Anyone feel like they are going to have Montezumas revenge in OR?

[G0S2]

Happened twice to me so far. Today. Sudden and panic mode. Opened door and grabbed buddy anesthesiologist walking down hall. Just a nightmare.

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[HollywdAnesth]

We had a CRNA where I trained with a bad prostate. If he didn't get a break every hour, you'd find him peeing in the trash can.

I've had to sprint out of cases before. I have handed the circulator a syringe of phenylephrine and said give 1cc if the pressure drops, I'll be back in 10 minutes.

 

[scudrunner]

HAHAHAHAHAHA, that sucks! Hadn't considered this situation before now

 

[jeffblue]

Not the greatest specialty if you have irritable bowel syndrome or over active bladder. If thats what it is. Becuase there are many times when there are NO BREAKS for t he foreseeable few hours, period. Unless you run out of the room and tell the nurse sit here until i come back which i believe is frowned upon at the asa for the past 15 years or so.

 

[IveGotTwins]

http://www.stadiumpal.com/what-works.html

#2 would be much more problematic obviously.

 

[Philosiraptor]

Depends.

 

[Jalopycat]

A couple of months ago I was in the OR and started having heartburn/stomach pain mid-morning. By the afternoon I had severe epigastric pain and was doing cases slumped over the anesthesia machine drenched in sweat. I've never been in so much pain in my life and there wasn't anything I could do because we kept getting add-ons (it was a Friday). When I finally got finished around 4pm, one of the surgeons took a look at me and could palpate my appendix it was so big. My white count was 21,000. Got an appendectomy that night and went back to work 3 days later.

 

[chocomorsel]

A couple of months ago I was in the OR and started having heartburn/stomach pain mid-morning. By the afternoon I had severe epigastric pain and was doing cases slumped over the anesthesia machine drenched in sweat. I've never been in so much pain in my life and there wasn't anything I could do because we kept getting add-ons (it was a Friday). When I finally got finished around 4pm, one of the surgeons took a look at me and could palpate my appendix it was so big. My white count was 21,000. Got an appendectomy that night and went back to work 3 days later.

This really sucks. You couldn't do anything? Tell anyone/colleague, call in a backup/post call from home to help out? You were possibly going into sepsis but just had to keep going? Because you had no other choice as the surgeons were piling on the cases? I think there's something wrong with this.

 

[Spinach Dip]

I knew a female spinal surgeon who would foley herself before long cases so she wouldnt have to scrub out and back in. (No joke.)

I suppose for men it would be easier, what with condom caths and stadium pals and such.

But for sudden, explosive diarrhea... I have no idea. There's got to be some sort of acceptable answer... (This information wasn't part of your residency training?)

 

[Jalopycat]

This really sucks. You couldn't do anything? Tell anyone/colleague, call in a backup/post call from home to help out? You were possibly going into sepsis but just had to keep going? Because you had no other choice as the surgeons were piling on the cases? I think there's something wrong with this.

Well it does sound messed up but it's partly my fault. The surgeon saw me in the lounge laying down in between cases earlier that day and offered to take a look at me, but I didn't want anyone making a fuss over what I thought was clearly "the world's worst indigestion". Obviously I wasn't thinking straight. Indigestion doesn't make you roll around on the floor sweating and shaking. Had I accepted some help earlier, I'm positive back up would have been called in-I was just being stubborn. The only reason I got help in the end is because I hurt too bad to drive. But yes, somebody earlier in the day should have overridden me and gotten a replacement. It all worked out how it should have though: if I had gone home like I wanted to it would have ruptured so it was really a blessing I got busy. Even after the surgeon insisted it was my appendix, I didn't believe him and told him I really wanted to go home. Thank God he didn't let me go. It's just I NEVER get sick and I couldn't believe I could be that sick in just a few hours. It's all good though, I'm a tough lady. I was back to running a week later and since then I've run 2 5 K's, 2 10 K's, and a half marathon.

 

[chocomorsel]

Awesome!!! Thought by your post you were a man. Haha. Tough chica!

