Falling asleep during laparoscopic procedures

[driedcaribou]

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I find that no matter how much sleep I get, no matter how 'fit' I am at the time, I just get so bored holding the camera during laparoscopic procedures that I find myself nodding off.

I don't know if it's because the lights are off or because dissecting the gallbladder in a lap chole is just so boring.

My eyes feel heavy and I just don't want to follow the operation.

With everything moving towards minimally invasive techniques, I question whether or not being a surgeon is right for me anymore because if I can't stay awake holding the camera, should I even be allowed to use the instruments???

Any tips on staying awake?

I only have this problem retracting if I've had less than 5 hours of sleep.
But the camera thing.... is like all the time.

 

[Winged Scapula]

It can be very soporific just standing there holding the camera even if you are well-rested.

A memorable event of my intern year was the "coup" of being allowed to scrub in on a lap Nissen post-call. I was placed on a stool, holding the liver and GB retractors while one of the Chiefs did the case. Needless to say, post-call, late afternoon case, dark room...I slipped, nearly fell off the stool.

According to the attending, I "&^*&ed the case up", which was ridiculous but I was embarassed nonetheless.

Anyway, the tips for staying awake are the same as always:

- try to move your feet, bend your knees
- pinch yourself, bite your cheek, etc.
- look away occasionally (but don't drop the camera)

and try to only scrub in on lap choles that a more senior resident is doing..it should go quicker.

 

[Castro Viejo]

With everything moving towards minimally invasive techniques, I question whether or not being a surgeon is right for me anymore because if I can't stay awake holding the camera, should I even be allowed to use the instruments???

Let's not mince words. Holding the camera is boring and it's meant for you to doze off. It's a fact of life.

I used to hit the floor all the time holding that camera. Like, the minute I touched the scope it was off to sleepy time.

Then I grew older and advanced in the program and I started doing the case. Now three or five hours in a laparoscopic case flies by when I have the instruments in my hands. The PA or the intern holding my camera dozes off, but heck, I'm all juiced up. You'll do just fine. It's different when you're the one operating. Assisting is meant to be boring.

 

[chaser08]

OP-

I was wondering the same thing! I was to the point of trying to determine which surgical subspecialty had the least amount of laparoscopic time because I hated laps so much!

The only thing that has helped me other than avoiding laps when possible is finding something else to think about...mentally pimping myself, doing math, a funny story, my to-do list, etc. It doesn't always work, but that's all I've got so far.

Any other suggestions will be greatly appreciated.

 

[driedcaribou]

Thanks for the feedback Dr. Cox and Dr. Viejo.

I feel better knowing I'm not the only one!

I hate that bloody camera....

The only thing that has helped me other than avoiding laps when possible is finding something else to think about...mentally pimping myself, doing math, a funny story, my to-do list, etc. It doesn't always work, but that's all I've got so far.

I think part of the problem for me IS daydreaming.... I end up not following the operation.

I will have to learn the technique of moving my legs without moving the camera....

 

[Celiac Plexus]

Wear comfortable shoes.

And shift your weight from side to side to keep your legs from getting cramped.

 

[doc02]

I was in a laparoscopic case as a student (now I'm an intern and they won't let me in the room) and I remember I almost collapsed onto the patient because I was falling asleep. This has resulted in me never giving any patient any sleep medication because my philosophy is that if you can't sleep then you're not tired. I don't care about what they say about how it's loud in the hospital or whatever. I could fall asleep while someone was kicking my a$$ (as long as they didn't go for the groin) at high noon on a highway divider.

 

[SLUser11]

This has resulted in me never giving any patient any sleep medication because my philosophy is that if you can't sleep then you're not tired. I don't care about what they say about how it's loud in the hospital or whatever. I could fall asleep while someone was kicking my a$$ (as long as they didn't go for the groin) at high noon on a highway divider.

Well, since you have no problems falling asleep, I can see why you would then assume that all of your patients are the same. That's excellent reasoning.

As for me, I have a high tolerance for pain, so I don't give any of my patients pain medicine. My blood pressure is also fine, so I don't give any BP meds either.

