How challenging is anesthesiology on a daily basis?

[Etorphine]

As per the title, how challenging is anesthesiology on a daily basis for residents/fellows/attendings? How many times do you feel like the poop is hitting the fan and your palms start sweating? Do these situations make you nervous, or is your training sufficient to the point where you can do everything on autopilot and use minimal brain power even if a bad situation presents itself.

I love physiology and think the idea of manipulating it with potent meds is interesting, but I am wary of the power an anesthesiologist has as well. On one hand I have heard anesthesiologists have very stressful jobs when things go south, but on the other hand I have heard that anesthesiologists have very stress-free lives, especially with the advent of newer patient safety protocols that have standardized many components of daily practice. As a M3 with little experience in the field, I am guessing the truth is somewhere in between and will vary with practice environment.

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[2ndyear]

We actually go to great lengths to minimize the "poop hitting the fan" moments by careful planning and monitoring and a large degree of risk reduction. As far as newer patient safety protocols standardizing daily practice I'm not so sure. No matter how many protocols there are there will be patients and situations that don't fit them. That's where your training comes into play. As an M3 your best exposure to the field is to get into the OR and do a rotation.

 

[HoboCommander]

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

 

[Arch Guillotti]

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

 

[Stank811]

Every single time I put someone to sleep I have a certain level of fear….every patient and procedure is different. I have seen enough to know it is not the big cases on sick patients that we find ourselves behind the 8 ball. It is the simple cases on healthy people that will catch you off guard. No such thing as autopilot in anesthesia and as soon as you think you are in auto pilot is when you get burned. Are there times in a case that are less stressful than others "autopilot"…absolutely…but if you don't maintain your vigilance when watching over your patient you are not doing your job.

When things go bad in anesthesia they happen quickly. We may make it seem like a smooth, non stressful process, but understand what we do scares the pants off of most other medical professionals when they are put in our position. Talk to any medical or surgical colleague at your school and ask them if they every had to induce someone and intubate them in the unit….I promise you that they hate doing it and it often doesn't go smooth….we do this everyday all day and become very skilled at it. It is not the intubating part that sets us apart….it is the critical thinking process of how to do it based on the patients underlying physiology and pathology.

I recently finished a critical care fellowship and was fortunate enough to be able to spend a significant amount of time in the MICU and SICU which were run by medicine and surgery respectively and then the CVICU which was run by the anesthesiology department. After that year I learned a ton from my colleagues in medicine and surgery but they learned a ton from me as well….it was eye opening how well trained we are for the CC transition compared to our counterparts in medicine and surgery. Can we all end up at the same competency…of course….but if we take what we established in the OR to the units they will become safer environments that run more efficiently.

It is often thought that patients go to the CC unit to die…sometimes true…but that frame of mind really makes it easy for everyone to turn a blind eye to events we would consider a clean kill in the OR. I can't tell you how many times on reviewing morbidity and mortality in the MICU and SICU did the code or death occur on intubation. Know how many times it happened to me during my fellowship…zero….did I just get lucky?

 

[AStark]

Trolling... I would assume. Or hope.

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

The trick is that (as the previous post indicated) it often looks easy because all the thinking that goes into it isn't necessarily verbalized or explained - especially not to a student who might not have read enough going in. It's good that you haven't seen anything "worse" than that patient, but unless you were the one setting up the second pressor infusion while struggling to keep SBP > 60, I'm not sure you've had quite enough experience here.

It's fair to say of course that most areas in medicine are not necessarily all that challenging on a daily basis. On cardio call, it's easy enough to sort out who to admit and treat as ACS and who we can bring back to stress later in the week. But that requires knowledge and experience, something med students don't really have.

 

[deleted171991]

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

And how is nursing school going for you?

 

[Spinach Dip]

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

Anesthesia is so chill, dude.

It has something to do with sevoflurane and improper cuff pressures i believe.

 

[anes]

As per the title, how challenging is anesthesiology on a daily basis for residents/fellows/attendings? How many times do you feel like the poop is hitting the fan and your palms start sweating? Do these situations make you nervous, or is your training sufficient to the point where you can do everything on autopilot and use minimal brain power even if a bad situation presents itself.

