A Bump in the Night

Last night was rough. Following the surgery little Alasdair has been in some pain. The look on his face is just awful. He's not moving much, I think to do so hurts. His heart rate was up over 200 bpm until this morning. They have him on morphine for the pain, but it's a double-edged-sword for him right now. They cannot give him very much, he's just too little, too young. And morphine is a 'respiratory inhibitor' meaning that it can make it difficult to breathe. Nonetheless, the nursing team bumped him up a little from his base dosage. He was approved for 10-30 micrograms per kilogram of weight per hour. When he arrived back at the room from recovery he was at 10. Within a couple of hours they bumped him up to 20 then around 10pm they bumped him up to 30, for his heart rate just wasn't dropping. Once at 30 his heart rate did finally begin to drop, to about the 180-190s.

This morning, around 3:30am it seems he coughed up a little something that blocked his airway. He either didn't have the will or ability to clear it. Quickly his O2 saturation began to drop significantly (as detected by his glowing toe). It dropped all the way to 23% (from his normal 100%) and all sorts of alarms went off in the room and throughout the wing. Swarms of doctors and nurses converged on him very quickly. I was initially just confused, having finally dozed off and re awoke to 19 new faces in the room (yep, I counted) there were 5 or 6 more people outside too, I think about 30 people total came milling through here during the next hour.

They gave him some two doses of narcan, a drug which reverses the effects of opiates, and which certainly kick started Alasdair. He began breathing normally right away, though it also shot his heart rate back up quite high into the 220s and he was demonstrating a reaction to pain again. They monitored him very closely for the next couple of hours. Slowly they began to ease the morphine back again to help him manage.

And that's where we will be for the next day or so while he continues to recover: walking this tightrope of easing his pain, but remaining very cautious not to give too much. He is currently doing just fine, sleeping normally. His morphine is back down at 10mcg/kg/hr and his heart rate is down to a very normal 160 (or so) and his breathing is much smoother. As another comfort they did remove his naso-gastric tube (the one that yields that adorable green gunk). One less thing to block breathing. They have also removed the i.v. line in his scalp and will remove another they put in his arm during surgery shortly. He also needs to get his fluids back up, it seems there was some bloodloss during surgery and he's looking pale. This morning they have administered two additional boluses of regular saline, boosting his fluids is another way they can bring his heartrate down. Seems to be working.

So, once again, Alasdair is doing well. I don't think there will be much more cause for worry at this point. Last night was just one more bump in the road, but it's past and I am looking forward to seeing him get back to a more normal routine for a 10 day old.

Jess will be coming down tonite, and relieving me here. I'll head back home and stay with the girls for the next several days while Jess remains at the hospital. Hopefully he can begin feeding soon.

Oh, and he pooped! A very good sign. Sorry, I didn't take a picture.