Cardiac: how long should it take...

[deleted171991]

No, but the surgeons' and OR nurses' opinion of the anesthesiologist that can do 7:49 as opposed to 7:59 will get a boost.

Until the next case.

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[Ignatius J]

It's really more for our own benefit than the patient's. After doing things for awhile everything becomes routine. I think a lot of people who do cardiac are looking for more challenge. Timing ourselves, refining technique, streamlining the process are all ways to keep things interesting and fun. And when it's necessary to do things quickly and efficiently, it's good to have practiced.

As long as we can admit it's in good fun.

 

[deleted171991]

It's really more for our own benefit than the patient's. After doing things for awhile everything becomes routine. I think a lot of people who do cardiac are looking for more challenge. Timing ourselves, refining technique, streamlining the process are all ways to keep things interesting and fun. And when it's necessary to do things quickly and efficiently, it's good to have practiced.

There is a difference between wanting to and having to.

Just for challenge, I used to do my short (peri)anal surgery cases without an airway, the goal being no laryngospasm on dilatation (give it a try once, especially when teaching a resident about laryngospasm). It made me better at TIVA with natural airway, and it made me look cool, with just the nasal cannula. Me and the fastest cataract surgeon used to race the other rooms, for fun, finishing hours ahead, . I used to time myself; door to anesthesia-ready for outpatient GA had to be under 10 minutes (usually much less). It was just part of my professional pride, the same as using NC where others were using LMAs, or LMAs where others ETTs.

But if I had to do it that way every single case, busting my back for an ungrateful arrogant cardiac surgeon, I would hate my job.

There is a difference between wanting to and having to...

 

[Ignatius J]

No, but the surgeons' and OR nurses' opinion of the anesthesiologist that can do 7:49 as opposed to 7:59 will get a boost.

I don't agree with that.

I guess you just have to make sure you aren't being frantic about it. The general reaction I see of a frantic pace is "why doesn't this guy calm the hell down?" It's like the anesthesiologists want to absorb themselves into the personality of the heart room.

Now being slow is one thing, but timing yourself and that stuff just seems a bit silly. I try to do it right and don't piddle paddle. Otherwise, my eyes don't look at the clock.

I would hope if I were a patient that the OR personnel left their stopwatch at home too.

 

[periopdoc]

Honest question, did the patient benefit from 7:49 as opposed to 7:59?

Perhaps you have me confused with someone who puts a lot of stock in these times.

As I said before, I'm not interested in a pissing match over times. I was just posting a real-world example of how long it took me to start the case that I happened to be doing on the day I responded to this thread. I figured it was an accurate example to compare to the estimated times that were viewed with some skepticism.

Given the "honest" nature of your inquiry and subsequent comment, I will point out that this was neither rushed nor frenetic, two detestable qualities.

In fact, after two weeks off, much of the post-induction time was spent catching up with the perfusionist and the circulators. Mostly we were chatting about our off-season bow tuning activities in preparation for the fall elk season.

This particular patient neither benefited from, nor was harmed, by 49 vs 59. I have cared for tenuous patients who likely did benefit from me completing procedures efficiently so I could get back to focusing on their hemodynamics.

As to the "stopwatch" barb, I was taught to document the entire case contemporaneously with times included. I continue to do so to this day. It can be handy when you try to recollect a sequence of events should you ever need to present the case to, say, a peer review or a deposition. Computerized charting now makes it simple to do. To post the times in this thread, all I had to do was pull up the existing anesthetic record and copy the times.


-bsd

 

[periopdoc]

"Frenetic" reminds me of a conversation I had with one of the chief residents during my intern year. She pulled me aside to let me know that some of the attendings were concerned that I was either bored or oblivious because of my completely flat reaction to some SHTF situations in the OR.

I took it as a complement.

For those who don't recall, I did a Gyn/OB internship.

-bsd

 

[Ronin786]

"Frenetic" reminds me of a conversation I had with one of the chief residents during my intern year. She pulled me aside to let me know that some of the attendings were concerned that I was either bored or oblivious because of my completely flat reaction to some SHTF situations in the OR.

I took it as a complement.

For those who don't recall, I did a Gyn/OB internship.

-bsd

I had an attending tell me that about a month ago. Guess that might not be something I need to work on.

 

[WholeLottaGame7]

I had an attending say something similar when I was a resident. I told her I was glad I appeared that way because I certainly didn't feel that way on the inside. Then she compared me to a duck, because it looks like they are peacefully floating on the water, but paddling furiously underneath. I laughed, and also took it as a compliment.

Just make sure it's not because you're oblivious. I've walked into a few situations with residents or CRNAs where they were super chill because they didn't realize the gravity of the situation.

 

[pgg]

For those who don't recall, I did a Gyn/OB internship.

