Anesthesia Elective: Part II
Once the patient is asleep, you’re feeling confident so you toss a large bore IV in the patient that we will use to transfuse blood or bolus fluids if needed.
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Once the patient is asleep, you’re feeling confident so you toss a large bore IV in the patient that we will use to transfuse blood or bolus fluids if needed. 〰️
It’s your second week on the rotation, our second time working together. Today’s case is an all-day affair spine case with neuromonitoring. Before we go see the patient, I take you through the infusion pumps that will be delivering our anesthetic for the day - propofol, remifentanil, lidocaine, and phenylephrine.
When we go to see the patient, you tell me you’ve practiced a few IV’s in the past week. So I let you put this one in and you keep your successful IV streak alive.
As we slide the patient over to the operating table, you help place the monitors on the patient and start the preoxygenation process. This time when you intubate, you do it with direct laryngoscopy, talking us through everything you see. Once you visualize the vocal cords, you smoothly place the breathing tube without ever rushing in the process.
Once the patient is asleep, you’re feeling confident so you toss a large bore IV in the patient that we will use to transfuse blood or bolus fluids if needed. Then I take you through placing an arterial line using the ultrasound to find the tip of your needle and follow it into the lumen of the artery.
Once we flip our patient prone, hook up our IV infusions, and catch up on charting, we head out for our morning coffee break. After catching up with some of my co-residents, we head back to the OR. Time for my second-favorite “back-of-the-napkin” lecture, “hypoxemia”. Again, my biggest goal is at the end for you to be able to rattle of the 5 causes of hypoxemia: low FiO2, hypoventilation, V/Q mismatch, R->L shunt, and diffusion abnormalities.
If I get the sense that you’re into anesthesia, this usually lends nicely to then going over all the numbers and knobs on the ventilator. I’ll show you in real-time how we can manipulate the end-tidal CO2 by changing the minute ventilation and how FiO2, PEEP, and a recruitment breath can improve oxygenation. At this point, I’ve definitely talked your ear off so you’ll get a nice early dismal right around lunch time to enjoy the rest of your day!