I love physiology and think the idea of manipulating it with potent meds is interesting, but I am wary of the power an anesthesiologist has as well. On one hand I have heard anesthesiologists have very stressful jobs when things go south, but on the other hand I have heard that anesthesiologists have very stress-free lives, especially with the advent of newer patient safety protocols that have standardized many components of daily practice. As a M3 with little experience in the field, I am guessing the truth is somewhere in between and will vary with practice environment.

It is so easy that a nurse can do it.

What's the worst that can really happen during an anesthetic?

 

[Spinach Dip]

It is so easy that a nurse can do it.

What's the worst that can really happen during an anesthetic?

Just ask Joan Rivers!

 

[anes]

Just ask Joan Rivers!

Also... what other specialty uses drugs whose LD50 is equivalent or less than the ED50 on a daily basis?

 

[GA8314]

I really love this job. I enjoy going to work. Most days of the week I feel very good about something I've been able to do. The skillset you acquire in training is empowering.

 

[gasdoc77]

"on the other hand I have heard that anesthesiologists have very stress-free lives, especially with the advent of newer patient safety protocols that have standardized many components of daily practice."

Early in your studies you may see value in protocols. They are an equalizer and until you mature clinically, they may help bring you to the middle. However, they often are implemented for those that need help with clinical judgement calls (hence the reason nursing relies so heavily upon them). As you feel more secure as a diagnostician, you will find them highly irritating, as you will the administrators that think they are a substitute for free thought.

 

[Ipassgas]

It's so chill! Yesterday I was the only anesthesia person at a free standing ASC!

It was super cool when the pack a day smoker (sure it isn't 2 pal?) dropped into the 50's (SaO2) as they were prepping for his spinal decompression when the machine crapped out.

I solved the problem effectively enough, finally. When I got his sats back to the 80's, I looked up and the staff was hugging the walls, like roaches. I knew exactly how much help I had (with perfect correlation to how much I expected) - none.

It got so chill, if was frigid.

Granted, it was a rare situation (so rare I'd never experienced it before), but unexpected things happen and people in the OR die in a hurry. Vigilance actually saved this man's life - 😉

Every time I induce General anesthesia I have 3-5 minutes to save a life. Eventually, I
expect that won't be enough, and it will be with someone unexpected or for a reason unexpected.

Every day I wonder if today will be the day.
I believe the reason anesthesiologists have decreased life expectancy is from the stress.

But it's so super chill!

nb: I was a surgeon for too long. Only incompetent surgeons are always stressed. Especially for ER consults.

 

[deleted171991]

It's so chill! Yesterday I was the only anesthesia person at a free standing ASC!

It was super cool when the pack a day smoker (sure it isn't 2 pal?) dropped into the 50's (SaO2) as they were prepping for his spinal decompression when the machine crapped out.

Just for the residents: in a situation like this, you get a Jackson-Reese or an ambubag (looking for it should be part of your machine check), connect it to the auxiliary O2 outlet, and manually ventilate the patient (preferably by nurse) while figuring out what's wrong with the machine. If it's unfixable, either the case gets cancelled (ASC, ergo elective case) or another OR (with a working machine) is set up and the patient is moved over.

 

[urge]

As per the title, how challenging is anesthesiology on a daily basis for residents/fellows/attendings? How many times do you feel like the poop is hitting the fan and your palms start sweating? Do these situations make you nervous, or is your training sufficient to the point where you can do everything on autopilot and use minimal brain power even if a bad situation presents itself.

I love physiology and think the idea of manipulating it with potent meds is interesting, but I am wary of the power an anesthesiologist has as well. On one hand I have heard anesthesiologists have very stressful jobs when things go south, but on the other hand I have heard that anesthesiologists have very stress-free lives, especially with the advent of newer patient safety protocols that have standardized many components of daily practice. As a M3 with little experience in the field, I am guessing the truth is somewhere in between and will vary with practice environment.

Don't go into anesthesia if your are an anxious person. You will be miserable.

