Indexing Title: MPADUA’s Medical Anecdotal Report [04-3]

MAR Title: Patient who Underwent Cholecystectomy

Date of Medical Observation: May 12, 2004

Narration:

M.S., a 49 year old private patient of one of our consultants was admitted one day prior to her operation, no work-ups done on her although she was a known hypertensive for 2 two years, which is controlled by intake of anti-hypertensive medications. Highest blood pressure was 180/100, usual blood pressure was 140/90. She consulted with ultrasound report of Cholecystolithiasis and was then scheduled for the operation after an essentially normal physical examination.
 

Operation was scheduled first case in the morning, the specimen was out after 40 minutes. The surgeon scrubbed out while we close the skin, but he stayed until the patient was extubated. During which the patient was not responding to physical stimuli (suctioning, sternal compression), we waited for 30 minutes and still no response. The Anesthesiologist suggested referral to Internal Medicine, the initial working impression then was hypertensive bleed intra-op.
 

Patient was perspiring and breathing deeply. No localizing signs were noted. The consultant was also considering deepened anesthesia. After almost 2 hours, the patient woke-up with no residual. And post-operatively, no other complications were noted.
 

Insights :

Reinforcement

A complete history and physical examination is the most valuable tool that we doctors must possess. We must also learn how to interpret these signs and symptoms to arrive at a logical diagnosis. We are fortunate that at OMMC, Department of Surgery we are thought how by the introduction of the Patient Management Process.
The patient saved time and money because unnecessary laboratories, ancillary procedures, and pre-operative clearances were not routinely done.

Stimulus

Learn something about delayed emergence.