Well I'm sure they created plenty of exposure to SHTF situations.

Glad to see you posting lately.

 

[NOsaintsfan]

I can do it in 7 minutes. Taping the eyes after finishing preop interview saves me 30 seconds. I save another 30 seconds by inducing from a drained 50ml saline bag that I have filled with my induction meds. I have my 3rd anesthesia tech open the piggyback after I stick the radial. Number 2 is connecting the tubing to the a line. I just leave the wire in the artery and let her handle the rest. Number one holds cricoid and mask ventilates if number 3 opens the piggyback to early.

This ^^^

 

[sevoflurane]

Perhaps you have me confused with someone who puts a lot of stock in these times.

As I said before, I'm not interested in a pissing match over times. I was just posting a real-world example of how long it took me to start the case that I happened to be doing on the day I responded to this thread. I figured it was an accurate example to compare to the estimated times that were viewed with some skepticism.

Given the "honest" nature of your inquiry and subsequent comment, I will point out that this was neither rushed nor frenetic, two detestable qualities.

In fact, after two weeks off, much of the post-induction time was spent catching up with the perfusionist and the circulators. Mostly we were chatting about our off-season bow tuning activities in preparation for the fall elk season.

This particular patient neither benefited from, nor was harmed, by 49 vs 59. I have cared for tenuous patients who likely did benefit from me completing procedures efficiently so I could get back to focusing on their hemodynamics.

As to the "stopwatch" barb, I was taught to document the entire case contemporaneously with times included. I continue to do so to this day. It can be handy when you try to recollect a sequence of events should you ever need to present the case to, say, a peer review or a deposition. Computerized charting now makes it simple to do. To post the times in this thread, all I had to do was pull up the existing anesthetic record and copy the times.


-bsd

Yeah. Efficient doesn't translate to neither rushed or frenetic.

I can tell you this, for those of us who have been in an eat what you kill set up, the combined efficiency of a fast and talented surgeon along with a fast and talented team that knows how to turn over a room and get things going equals a short day for everyone with good returns on efficiency investment. Everybody wins.
You do more cases per hour and you go home earlier. What's not to like?

I love watching some of our surgeons work... the conservation of movement is truly remarkable.

 

[periopdoc]

Well I'm sure they created plenty of exposure to SHTF situations.

Indeed. I'm pretty certain I know the exact attending and case that fostered the discussion.

We had a c-section where there was some collateral damage and significantly more than expected bleeding. While I was placing the stitch that ultimately stopped the bleeding, I mentioned to the attending that, "If we leave him (anesthesia) alone, perhaps he could focus on getting the blood in the room and into the patient." She was so focused on mercilessly haranguing the poor resident about the blood that I was operating solo at that point, and the anesthesia resident couldn't break off the conversation to actually do things like check and hang blood.

I'll give her this, I learned a lot from her, much like I learned a lot from the anesthesia attending who shared many similar personality traits. Neither could understand why they were such $@t magnets.

Congrats on the fellowship. Glad the gov finally came to its senses.

-bsd

 

[tracheatoedoc]

What I find is that once the patient enters the room, it takes at least 5 minutes for the staff to get the patient over to the OR table and apply monitors. I pre oxygenate for 1 min and induce, I generally place an art line after intubation, and that can take anywhere from 1 to ? minutes. You have to remember that the OR staff is involved in all of these steps, and not in any hurry. I wash my hands for at least 5 minutes before inserting a central line, sometimes closer to 10 if I am chatting with someone in the hall. Insertion of the CVL is usually quick, then the staff gets the swan connected and I float it. If everything is perfect, it takes 25 minutes to get to this point

 

[Chloroform4Life]

5 minutes?

Most surgeons don't even take 2 minutes to scrub.

 

[periopdoc]

The hand gels are faster and superior anyway (assuming you did a basic handwashing since doing anything really dirty like your morning constitutional)

-bsd

 

[urge]

The hand gels are faster and superior anyway (assuming you did a basic handwashing since doing anything really dirty like your morning constitutional)

-bsd

Are you a morning person too?

Is it common among anesthesiologist?

There are some big problems later on if I skip it.

 

[periopdoc]

Hahahahaha

Yes. I would assume so. Me too.

 

[Stank811]

My personal fastest time was 22min from in the room to having art line, introducer, swan, SC TLC and TEE placed. Times are possible with HELP. But usually around the 30min range. I don't prep or prepare anything just responsible for the procedure themselves and most everything that can be is handed to me or waiting. But then of course we leave the room 5 hours later for 3-4CABG etc...so doesn't bother to much if my lines take 10-15min more as long as they are done right and without pt harm.

 

[tracheatoedoc]

5 minutes?

Most surgeons don't even take 2 minutes to scrub.

I scrub my hands well, and generally chitchat with people passing by the sink. It's not a race