 

[geogil]

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

Totally. I would so much rather have a laryngospasming kid with a dicey airway than see some consult in the ED. What's that, we're prone and lost the airway? Whew. At least I'm not down in the ED. Wait, the SRNA just yanked out the central line with 3 pressors on it while transferring the patient? Good thing the ED is way worse. I will have all the time in the world to re-work the lines, and start another central line. So much more chill than checking out the belly labs and obligatory CT scan in the ED.

 

[Noyac]

It's like the chillest field I've ever rotated in. It's so easy. The worst situation I saw was septic shock during a surgery which after enough meds were given, patient was fine. It's not like surgery where you are stressed out all the time. Even doing a routine ED consult is more stressful than anything encountered in anesthesia.

Sounds like the rotation was a bit above your level of understanding.

 

[Noyac]

Urge nailed it. If you are a nervous person, anesthesiology will not serve you well.
It's one thing to take someone to the brink of death when there is no option because they are bleeding out or septic or whatever. There is no option in this case so you do what you do. But to take someone that was previously completely healthy but under your care for something totally elective and induce them only to find out that you can't recover them for some reason is gut wrenching.
My personal worst disaster was as gut wrenching, emotionally and professionally for me as it was for the surgeons involved. Tragedy spares nobody. And I'm sure that the ER folks involved in this case were devastated as well. So "real" stress spares no one. But anesthesia seems to have as much as any other specialty. I think the only specialty that I couldn't do would be pediatric oncology. I handle stress well but that would crush me.

 

[DreamLover]

87 yo M with 8.1 juxtarenal AAA for open repair (not endovasc candidate) 2 weeks ago. Pt has all the co-morbidities that 87yo's with 8.1cm AAAs have. So I'm prepared. I'm ready.

Before surgeon even clamps, a large hole is torn in the IVC from a sheared vertebral vessel and in 3 seconds MAP is 25. No bueno.

After some anesthesia magic and uncertainty, a 6L blood loss and an unrepaired 8.1cm AAA, he was closed, extubated and thanking me for taking care of him on our way to the ICU.

Things never go as planned, but quick thinking on your feet and good patient care is extremely satisfying.

I hate doing consults in the ED. Shoot me first.

 

[Mman]

My day to day life is pretty chill, but that's because I'm the coolest customer in the building. I don't start to sweat until the patient is probably 15 seconds from imminent death. Then my pulse picks up a bit above 50. Every single case is a potential disaster, especially with all the fat unhealthy train wrecks we see on a daily basis. It just looks like it's easy to everyone else because I maintain my calm in the face of the storm. I've found it's easier to get the other people in the room to be helpful if I'm not screaming and throwing things when the situation gets dicey. If I stay calm, they all perform better. And if they all perform better, it makes my job easier.

 

[GA8314]

My day to day life is pretty chill, but that's because I'm the coolest customer in the building. I don't start to sweat until the patient is probably 15 seconds from imminent death. Then my pulse picks up a bit above 50. Every single case is a potential disaster, especially with all the fat unhealthy train wrecks we see on a daily basis. It just looks like it's easy to everyone else because I maintain my calm in the face of the storm. I've found it's easier to get the other people in the room to be helpful if I'm not screaming and throwing things when the situation gets dicey. If I stay calm, they all perform better. And if they all perform better, it makes my job easier.

This. It can be learned as well. I often fake being calm when I'm not feeling that way. I talk in a calm tone. Say please and thank you but act decisively and take command as necessary.

This gig is NOT for everybody.

 

[BLADEMDA]

 

[BLADEMDA]

Anesthesia is just like the picture above... be careful where you walk because things can blow up on you.

 

[deleted171991]

@Etorphine
Fake it till you make it. Never truer than in anesthesia during a crisis situation. Everybody is looking at you and for your leadership. You are the one person in the room not allowed to lose her calm.

I think what matters most is to have insight about your own personality (disorder) and be able to compensate for it (both for too anxious and too calm). That can be very difficult when the **** hits the fan, especially if it's the first time you encounter that particular situation. You have to be prepared for anything, anytime.

The more storms you weather, the lower the risk of a periop MI (for you, not the patient). This is one of the specialties with the highest risk of dying in your 40's-50's. Some people love climbing steep and tall mountains the same way others love practicing anesthesia; at the end of the day, the satisfaction is proportional to the challenge. 🙂

 

[Ipassgas]

To paraphrase Sam Shem, the first step in any code is too check your own pulse.

