fine line between true anesthesia and conscious sedation, and though he wanted to make Robbie comfortable, he didn’t want him too sedated, just out of it long enough to get a minitour inside his lungs. After she had set up Robbie with pulse oximetry, heart and blood-pressure monitor, and supplemental oxygen, he directed her to give the standard pediatric dose for fentanyl and benzodiapine instead of a newer, short-acting drug.
“No offense, but I only use Propofol when I have an anesthesiologist working with me.” He smiled at her through his mask.
She tossed him a sassy look. “Believe me, no offense taken, I already feel out of my element here.” With skilled and efficient hands she titrated the drugs into the IV as he applied the topical numbing spray toRobbie’s throat, and within seconds Robbie drifted into twilight sleep.
“I called ahead to the preschool to hold his lunch, but Robbie loves to eat so much he almost snuck a snack around three today. Fortunately, they caught him, so we shouldn’t have a problem with emesis.” He flipped on the suction machine, using his elbow to protect his sterile gloves. This would be his backup contingency plan in case Robbie did vomit.
“I’m going to use a pediatric laryngeal mask airway instead of an endotracheal tube.” He showed her the small spoon-shaped device. “As Robbie has the typical shortened Down syndrome neck, an endotracheal tube would have been tricky anyway,” he said as he lubricated the tablespoon-size silicone mask and slipped the tube inside Robbie’s slack mouth. The boy didn’t flinch. “See? I don’t even need a laryngoscope with this gizmo.”
Once the LMA was in place, Phil immediately reached for his bronchoscope and slipped the flexible tube down Robbie’s trachea for a quick look-see.
“See that?” he said to Stephanie, who took turns intently watching the procedure on the digital TV screen, keeping track of the heart and BP monitor readings, and watching Robbie in the flesh. Sure enough, due to softened cartilage, his trachea showed signs of floppiness and collapsed while he breathed under the sedation. The same thing happened while he slept each night. “This is classic TBM.” Keeping things short and sweet, and already having digitally recorded his findings, Phil removed the scope and quickly followed suit with the laryngeal mask airway. Even though sedated, Robbie coughed and sputtered. “All the kid needs is continuouspositive airway pressure while he sleeps, so he won’t have to cough every time his trachea collapses.”
“That’s great news,” Stephanie said, watching Robbie like an anxious mother hen.
True to the short-life drug effect, Robbie started to come out of his stupor. “There you go, buddy, we’re all done,” Phil said. He bent over and looked into his blinking eyes. “Are you in there somewhere?”
The bleary-eyed Robbie tried to look in the vicinity of his voice. Phil set the scope on the counter and prepared to wipe it clean before putting it in the sterilization solution overnight.
“Can you watch him a few minutes while I clean up?” he asked.
She nodded, undoing her mask and letting it hang around her neck, though keeping a safe distance from Robbie.
As with many recently sedated children, Robbie woke up confused, fussing and crying. Phil worked as quickly as he could. “You’re okay, Rob. I’m right here, buddy,” he said. The boy seemed to calm down immediately. Phil smiled, assuming the sound of his voice had done the trick, but when he glanced over his shoulder, he saw a sight that made him smile even wider.
The I-don’t-do-kids doctor was holding Robbie’s hand and patting it.
“You at all interested in getting takeout and keeping me company tonight while I help my kid brother recover from major surgery?” He’d lay it on thick, and hope for the best.
She remained quiet for a few seconds, then let go of Robbie’s hand.
“I can’t, Phil. I’m sorry.”
On Wednesday
“No offense, but I only use Propofol when I have an anesthesiologist working with me.” He smiled at her through his mask.
She tossed him a sassy look. “Believe me, no offense taken, I already feel out of my element here.” With skilled and efficient hands she titrated the drugs into the IV as he applied the topical numbing spray toRobbie’s throat, and within seconds Robbie drifted into twilight sleep.
“I called ahead to the preschool to hold his lunch, but Robbie loves to eat so much he almost snuck a snack around three today. Fortunately, they caught him, so we shouldn’t have a problem with emesis.” He flipped on the suction machine, using his elbow to protect his sterile gloves. This would be his backup contingency plan in case Robbie did vomit.
“I’m going to use a pediatric laryngeal mask airway instead of an endotracheal tube.” He showed her the small spoon-shaped device. “As Robbie has the typical shortened Down syndrome neck, an endotracheal tube would have been tricky anyway,” he said as he lubricated the tablespoon-size silicone mask and slipped the tube inside Robbie’s slack mouth. The boy didn’t flinch. “See? I don’t even need a laryngoscope with this gizmo.”
Once the LMA was in place, Phil immediately reached for his bronchoscope and slipped the flexible tube down Robbie’s trachea for a quick look-see.
“See that?” he said to Stephanie, who took turns intently watching the procedure on the digital TV screen, keeping track of the heart and BP monitor readings, and watching Robbie in the flesh. Sure enough, due to softened cartilage, his trachea showed signs of floppiness and collapsed while he breathed under the sedation. The same thing happened while he slept each night. “This is classic TBM.” Keeping things short and sweet, and already having digitally recorded his findings, Phil removed the scope and quickly followed suit with the laryngeal mask airway. Even though sedated, Robbie coughed and sputtered. “All the kid needs is continuouspositive airway pressure while he sleeps, so he won’t have to cough every time his trachea collapses.”
“That’s great news,” Stephanie said, watching Robbie like an anxious mother hen.
True to the short-life drug effect, Robbie started to come out of his stupor. “There you go, buddy, we’re all done,” Phil said. He bent over and looked into his blinking eyes. “Are you in there somewhere?”
The bleary-eyed Robbie tried to look in the vicinity of his voice. Phil set the scope on the counter and prepared to wipe it clean before putting it in the sterilization solution overnight.
“Can you watch him a few minutes while I clean up?” he asked.
She nodded, undoing her mask and letting it hang around her neck, though keeping a safe distance from Robbie.
As with many recently sedated children, Robbie woke up confused, fussing and crying. Phil worked as quickly as he could. “You’re okay, Rob. I’m right here, buddy,” he said. The boy seemed to calm down immediately. Phil smiled, assuming the sound of his voice had done the trick, but when he glanced over his shoulder, he saw a sight that made him smile even wider.
The I-don’t-do-kids doctor was holding Robbie’s hand and patting it.
“You at all interested in getting takeout and keeping me company tonight while I help my kid brother recover from major surgery?” He’d lay it on thick, and hope for the best.
She remained quiet for a few seconds, then let go of Robbie’s hand.
“I can’t, Phil. I’m sorry.”
On Wednesday
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