How Exciting is Anesthesiology?

[Twiggidy]

At that point, wouldn’t you rather just be a general surgeon so you can handle whatever comes in as well as the traumas?

Trauma surgeons are specialized for that field. Most "general" surgeons don't want to be anywhere near a trauma. They want their elective cases from patients with good insurance. That's what pays the bills. Most trauma surgeons are rounding in a SICU and doing whatever city hospital appy, chole, hernia they can get their hands on before the next trauma....all while likely getting a university salary.

Don't let the "excitement" factor fool you. As others have said, once you've made it through medical school and get a taste of residency, you realize excitement is the last thing you want. Give me a straightforward Aortic Valve Repair so I can get home at the end of the day.

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[Psai]

1/4. I get it's not your job to decide surgical indications. And I also get that some patients may have indications for more intensive monitoring. Putting an A-line in on EVERY prostate as many of our anesthesiologists do is wasteful and inefficient. I have trouble believing that is personalizing care to the risk of the patient and doing what is necessary.

2. I know anesthesia is (usually) not trying to be slow. Many (in academia) give little thought to going fast, however, as it doesn't effect their bottom line or when they get home. Incentives are a powerful thing. After years at an academic center I was utterly blown away by what a experienced and motivated anesthesia team could accomplish at our affiliated surgicenter. Of course there they don't work in shifts, they stay until the day is done, so motives are aligned.

3. Before the OR is as it should be. Communication could break down on both sides, but generally I agree the buck stops with the surgeon and its my job to make sure you're aware of potential issues from the operative standpoint with the case just as you need to let me know forseen anesthetic issues.

Is this a joke? The wakeup is only slow because it takes you guys 3 hours to close. Who do you think you are, plastics? If I had a dollar for every time a surgical resident told me "oh just another 30 minutes" only for us to roll out of OR 2 hours later, I'd retire right now. Probably 70% of the problems you have with how much time we take is because you guys are bad. Not sure why you jokesters have it in your heads that you're some sort of surgical god but you're actually not that good and you take forever to do literally everything. OR time doesn't take long because of a 15 minute art line but because a 40 minute appy is somehow taking you 4 hours.

SURGERY STOP BEING SO DAMN SLOW

 

[deleted162650]

Is this a joke? The wakeup is only slow because it takes you guys 3 hours to close. Who do you think you are, plastics? If I had a dollar for every time a surgical resident told me "oh just another 30 minutes" only for us to roll out of OR 2 hours later, I'd retire right now. Probably 70% of the problems you have with how much time we take is because you guys are bad. Somehow you jokester have it in your heads that you're some surgical god but you're actually not that good and you take forever to do literally everything. OR time doesn't take forever because of a 15 minute art line but because the 30 minute appy is taking you 3 hours.

SURGERY STOP BEING SO DAMN SLOW

Heard another good one from one of my partners today:

“Nurse, can you please get him an adson. A scab has formed, and he needs to pick it off to finish his closure.”

 

[Iso4ane]

Is this a joke? The wakeup is only slow because it takes you guys 3 hours to close. Who do you think you are, plastics? If I had a dollar for every time a surgical resident told me "oh just another 30 minutes" only for us to roll out of OR 2 hours later, I'd retire right now. Probably 70% of the problems you have with how much time we take is because you guys are bad. Somehow you jokester have it in your heads that you're some surgical god but you're actually not that good and you take forever to do literally everything. OR time doesn't take forever because of a 15 minute art line but because a 40 minute appy is somehow taking you 4 hours.

SURGERY STOP BEING SO DAMN SLOW

Maybe we have spoiled the surgeons too much with sevo and des. We should go back to just iso or anything with a decent context sensitive half life.

 

[coffeebythelake]

Maybe we have spoiled the surgeons too much with sevo and des. We should go back to just iso or anything with a decent context sensitive half life.

What's the context sensitive half life of ether

 

[deleted171991]

What's the context sensitive half life of ether

For ether, it was called context-sensitive half death.

 

[anbuitachi]

1/4. I get it's not your job to decide surgical indications. And I also get that some patients may have indications for more intensive monitoring. Putting an A-line in on EVERY prostate as many of our anesthesiologists do is wasteful and inefficient. I have trouble believing that is personalizing care to the risk of the patient and doing what is necessary.

2. I know anesthesia is (usually) not trying to be slow. Many (in academia) give little thought to going fast, however, as it doesn't effect their bottom line or when they get home. Incentives are a powerful thing. After years at an academic center I was utterly blown away by what a experienced and motivated anesthesia team could accomplish at our affiliated surgicenter. Of course there they don't work in shifts, they stay until the day is done, so motives are aligned.