As a group, I've found we're the chillest cats in the hospital. Probably because of both nature and nurture. I guess that the anxious, panicky types either don't last long, or take a lot of benzos (though I did see a few in residency). Panicking has never saved a life - and somehow we all know that and actually live that.

Also like in the Princess Bride, we deal with the "mostly dead" as a matter of routine - and routinely make them undead with the anesthesia magic. It can be stressful, but I don't see anything to gain from showing that to the world.

 

[Ezekiel2517]

Acquire this quality:
Equanimity (Latin: æquanimitas having an even mind; aequus even animus mind/soul) is a state of psychological stability and composure which is undisturbed by experience of or exposure to emotions, pain, or other phenomena that may cause others to lose the balance of their mind.

 

[WholeLottaGame7]

It's not the land mines I can see that bother me; it's the ones I can't see that scare me.

 

[IlDestriero]

Acquire this quality:
Equanimity (Latin: æquanimitas having an even mind; aequus even animus mind/soul) is a state of psychological stability and composure which is undisturbed by experience of or exposure to emotions, pain, or other phenomena that may cause others to lose the balance of their mind.

I will work that into my self eval in next year's annual review. I wonder if the chief will look it up, comment on it, or ignore it?

 

[DreamLover]

To paraphrase Sam Shem, the first step in any code is too check your own pulse.

As a group, I've found we're the chillest cats in the hospital. Probably because of both nature and nurture. I guess that the anxious, panicky types either don't last long, or take a lot of benzos (though I did see a few in residency). Panicking has never saved a life - and somehow we all know that and actually live that.

Also like in the Princess Bride, we deal with the "mostly dead" as a matter of routine - and routinely make them undead with the anesthesia magic. It can be stressful, but I don't see anything to gain from showing that to the world.

For the most part, due to our training and/or personalities, I feel we often make the super stressful or very complicated, look easy.

Because we have composure and self control, some people think they can easily do what we do-but it is evident at 100% of the code blues I go to out of the OR...that's in no way possible

 

[Noyac]

For the most part, due to our training and/or personalities, I feel we often make the super stressful or very complicated, look easy.

Because we have composure and self control, some people think they can easily do what we do-but it is evident at 100% of the code blues I go to out of the OR...that's in no way possible

That was very well said. Cheers.

 

[Noyac]

Last year I had a case that could have been a **** show. It was a morbidly obese, drug induced meth addict with presumed perforated bowel for 2 days. Needless to say, this guy was sick as ****. But the meth kept him alive. The ER couldn't get a BP but the guy was wide awake and communicating without any difficulty. Surgeon saw the pt and the CT showed free air in the abdomen. So I was called in. I saw the guy in the ER and immediately thought I was screwed. I pushed him up to the PACU ( yes I push my own pts to the OR) and tried to get a BP. Nothing! Tried to find a radial pulse, nothing. Then the pt started to really crump. This was now at 2am and there is no help whatsoever. The OR nurse and I push to the OR. We all ( me, nurse, scub and surgeon) get the 400+ lb pt to the OR table. At this point the pt was starting to talk to us again. Surgeon and I discuss the issue, we could admit to the ICU and see what happens or we can attack the issue. This guy ain't gonna survive the ICU. Hopefully, his entire intestine isn't dead.
I could have fished around for an A line but I chose to induce and go. This guy was dead otherwise as far as I could tell. I induced with epi and a stunning dose of propofol. Intubated in less than 30 sec and started looking for BP. THERE WAS NONE. The surgeon was preparing to place a foley, yeah that's how bad it was, surgeon placing the foley. With his hand on the penis I said, hey Jay see if you feel a femoral pulse.
Until this point everyone in the OR thought this was just another sick pt. But I was convinced that he was dead at this point. I started resuscitating and the rest of the crew jumped into crash mode. I got the guy back and we come,teed the case. The pt left the hospital 5or 6 days later doing fine. After it was all over the nurse and surgeon separately commented on how calm the environment was.
We see this **** more than any other specialty. We deal with it more than any other. We should be the calm ones.
We should all have the reputation of being calm and cool under pressure.

