that at some meetings, she often called for improving the labor value of anesthesiologists and attracting more excellent doctors to join the anesthesia team.
In the early years, some medical colleges and universities set up anesthesia majors, but Yan Min hoped that more clinicians would join the anesthesia team and more residents would choose to specialize in anesthesia besides college students.
China Anesthesia Week, let's pay tribute to the national anesthesiologists!