Here's a scenario that took place recently in the unit I work in....
Patient "X" has a condition that requires daily debridements in the OR. X goes to the OR for a debridement and wound vac placement. Surgery goes fine but my question is with the anesthesia. Patient was on morphine and versed drips prior to surgery and said drips were shut off just prior to rolling out to surgery. Patient is easily roused and responds appropriately on these drips, just enough to keep X comfortable. X is 38 years old with near normal liver function, diabetic and has renal impairment. If it matters X is also grossly obese.
In surgery Sev is started at 1.5% initially, patient is also given 10mg of Vec. about 15 minutes later Sev is decreased to 1.2 and another 10mg of Vec is given. Approximately 15 minutes later Sev is decreased to 1.0 and remains at 1.0 until finishing. According to the flowsheet at the about the same time the Sev was turned down to 1.0 the patient's heart rate increased by about 20 beats per minute and his blood pressure sharply trended up and when we received X back in our unit his heart rate was about 110, up from 80's, BP 220's/110's, his norm being 140's/70's. He received not one drop of narcotic nor any sedative/hypnotic of any kind during surgery. After we received X we promptly restared the drips and he received a 10mg bolus of Morphine and he eventually returned to baseline after about 30 minutes.
I got this in report, all second hand from the previous shift, and was quite disturbed by the whole scenario. I ended up filing an incident report after talking to my charge nurse, nursing supervisor and our trauma resident who were also disturbed by the situation.
Did we blow this out of proportion? Did we miss something in regards to anesthesia?