3. Before the OR is as it should be. Communication could break down on both sides, but generally I agree the buck stops with the surgeon and its my job to make sure you're aware of potential issues from the operative standpoint with the case just as you need to let me know forseen anesthetic issues.

I agree in academics everything is slower, but honestly, lets be real, the anesthesiologist being slow is probably the least contributory. The only time the anesthesiologist is working and the surgeon is not is lining the patient up, inducing/intubating, and extubation and some parts of emergence. The 2nd reason academics is slow is because room turnover takes 40 minutes on average. An anesthesiologist lining patient up faster or extubating faster will save you tens of minutes at best over the course of a day on average. A fast surgeon will save you hours.
And I disagree with what you said about bottom line and when to go home. While that may be true for some places, I am at a major academic center where anesthesiologists get paid by cases, and they go home when their room is finished unless it's so late that the call team is free for relief. And since it's a teaching hospital, closing literally takes forever, it makes it more difficult to time. But hey at least as a surgeon, if you feel like going home you can just cancel your cases and walk out, something anesthesiologists can't do for no reason.

W regards to the robotic prostate. Putting in arterial lines in every robotic prostatectomy sounds like it's over kill unless the surgeon is god awful, and I have heard of stories of these cases from other institutions. Thankfully the robotic prostate surgeons are good here since we are high volume, and we can get away with 1 IV unless really sick.

 

[Adrenaline Junky]

Can anyone link me to a detailed or thorough list of procedures Anesthesiologists do? Google just comes up with the basic and vague answers.

 

[spacegun]

Can anyone link me to a detailed or thorough list of procedures Anesthesiologists do? Google just comes up with the basic and vague answers.

The ABA should have this information.

Stanford has a good list on their Quick Guide to Common Anesthesia Procedures.
Insertion of Peripheral IV
Standard Induction of General Anesthesia
Mask Ventilation
Laryngeal Mask Airway Insertion
Endotracheal Intubation
Awake Fiber Optic Intubation
Insertion of Left-Sided Double Lumen Tube
Wire Crichothyroidotomy
Radial Artery Catheterization
Central Venous Catheterization (Internal Jugular)
Spinal Anesthesia
Lumbar Epidural Placement
There are also other ones like TEE and all the different regional blocks.

 

[Adrenaline Junky]

The ABA should have this information.

Stanford has a good list on their Quick Guide to Common Anesthesia Procedures.
Insertion of Peripheral IV
Standard Induction of General Anesthesia
Mask Ventilation
Laryngeal Mask Airway Insertion
Endotracheal Intubation
Awake Fiber Optic Intubation
Insertion of Left-Sided Double Lumen Tube
Wire Crichothyroidotomy
Radial Artery Catheterization
Central Venous Catheterization (Internal Jugular)
Spinal Anesthesia
Lumbar Epidural Placement
There are also other ones like TEE and all the different regional blocks.

Thank you!

 

[abolt18]

...

 

[Adrenaline Junky]

...

? Did I offend you in some way? If i did i truly apologize it was not intentional.

 

[abolt18]

? Did I offend you in some way? If i did i truly apologize it was not intentional.

No, I just answered a question, then realized the question had previously been answered sufficiently by another poster.

 

[faithwalk]

I stole it from one my mentors/heroes/smartest human I’ve ever met, John Drummond.

I knew I recognized that quote. Drummond is the greatest.

 

[nimbus]

It cuts both ways. I've seen many anesthesiologists who insist on putting in (very slowly) A-lines on every robotic prostate. Here's a tip. If they're sick enough to need an A-line for that surgery, they probably don't need their prostate out. Alternatively, we've found ourselves with crap access and no art-line on giant partial nephrectomies in solitary kidneys. There is fault on both sides, and what is needed is open and honest communication between surgeon and anesthesiologist before cases. The problem is half the time they don't even cross paths because anesthesia tubes and leaves while surgeon isn't in room until prep is dry.

Seriously, how about a huddle, text or phone call before the patient goes to the OR? I do this every single time with our cardiac surgeons and with any other case where there is a question. This is a failure of both parties.

You should have every anesthesiologist’s cell on your contact list and they should have yours.

 

[deleted171991]

You should have every anesthesiologist’s cell on your contact list and they should have yours.

I guess that's how one makes anesthesiology more exciting.