Page 64 - CASA Bulletin 2022, 9(6) 增刊

CASA Bulletin of Anesthesiology

Several main factors made this case a huge challenge for us: 1) Early diagnosis is difficulty
so vigilance and high suspicion are the keys. 2) We cannot
resuscitate the patient while in prone position. We have to turn
the patient back to the supine position promptly. Timing is
essential during life-threatening situations; Difficulty to turn
the patient supine quickly because of tangled with peripheral
intravenous & central access, artery line, blood pressure cable,
EKG wires, SSEP/MEP monitoring wires, BIS monitoring
cable, etc.; 3) Large open surgical wound with continuing
bleeding and resultant low blood pressure. Cannot be
heparinized and put in the cardiopulmonary bypass machine
due to T3-Sacrum wound; 4) A large venous air embolism is
lethal just like massive pulmonary emboli to obstruct
pulmonary artery blood circulation. Once occurred, it’s
usually very difficult to save patient’s life at that time, 20
years ago; and 5) Finally, a fresh attending anesthesiologist
working with an internationally known spine surgeon and
Chief of Spine Surgery at WashU.
From this case, I have learnt leadership decision-making is essential for success. Mutual
understanding and trust between surgeon and anesthesiologist will secure our patient’s safety.
There is no doubt that effective communication and knowledge had played an important role in
this case’s appropriate management.
The surgeon trusts my critical thinking and judgment even I was a fresh attending
anesthesiologist who initiated immediate resuscitation measures. I wish I informed the surgeon
the first time, about two minutes earlier. Since then, we made lasting changes during posterior
spine surgeries: inform surgeon as soon as we are suspicious of embolism (VAE or PE).
6. 正在进行科研的，您从事的课题，是什么原因您选择这个课题？
因忙于临床工作, 教学和管理工作, 我暂时没有做科研了, 非常可惜.

7. 曾去过中国医院访问或教学的，您认为两国麻醉最大的区别是什么？
稍欠缺同质的住院医师规范化培训教学与
临床实践, 临床麻醉思维与判断能力及根因分
析，这与参差不齐的住院医师规范化培训有

关.根因分析（RCA）是结构化的问题处理
法，逐步找出问题的根本原因并加以解决.
我的最近部分讲座照片分享, 包括北京大学
第三医院主办的全国高危产科及围产医学会

议, 复旦大学附属华山医院, 武汉大学附属省
人民医院, 华中科技大学同济医院, 等等。

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