Do you need steady hands?

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Your hands are unsteady ... why? Nervousness? You quit drinking 48 hours ago?

I knew an anesthesiologist with early onset Parkinsons, who kept working after having a deep brain stimulator put in.

I suspect you'll be fine, like all the people who once fainted at the sight of blood who went on to be surgeons.
 
pgg said:
Your hands are unsteady ... why? Nervousness? You quit drinking 48 hours ago?

I knew an anesthesiologist with early onset Parkinsons, who kept working after having a deep brain stimulator put in.

I suspect you'll be fine, like all the people who once fainted at the sight of blood who went on to be surgeons.
Click to expand...

Side note. As of last year, he has been asked by his partners to step down from clinical work.
 
Years ago I had a resident with an unbelievable tremor. I don't know if he was drinking too much coffee, or had an essential tremor, or what... but the tremor didn't seem to interfere with his work nearly as much as I had feared it might.
 
Thx for the replies. Yeah, I think I drink to much caffeine combined with a natural small tremor. Or maybe I'm getting nervous the first time I'm doing stuff 3rd year.

Thx

Maybe I will cut caffeine and see if that helps.
 
happygilmore said:
Thx for the replies. Yeah, I think I drink to much caffeine combined with a natural small tremor. Or maybe I'm getting nervous the first time I'm doing stuff 3rd year.

Thx

Maybe I will cut caffeine and see if that helps.
Click to expand...

My friend,

You have to learn how to relax...
Before you wheel the patient to the room sit down, take a deep breath, and think of something pleasant... like graduating and finding a job making big bucks
Close your eyes and inhale deeply, learn how to meditate
Remember... you will not kill anyone today... you are a competent doctor... and you can do this.
This is not rocket science... it's simple and it's safe... a nurse can do it so you too can.
There is no rush.. tune out all the crap and noise and just focus on enjoying what you can do...
Seek the pleasure of observing your magic in action... look at the patient slipping into peaceful sleep... help them relax and make it pleasant and safe.
Focus on the patient not on yourself
Think of yourself as the gate keeper who will take this patient's hand and guide them through this wonderful experience.
Always remember to breath deeply and admire the amazing results of your work.
 
psychbender said:
Side note. As of last year, he has been asked by his partners to step down from clinical work.
Click to expand...

Assuming we're talking about the same person (I can't imagine that there are many) I'm impressed he was able to practice so long. It was 2008 when I knew him (I was a resident).

Great guy, wonderful teacher.
 
I hope my anesthesiologist has steady hands if I ever need an A-line.
 
pgg said:
Assuming we're talking about the same person (I can't imagine that there are many) I'm impressed he was able to practice so long. It was 2008 when I knew him (I was a resident).

Great guy, wonderful teacher.
Click to expand...

I am assuming we are speaking of the same person, as those in your former program rotate at a certain hospital near my former program, where we also rotate. It was always fun working with him, and amazing to see just what he can still do. I can understand the issues that others had, though. I think he was staying on there in a teaching/admin role, only.
 
During sressful intubations, the hands of one anesthesiologist i know shake like crazy.
He gets the tube in on the first try every time, and is the head of anesthesia at our hospital.
 
Just practice a lot and you will be fine
Operation_Game_1965_Milton-Bradley_4545_web.jpg
 
happygilmore said:
Thx for the replies. Yeah, I think I drink to much caffeine combined with a natural small tremor. Or maybe I'm getting nervous the first time I'm doing stuff 3rd year.

Thx

Maybe I will cut caffeine and see if that helps.
Click to expand...

Titrate propranolol to desired effect. Seriously.
 
my hands shook when i was a medical student and intern - now - smooth as butter. you'll be fine.

desensitization.
 
gasattack3 said:
Titrate propranolol to desired effect. Seriously.
Click to expand...

Good point. I wonder what long term effects a low dose might have.

