“Upon inspection of the IV site, a swollen and mottled hand was noted.”
Patient: older adult male
Diagnosis: cerebral aneurysm
Procedure:embolization in interventional radiology
PMH: malignant HTN, Type 1 diabetes, BMI>30
Plan: General anesthesia, ETT
An older adult male, ASA III patient presented for urgent angiography embolization of a cerebral aneurysm in the interventional radiology (IR) suite. The patient’s past medical history included malignant hypertension, type 1 diabetes, and a BMI of greater than 30 kg/m2. Anesthesia was provided by an anesthesia care team. The preoperative anesthesia assessment was completed quickly and informed consent was obtained from the patient’s family. An indwelling, clamped 22 ga peripheral IV was noted in the patient’s right hand, assumed to have been placed on the floor, but there was date or time of placement marked on the dressing.
The patient was taken to IR suite and positioned on the table with his arms tucked at his sides. The interventional neuroradiologist was pacing back and forth in the room, implying that the anesthesia team needed to ‘hurry’. Standard monitors were applied and the patient’s initial vital signs were recorded. The existing peripheral IV was connected to the infusion set primed with 0.9% NaCl. The patient winced and grimaced with the initial IV flush and there was notable resistance to the injection. The resistance cleared with moderate pressure on the flush syringe and the IV fluid began to drip sufficiently.