Ok

Here is the quick info:

50's pt normal wt & height no allergies

Hx: myasthenia gravis, fibromyalgia, anxiety, high tolerance to narcotics
Rx: Plasmapheresis Bimonthly, vitamins, xanax

Severe PONV with anesthesia

Brought to the OR to reopen a fistula which was placed for Plasmapheresis

Pt given following meds:

Holding area: 2 mg midaz, 1 mg dilaudid (with little effect)

In OR typical induction: Propofol, 1 mg dilaudid -> LMA
Maintenance = Tiva prop gtt

pt spontaneous resp @ 15

Case takes 1.5 hours and in the last 30 minutes surgeon causes some ectopy with the wire. You mention it surgeon withdraws wire and ectopy seems to go away. Then more ectopy, surgeon checks with fluro and withdraws wire, ectopy does not go away and you see the EKG strip attached. (click to make larger)

What now?

Intraop.jpg