Feeling like you are going to faint in the OR

[han14tra]

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Hi all,
I recently participated in a surgery that lasted about 9 hours. I scrubbed in, and so I was standing in one spot. I was fine up until the 6th hour when I started feeling pre-syncopal 🙁This is such an embarrassing problem. I asked the resident if I could be excused to go to the bathroom, but I felt like I was being a wuss. I had to completely change and scrub again before I could get back in. After 5 minutes of sitting down and doing some squats to get the blood pumping, I felt fine for the rest of the surgery.

Does this happen to anyone else, and how do you avoid it?

PS.
I was not locking my knees. I was flexing my leg muscles. I drank a bottle of water before I left for the surgery, but my throat was extremely dry after 9 hours. I also ate a big dinner the night before. But, I was about 30 hours without sleep at that point.

Help please. What am I going to do during my surgery rotations?

Thanks

 

[illixir]

All the residents in the room and others that were sterile, they all just stayed in the room for 9 hours? Wow, I don't see how you could not need to use the restroom in that much time, and you drank a bottle of water beforehand and could go 6 hours. I find that crazy.

As for the fainting itself, don't get too worried about it. Every 3rd/4th year I know or doctor has had at least a pre-syncopal episode happen. You don't need to be and should not be going 30 hours without sleep, especially in first year!

 

[han14tra]

All the residents in the room and others that were sterile, they all just stayed in the room for 9 hours? Wow, I don't see how you could not need to use the restroom in that much time, and you drank a bottle of water beforehand and could go 6 hours. I find that crazy.

As for the fainting itself, don't get too worried about it. Every 3rd/4th year I know or doctor has had at least a pre-syncopal episode happen. You don't need to be and should not be going 30 hours without sleep, especially in first year!

Thank you. All the residents and doctors did stay in the room the entire time. The nurses kept leaving, but not the doctors which is why I felt like I should just suck it up.

Also, I was up for 30 hours because I was on call through a special program. They paged me at 10 o'clock at night when I was getting ready to go to bed. So, I was up the entire day, and then all night with the surgery and part of today. I've felt hung over all day. Wouldn't recommend going 30 hours without sleep to anyone else.

 

[mdob]

I actually find that wearing the TED pressure stockings makes a huge difference!

 

[Catalystik]

When I had to be in the OR (after learning the hard way, like you that I needed to do something), I made a point of not just drinking extra fluids, but also getting in some extra salt somehow to keep the BP up (and decrease diuresis).

 

[Depakote]

Some of it comes with experience, you'll learn your triggers and how to avoid them.

Common stuff would be to eat a big breakfast and make sure you're appropriately hydrated. Most OR break rooms have snacks and sugary drinks you can munch on before cases.

Now... here's your problem:

But, I was about 30 hours without sleep at that point.

Call is dumb. They do it to residents because they can make them... there's no reason a M1 should be up for 30 hours. Even then, most surgery residents go home at the 30 hour mark, or at least don't get themselves into a 9 hour case at the tail end of it.

Give yourself a reasonable amount of sleep before you put yourself through physically/mentally demanding tasks. It's less dangerous to you and the patient.

 

[PranBobbyJohnny]

Eat a slow digesting meal for breakfast if you can. If you are going to faint then definitely leave and get some juice or soda.

 

[cpants]

Not a big deal. Happens to everybody at some point. The important thing is that you did the right thing: stepped out of the case. It might be embarrassing to have to scrub out of a case, but nowhere near as embarrassing (and dangerous) as face planting into a sterile field.

 

[GoUSFBulls]

I seem to have pre-syncopal symptoms every time I scrub in for any type of procedure/surgery that requires sterile gowning. I have found that drinking large amounts of fluids before any procedure makes the episodes not occur. It is definitely embarassing though, and for this i'm glad that i'm a 4th year, and going into medicine where full on sterile gowning isnt as common.

 

[sprinkibrio]

It's usually not locking your knees, not eating, not drinking, or not sleeping. It's just a really intense experience that most normal people would respond to with fainting... especially if you're not very involved in the case and don't know what is going on, so your mind has time to wander. There is not one med student I know that hasn't had a presyncopal or syncopal episode before graduating. Most happen third year. Most happen at random times when you least expect it. I've never seen it become a real issue, even in someone like me who expected to faint a lot third year because of my previous clinical experiences. I understand it was embarassing for you because you really want to impress your attendings, etc, as a third year, you're so constantly embarassed, that almost fainting becomes insignificant. Really, your going ons are insignificant to these people and they've seen it before.

 

[ucsfstudents]

It's nothing to worry about. It happens to medical students and residents all the time. I agree with the recommendations above. One surgeon's approach is to eat a nice fatty meal before going into the OR. BTW, no more 30 hours without sleep, OK? That's what internship is for. 🙂

Good luck!