Retractions

TOday was my most intense sedation yet. 1 year old hypotonic, failure to thrive with chronic right upper lobe atalectasis. He was being sedated to get a spinal tap, Percutaneous Gastrostomy tube, and a bronchoscopy. His underlying health status was poor. He was weak. His chest wall was weak and soft. His loudest cry sounded more like a weak whine. He had no cough to speak of to get rid of the secretions building up in his throat. He desaturated immediately upon initiation of the sedation. We bagged him up to 100%. The endoscopy started and his sats dropped to 80%, 70%, 60%, 50%…finally 47%. I was getting frantic. Head tilt, chin lift, jaw thrust, blowby O2 were not helping and his sat’s dropped fast. I had to ask the endoscopist 3 times to remove his scope. The bite block got in the way of our suction. We ripped it all off and bagged him back up to 100%. We started over with a special mask that had a port in the diaphragm so that he could insert his scope through it. The dumb mask had major leaks everywhere between the nasal cannula, the bite block, and the leaking diaphragm. We finally ripped the diaphragm off and used a sterile glove to cover the large hole that he was scoping through. They placed the peg tube with few difficulties. “Are we done yet?” I thought to myself. The bronchoscopy was next. Poor kid. At least the pulmonologist was in his lungs and could help pump a little oxygen in. After the procedures were over, he took FOREVER to wake up, thewhole time I had my fingers under his chin or his jaw to keep his airway open. I had asked the bronchoscopist to view the cords, and then the epiglottis with his scope while I played with his head position. It was pretty impressive to see the airway close off with just a small head tilt forward. And seeing it open up again with a little jaw thrust or chin lift was very impressive as well.

I cut out of lecture early to attend this sedation. Ironically, the lecture I left was on conscious sedation…but I think my experience was much more instructive.

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