Interesting Story and questions

[2ndyear]

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Doing my TY year at a community hospital system. One of the smaller ones just brought in a new thoracic surgeon, mainly to do cancer work. I was talking with him the other day and he was really mad at the anesthesia quality he was getting. He said that this group just couldn't handle the big cases and he was having trouble even with VATS, etc. Said he's had to bail on several cases already.

Nothing against the group that works at this hospital, it seems that they existed on pretty much bread and butter cases for many many years until this new guy comes in. Is it possible to lose your skills for the more complex cases if you don't use them? How about if a hospital gets a new surgeon like in this case, does the anesthesia group go looking for a fellowship trained person if nobody is comfortable doing these cases?

If nothing else, this should serve as a pretty good example that Anesthesiolgy isn't really a dying field, seems pretty needed in some parts.

 

[Tenesma]

gimme a break... a VATS is pretty straightforward... sounds like the anesth. people at your TY hospital are pretty lame

 

[jwk]

They're only straightforward if you're used to doing thoracic cases. If you haven't done a thoracic cases or placed a double-lumen tube in 20 years, I can see where it would be difficult. We do them here, but I had to think for a minute what "VATS" stood for. I've done open hearts - but 25 years ago. I couldn't just walk in and do one now after 25 years of not doing them. Like 2ndyear said - small community hospital, bread and butter cases. I can see where a VATS might be a very big deal.

I wonder if the surgeon had any discussions with the anesthesia department about these procedures BEFORE he posted one. If this is a small hospital that has never done chest cases and you have a just barely ex-resident who is used to being catered to in a major medical center, I can see where there could easily be a problem. A little communication ahead of time goes a long way!

 

[Skip Intro]

At the hospital I did my first anesthesia rotation at, they were switching from double-lumens to this newer intra-bronchial balloon. I watched a VATS (on my first day) and, with this new system, the lung kept re-inflating. The surgeon was getting pissed (i.e., wasting his time, etc.). They kept replacing this balloon and kept checking it with the fibroscope, etc., but despite good placement and repeated checking the damn lung just kept reinflating.

Maybe this had something to do with it. Not necessarily poor staff, but poor and/or ineffective equipment.

-Skip

 

[jwk]

At the hospital I did my first anesthesia rotation at, they were switching from double-lumens to this newer intra-bronchial balloon. I watched a VATS (on my first day) and, with this new system, the lung kept re-inflating. The surgeon was getting pissed (i.e., wasting his time, etc.). They kept replacing this balloon and kept checking it with the fibroscope, etc., but despite good placement and repeated checking the damn lung just kept reinflating.

Maybe this had something to do with it. Not necessarily poor staff, but poor and/or ineffective equipment.

-Skip

That's an endo-bronchial blocker. We have pretty good luck with them, though I'm not sure there is really a clear-cut advantage to using them. The position has to be verified with bronchoscopy before and after the patient is positioned, and they do tend to shift.

When all else fails, remember that anesthesia makes surgery possible, not easy.