Will look into this.

slavin said:
my hands shook when i was a medical student and intern - now - smooth as butter. you'll be fine.

desensitization.
Click to expand...
Yeah, I think I'm anxious or trying to hard. Definitely not relaxed. Thx
 
happygilmore said:
Thx for the replies. Yeah, I think I drink to much caffeine combined with a natural small tremor. Or maybe I'm getting nervous the first time I'm doing stuff 3rd year.

Thx

Maybe I will cut caffeine and see if that helps.
Click to expand...

Titrate propranolol to desired effect as tolerated. Seriously.

Was supervising the start of a case with a CA1 of ours. A-line, dbl lumen, and he had quite a tremor going on. I think it dissipates with time, but if it's nerves I'm sure you can address that pharmacologically. He got them both but it was somewhat painful to watch. Again, I feel this was "newbie" nerves as he's a strong resident from what I hear.

If not? Beta block!

You'll be fine. Now if you came here stating that your interpersonal skills sucked, then my advice would be dramatically different.
 
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There are a number of threads in the surgical forums about tremors and operating. Most of the surgery people seem to think that almost everyone has a bit of a tremor and that it isn't that big of a deal. I have a bit of one sometimes, moreso when I think about it but I still manage to be pretty quick with procedures most of the time. I drink a bunch of caffeine too and have no plans to cut back.
 
Don't worry about it. It is typical of a nervous MS3 and will get better with time. I used to piss down my leg even speaking in front of small peer groups but now I don't have any problem with doing a journal club in front of the department. My first central line as an MS3 I was jittery too. Now no problems but I have done a couple hundred. Time, practice, confidence.
 
Planktonmd said:
My friend,

You have to learn how to relax...
Before you wheel the patient to the room sit down, take a deep breath, and think of something pleasant... like graduating and finding a job making big bucks
Close your eyes and inhale deeply, learn how to meditate
Remember... you will not kill anyone today... you are a competent doctor... and you can do this.
This is not rocket science... it's simple and it's safe... a nurse can do it so you too can.
There is no rush.. tune out all the crap and noise and just focus on enjoying what you can do...
Seek the pleasure of observing your magic in action... look at the patient slipping into peaceful sleep... help them relax and make it pleasant and safe.
Focus on the patient not on yourself
Think of yourself as the gate keeper who will take this patient's hand and guide them through this wonderful experience.
Always remember to breath deeply and admire the amazing results of your work.
Click to expand...

👍 well put. works at 3am when bad stuff happens.
 
happygilmore said:
Good point. I wonder what long term effects a low dose might have.

Will look into this.


Yeah, I think I'm anxious or trying to hard. Definitely not relaxed. Thx
Click to expand...

If you seek a doctor to help you with this then you should get a baseline EKG of course. I would think a low dose like maybe 20 mg would be o.k.

Long term? One of our head trauma/ICU surgeons told his personal story that he convinced his internist to start him on a B-blocker many many years ago. He thinks it's been rather protective against some of the stress-induced catecholamine release many in this line of work (procedures under, at times, stressful circumstances) are "exposed to".

I think everyone has a different fight/flight response. I believe some people get a very pronounced adrenal discharge, thus causing things like tremor and palpitations.

Do you get palpitations? If so, then maybe a low dose B-blocker would help you a great deal. Propranolol seems to be the drug of choice for these things, and it's been used to treat performance anxiety, off label, for a long time.

You should do this through your doctor of course, to make sure there are no contraindications. But, look into it. You will find references to things like professional musicians and public speakers using them for this purpose.

I'm sure that the surgeons are rather in tuned to this as well.

Also, like another poster stated, desensitization is a big factor too. So, maybe you use it to get over this little hump so you don't get discouraged and make matters work by focusing on it. Perhaps it doesn't even need to be a super long term thing for you. But, if it does, I'm not sure it would harm you, and may even help you if it's catecholamine driven for you.

Good luck. But, no, don't let this discourage you from this field so readily.
 
gasattack3 said:
If you seek a doctor to help you with this then you should get a baseline EKG of course. I would think a low dose like maybe 20 mg would be o.k.

