At some point during the past year and a half year of my medical training, I fell in love with anaesthetics. I think the attraction is due to a combination of the common scientific territory that it shares with my undergrad major (neuroscience); the largely controlled nature of the field ("control-freak" here!!); the fact that it has changed surgery in a way that only the invention of antibiotics can rival; and the quirky combination of theory and prac work involved. So it was without hesitation that I took up the opportunity to hang out with the anaesthetics team during today's dental surgery list at the hospital. The procedures (mostly extractions) were done by a visiting dentist who comes up from Bathurst to Mudgee once a month; while the anaesthetist was a local GP-anaesthetist (Dr L) from the team of five at the medical centre.
All up, there were five procedures - three children and two adults - done under a GA. I was hoping to get a chance to intubate but when it came to it, I didn't feel comfortable practising something I didn't know very well on children (and unfortunately the adults had class III and IV airways, so again, not ideal for practising on!!). But no big deal - there'll be plenty of opportunities to practice in due time. I still got to cannulate and take bloods off patients before their procedures; plus I was assigned to "check-lung-sounds-are-present-and-equal-post-ETT-insertion" duty :-P
They say that anaesthetics is like flying a plane - smoooth execution of take-off and landing are crucial and make up the majority of the anaesthetist's role. Part of the take-off involves calming the patient down and reassuring them - no easy task in adults, let alone children. Luckily I'd gotten some insider tips from my good friend Andre who is an anaesthetics nurse, particularly in the way of making the induction like an adventure for the kiddies: "Hey kid, would you like to go into outer-space?" *Cue overhead lights* "Whao! Your rocket is ready! Just put on this astronaut (gas) mask and off we go counting down for lift off - ten! nine! eight! seven! six!...". They're asleep before five! Pretty neat stuff, yeah? Of course the landing is somewhat trickier :-S People tend to get quite irritable and aggitated after a GA - they'll try to sit up and some trash about wildy. This is where it helps to have strong and sturdy assistants around (particularly if, like me, you're not so yourself)... or else start working on upper body strength if you're planning on going into anaesthetics cos you sure as hell will need it!
Throughout the day Dr L gave me little tutes on the drugs he was using. My favourite is Suxamethonium because you can actually see it working it's way up the body via fasciculations that travel from the toes to the eyelids. Light sedation with Ketamine is also pretty interesting, especially if you have any conversations with the person during the procedure and then ask them what you talked about after the K has worn off. Twisted ;-P What's your favourite?
With some dental procedures they do nasal tubes as well. Those are cool. Not cool was when we had a load of bis sensors not working. But the general coolness of anaesthesia did dominate.
ReplyDeleteYeah, with the class IV airway case, the anaesthetist tried to insert a nasal tube - it didn't work unfortunately and when he pulled it out it was covered in blood :-S He then had to resort to ETT intubation (which was going to make things harder for the dentist because it was a full-set clearance :-O
ReplyDeleteAnaesthetics rocks my socks, that's for sure!