 

[chaser08]

I think part of the problem for me IS daydreaming.... I end up not following the operation.

Are you talking about while holding the camera or just being in the room/scrubbed in?

I can't say I've ever gotten sleepy while holding the camera - I'm too afraid of getting yelled at when I haven't read the attending's mind on where he wants me to move the camera next.

When not driving the camera and trying to stay awake, if imagining what kinds of sounds my attending makes at the point of climax means that I'm not following the surgery, so be it.

 

[Winged Scapula]

When not driving the camera and trying to stay awake, if imagining what kinds of sounds my attending makes at the point of climaxing means that I'm not following the surgery, so be it.

And what hospital are you at?

I used to count the number of freckles on the necks of my attendings or look for suspicious lesions when I was just standing there. Apparently this is a well-known tactic because one of my attendings told me he did the same, and actually found a MM on the neck of one of his attendings during residency.

 

[Blade28]

I used to count the number of freckles on the necks of my attendings or look for suspicious lesions when I was just standing there.

That's not a bad trick!

Sometimes I would just start flexing/stretching a leg muscle, surreptitiously, in counts of 5. (That's my OCD acting up again.) Or I would think of a song or funny TV show or movie in my head.

 

[driedcaribou]

Are you talking about while holding the camera or just being in the room/scrubbed in?

While holding the camera.

The lap appies are ok because there's more movement but a lap chole??? I cannot stand how boring it is. I just want to ram my hand in there and rip it out.

 

[SLUser11]

I just want to ram my hand in there and rip it out.

I totally understand. It's the "Bad guy from Indiana Jones Temple of Doom" technique. You begin chanting in weird tongues, and then you just insert your hand in there, and pull it out.

I've been a big proponent of that technique, but have yet to find a ninja attending that's willing to teach it to me......

 

[sponch]

something that works for me is that i imagine myself doing the case and anticipating what i'd do next. that usually keeps me juiced and sometimes i can even suggest a different approach...and sometimes they even listen to me...

 

[doc02]

Well, since you have no problems falling asleep, I can see why you would then assume that all of your patients are the same. That's excellent reasoning.

As for me, I have a high tolerance for pain, so I don't give any of my patients pain medicine. My blood pressure is also fine, so I don't give any BP meds either.

Silly me, I forgot that in today's world all of the formerly natural functions of human body now require medication because they are so alien to us. Thank you for showing me the way, good sir!! Drugs for everyone!!

 

[SLUser11]

Silly me, I forgot that in today's world all of the formerly natural functions of human body now require medication because they are so alien to us. Thank you for showing me the way, good sir!! Drugs for everyone!!

Get off your soapbox. There are plenty of situations where the patient would benefit from a sleep aid. Hopefully you realize that someday, but your attitude sucks, so I'm not going to take the time to teach you.

 

[Winged Scapula]

That's not a bad trick!

Sometimes I would just start flexing/stretching a leg muscle, surreptitiously, in counts of 5. (That's my OCD acting up again.)

We all have a little bit of OCD. I used to do the same as well...a few standing stomach crunches, glute flexes, etc. just to keep in shape...about the only exercise I ever got!

 

[Blade28]

We all have a little bit of OCD. I used to do the same as well...a few standing stomach crunches, glute flexes, etc. just to keep in shape...about the only exercise I ever got!

That's what the lab is for!

I average 3 runs and 3 free-weight sessions a week now! 🙂 👍

 

[doc02]

I'm not going to take the time to teach you.

Darn, this is aggravating because everyone knows that you are one of the most world-renowned teachers ever. I have missed my opportunity for education. Hang on, I have to go to the pharmacy to get a bottle of artificial tears that I can apply to my cheeks to simulate how sad I am. Salty!

 

[SLUser11]

That may be the most pretentious comment I've ever heard one intern make to another.

I may only be a PGY-2, but it's not teaching that comes from a level of enlightenment or training, it's common sense. Did you read his comment? "I have no problems sleeping, so I don't prescribe sleep meds for my patients."

Hang on, I have to go to the pharmacy to get a bottle of artificial tears that I can apply to my cheeks to simulate how sad I am. Salty!

Get a Depo shot while you're down there.