This was the third time I went to the RTU (rapid treatment unit) with Andrew for an aspirate. I was pretty used to the protocol by now that I would bring Andrew into the room for the surgery, and be with him when they put him under. They gassed him the first time, used Remifentanil through his broviac line the second time, and used Remi again this last time. He was fighting it, so I stayed a bit longer than the last time to try to keep him from rolling off the table. The nurse said she would take over, so I left as usual. Apparently, only moments after I left, he started having a reaction to the Remifentanil that made his chest wall muscles become so rigid he couldn't breathe. They told me his oxygen dipped, so they had to intubate him until the drug had metabolized, then his muscles relaxed and they took him off the oxygen. They told me if he had become more rigid, they would have given him a paralytic and kept him intubated. Apparently you can develop a sort of resistance to these drugs so that you'll need more of the drug to have the same sedative effect, but the amount they used on Andrew was too much for him. Muscle rigidity is a known side effect of this drug to everyone when administered at high levels, but now along with morphine and codeine derivatives, we'll have to cross the fentanyl family off the list. This is not a great thing because it's a pretty big family of drugs.
I am glad for the protocol the doctors used in this situation--first, that they didn't have me in the room during the procedure even though it is routine, because I would have totally panicked. Secondly, I'm so glad the anesthesiologist took me in the room where Andrew was before he started telling me everything so I could see he was okay instead of panicking, wondering if he was really okay. I was only half listening to what he was saying anyway, and I wouldn't have listened any better outside the room.
This was a not-so-gentle reminder to me of the seriousness of Andrew's condition. That if just one little thing goes amiss, it can have life-threatening consequences. I know Andrew is a whole heck of a lot less maintenance for me than some other kids in the ICS, but I just hope I don't do something stupid like forget to ethanol his lines when I flush them, or forget to give him his oral meds, or get him around someone who's sick, or just something that will land us in the PICU.
Anyway.... It turns out he's still on track for his height, but he's dropped a few percentiles in weight. It is true his appetite hasn't been up to par this last round, and I know it'll only get harder, but we're just grateful he hasn't lost weight so far. He's been holding strong at around 18 pounds, so our job is to fatten him up as much as we can over the weekend before he starts chemo on Monday.