 

[pgg]

Very nice. Meth is a helluva drug.


Anesthesia done well often looks like we're doing nothing at all. Other staff in the room frequently have no idea how close to the edge we get. It's easy to see how a rotating student or intern, who's only there a couple weeks, can get the impression that it's an easy or even boring job.

 

[BuzzPhreed]

We see this **** more than any other specialty. We deal with it more than any other. We should be the calm ones.
We should all have the reputation of being calm and cool under pressure.

👍

 

[deleted547339]

Very nice. Meth is a helluva drug.


Anesthesia done well often looks like we're doing nothing at all. Other staff in the room frequently have no idea how close to the edge we get. It's easy to see how a rotating student or intern, who's only there a couple weeks, can get the impression that it's an easy or even boring job.

As a med student and intern, I really had no idea of the complexity of what y'all do. I thought it was 1) go to sleep 2) do crossword puzzle 3) pull out tube.

I'm in EM. The more I manage sick patients, read and listen to podcasts on airway/sedation/resus/etc, the more I think your field is truly fascinating.

 

[Noyac]

As a med student and intern, I really had no idea of the complexity of what y'all do. I thought it was 1) go to sleep 2) do crossword puzzle 3) pull out tube.

I'm in EM. The more I manage sick patients, read and listen to podcasts on airway/sedation/resus/etc, the more I think your field is truly fascinating.

TNR, I was headed to EM after med sch. Had it all planned out. I thought I would do an anesth rotation to get a jump on things like airway and access. It was the worst 2 weeks of my training. Not because anesth was bad but because I instantly knew I was making the wrong specialty choice "for me" by choosing EM. The next 2 weeks were better because I came to terms with it all and started the planning. It was after what is now known as IARS, I think, so I was going to pull out of EM and scrambled for an anesth spot. It's all history now.

 

[deleted547339]

TNR, I was headed to EM after med sch. Had it all planned out. I thought I would do an anesth rotation to get a jump on things like airway and access. It was the worst 2 weeks of my training. Not because anesth was bad but because I instantly knew I was making the wrong specialty choice "for me" by choosing EM. The next 2 weeks were better because I came to terms with it all and started the planning. It was after what is now known as IARS, I think, so I was going to pull out of EM and scrambled for an anesth spot. It's all history now.

I still think I would have done EM if I knew then what I know now, but who knows. I always try to pick the brain of the anesthesia upper levels when they're around. I think it catches them off guard when the EM guy asks about awake intubation, push-dose pressors, etc.

May end up doing anesthesia-based CC.

 

[Yo GabbaPentin]

Anesthesia done well often looks like we're doing nothing at all.

Then the academics at where I trained were absolute MASTERS of anesthesia!! They were so damn good that they didn't have to leave the break room!🙂

 

[Yo GabbaPentin]

So which ones in the picture are the administrators and which ones are the CRNAs?

 

[Random Anesthesiologist]

To the OP, I think it depends which resident you talk to. Brand new CA1?, it's all challenging. 1/2 way through CA1? We're operating like CRNAs. Easy cases are easy, hard cases are hard (generally speaking). And hard cases get easier as you move up the line. By "easy" I mean coming up with your plan and using the knowledge you've gained.

The schedule can be taxing, but not "hard". Finding time to read is taxing, but not "hard". Room turnovers can be taxing but not "hard". The hard part is learning anesthesiology and applying your knowledge, and it gets better as you progress through residency. Whatever you put into it, you will get out of it.

 

[BuzzPhreed]

Because we have composure and self control, some people think they can easily do what we do-but it is evident at 100% of the code blues I go to out of the OR...that's in no way possible

So true!

I heard one of our anesthesia techs the other day make a comment in the workroom, after observing one of my colleagues struggling a bit with a procedure in the OR, telling one of the other techs what he thought they should have done instead of what they had actually been doing.

I just started laughing while getting a little bit irritated. I said, "Yeah, and I guess you probably should've subbed yourself in for Colin Kaepernick last weekend and took a few snaps too."

It's easy to watch people do things and think that conveys some sort of knowledge and ability, especially when many of us normally do it with aplomb. How little they actually know.