Long term? One of our head trauma/ICU surgeons told his personal story that he convinced his internist to start him on a B-blocker many many years ago. He thinks it's been rather protective against some of the stress-induced catecholamine release many in this line of work (procedures under, at times, stressful circumstances) are "exposed to".

I think everyone has a different fight/flight response. I believe some people get a very pronounced adrenal discharge, thus causing things like tremor and palpitations.

Do you get palpitations? If so, then maybe a low dose B-blocker would help you a great deal. Propranolol seems to be the drug of choice for these things, and it's been used to treat performance anxiety, off label, for a long time.

You should do this through your doctor of course, to make sure there are no contraindications. But, look into it. You will find references to things like professional musicians and public speakers using them for this purpose.

I'm sure that the surgeons are rather in tuned to this as well.

Also, like another poster stated, desensitization is a big factor too. So, maybe you use it to get over this little hump so you don't get discouraged and make matters work by focusing on it. Perhaps it doesn't even need to be a super long term thing for you. But, if it does, I'm not sure it would harm you, and may even help you if it's catecholamine driven for you.

Good luck. But, no, don't let this discourage you from this field so readily.
Click to expand...
Wow. Thanks for all the helpful responses. These responses are great. In other specialty forums the responses are often malignant, accusatory or sarcastic.
 
had a terrible tremor in residency. at least 60% of attendings asked me at some point of I was nervous. more combination of essential tremor with adrenaline surge of wanting to nail that a line first try.

also having attendings ready to throw you aside when you take more than a few minutes for a spinal didn't help.

I noticed since residency it has gotten better now that there is no one breathing on my neck literally.
 
izzygoer said:
had a terrible tremor in residency. at least 60% of attendings asked me at some point of I was nervous. more combination of essential tremor with adrenaline surge of wanting to nail that a line first try.

also having attendings ready to throw you aside when you take more than a few minutes for a spinal didn't help.

I noticed since residency it has gotten better now that there is no one breathing on my neck literally.
Click to expand...

thanks for giving hope.
 
I do pedi cardiac anesthesia with a strong focus on neonates and I have to have very steady hands for my lines for these babies. I do arterial cutdowns which require steady hands and good eyesight. My department offered to buy me loops if I ever want them because the radial artery in a <3 kg baby is pretty tiny. I don't suspect many of you guys will do this in your practice but I at least have to tell you about my coffee and vacation experience.

I took a four month sabbatical and the first day back my hands were a tiny bit shaky. The steadiness has to be practiced. I had to take some needles and thread home to get my hands ready again. I recommend using your hands more and finding ways to rest your hand when performing blocks, lines, etc. You just need muscle memory and it comes with practice.

Finally, about the coffee. I only sip a little bit of coffee in the morning because I know that it makes me a bit more jumpy and when I say jumpy, I mean insignificant little movements that the general public would not notice. But when you work at the microscopic level, you notice everything.

Once I get the lines in for my first case, then I go and drink the rest of my coffee.

Oh, and don't drink too much booze either because that will cause the same or worse.
 
I have a small essential tremor and it causes zero problem with my work and I take no meds for it. For me (and I'm assuming most people) a tremor is only noticeable when you have your hand holding something and "floating" in the air. There is no tremor when my hand is resting on something. The only time it's noticeable during work is when I'm threading a central line over a wire and my work around is to grab the wire right at the tip and stabilize my hand on the patient's head so there is no tremor.

But how would a tremor effect an aline? I mean the catheter is through the skin and your hands are on the patient's arm. Or an epidural or a spinal where the tip of the needle is several centimeters deep. I mean you'd have to have a just terrible tremor to not be able to get the needle through the skin in the spot you intend to.


Now for some or many people being nervous is bad for a tremor. But nerves quickly get better when you've done something dozens and hundreds (and eventually thousands) of times. So unless someone has a massive tremor, I can't imagine it would have any clinical effect on their work as an anesthesiologist.
 
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