Baheti Sandip1
Diabetes is very common now-a-days. Incidences of diabetes are increasing day by day. If not managed properly it is a slow killing disease. Its detrimental effects on various organs are not revealed clinically during initial course of disease. Tendency of patients to take diabetes casually makes this disease more complicated. Because of tendency of patients to change physicians frequently, it is difficult for subsequent physicians to judge overall course of diabetes and its control. Fifty years old obese patient with ASA II was posted for open cholecystectomy. Intraoperatively blood pressure rose to 160/100 but managed with iv sedation midazolam and little increasing concentration of isoflurane. Total procedure was uneventful. Reversal started after slight attempt of respiration but even after reversal tone of muscle was inadequate. Additional dose of 0.75 mg of iv neostigmine was tried, but it was not helpful. Tone of muscles and respiration was not adequate to extubate. Dose of calcium gluconate was also tried but was not helpful. Adequate time was also given for spontaneous recovery but was not helpful. Decision to shift patient on ventilator on SIMV mode was taken. Additional dose of midazolam 2 mg was given. Patient came out of ventilator after 10-12 hrs later. After thorough search of cause, neostigmine tablet was found at his home- which patient was considering as tablets to decrease blood sugar level i. e. OHD. All this happened due to change in physician. New physician told him to stop all OHD and shifted him on insulin. Patient stopped neostigmine tablet also considering it as OHD. WHY NEOSTIGMINE WAS STARTED? WHERE WAS GAP DURING HISTORY TAKING? ->