Well it does sound messed up but it's partly my fault. The surgeon saw me in the lounge laying down in between cases earlier that day and offered to take a look at me, but I didn't want anyone making a fuss over what I thought was clearly "the world's worst indigestion". Obviously I wasn't thinking straight. Indigestion doesn't make you roll around on the floor sweating and shaking. Had I accepted some help earlier, I'm positive back up would have been called in-I was just being stubborn. The only reason I got help in the end is because I hurt too bad to drive. But yes, somebody earlier in the day should have overridden me and gotten a replacement. It all worked out how it should have though: if I had gone home like I wanted to it would have ruptured so it was really a blessing I got busy. Even after the surgeon insisted it was my appendix, I didn't believe him and told him I really wanted to go home. Thank God he didn't let me go. It's just I NEVER get sick and I couldn't believe I could be that sick in just a few hours. It's all good though, I'm a tough lady. I was back to running a week later and since then I've run 2 5 K's, 2 10 K's, and a half marathon.[/quo

 

[Jalopycat]

Nope I'm a She. I'm the only female in my group so I make a point to be tough and not be the weakest link. I was hoarse for 5 days after my surgery. My poor seasoned colleague said I was pretty anterior and my cords got banged a bit during the RSI. Kinda funny. And I was told I laryngospasmed a bit when I was extubated.

 

[Spinach Dip]

Nope I'm a She. I'm the only female in my group so I make a point to be tough and not be the weakest link. I was hoarse for 5 days after my surgery. My poor seasoned colleague said I was pretty anterior and my cords got banged a bit during the RSI. Kinda funny. And I was told I laryngospasmed a bit when I was extubated.

I have a question that I have discussed many times with people in the medical field. I know it is off-topic from the original point of this thread, but maybe you could humor me and give me your thoughts.

Do you think that being on the other side of the knife has made you more able to sympathize/connect with your patients? Has it changed your view on healthcare?

Thanks, and sorry for the tangent.

 

[Jalopycat]

Not really. The only thing I'm more sympathetic about after my experience is all the stuff the patient has to sign and fill out. After being giving morphine, I got very confused filling out the anesthesia questionnaire, and it's a form I pretty much have memorized. I also messed up the surgery consent form. So now if the paperwork is completed wrong or stuff is left off, I completely understand why.

 

[pgg]

Do you think that being on the other side of the knife has made you more able to sympathize/connect with your patients? Has it changed your view on healthcare?

It's influenced my practice. After suffering through some post-succinylcholine total body myalgia pain that was worse than my surgical pain, I don't use succinylcholine unless I have a solid indication for it (RSI and not much else).

The myalgia was so bad I thought maybe I'd coded and had chest compressions that knocked me off the OR table and down a flight of stairs.

 

[Colba55o]

It's influenced my practice. After suffering through some post-succinylcholine total body myalgia pain that was worse than my surgical pain, I don't use succinylcholine unless I have a solid indication for it (RSI and not much else).

The myalgia was so bad I thought maybe I'd coded and had chest compressions that knocked me off the OR table and down a flight of stairs.

Just out of curiosity, what do you use for short laparoscopic cases instead of succinylcholine? Say a lap appy in a young muscular man, or a frail old person who wont tolerate being very deep to get adequate relaxation? What about patients with OSA, wide necks, and likely difficult airways? Or patients with bad PONV who you would rather not give reversal agents to? Seems impressive to only use sux for RSIs.

 

[pgg]

Appendectomy usually deserves an RSI and I'll use succ. Patients that I want to intubate quickly after induction, usually because they're obese and will desaturate quickly, but I DON'T think they'll be a difficult airway, those people I'll often RSI and use succ with them; you can't beat it for fast optimal intubating conditions and the myalgias are a secondary concern.

I find that frail old people don't often need much relaxant at all, either for intubation or whatever procedure. Propofol + preemptive phenylephrine will get most of them deep enough to tube while staying stable enough.

Likely difficult airways I don't induce and paralyze. If they need relaxant for the surgery they can get it after the tube is in.

Short lap cases I tend to intubate with a reduced dose of roc (.3/kg or so), mask ventilate with volatile for a minute or two to let it work. They're reversible from the start.

Bad PONV patients I give dexamethasone, ondansetron, and droperidol to; if I know about them far enough in advance I'll give them Emend or a scop patch preop. And I'll try to avoid neostigmine reversal or at least minimize the dose. No perfect answer.

If I can avoid succ and be safe I will, if I need it I'll use it. I don't find that I need it that often though.