OMFS anesthesia experience

[carabelliscusp]

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For those that are recently grads in private practice what do you recommend to make the most out of your anesthesia experience during your rotation (not IV sedation)? Getting good at oral intubation?

 

[Colastick]

Get good at bagging people. It will save your butt some day

 

[carabelliscusp]

Get good at bagging people. It will save your butt some day

Not too sound like a pretentious intern whose bagged a small handful of people, but this seems like the easiest skill in the world to learn lol

Thanks for the advice

 

[SuxDrugs&Rocuronium]

Not too sound like a pretentious intern whose bagged a small handful of people, but this seems like the easiest skill in the world to learn lol

Thanks for the advice

That’s the mindset that will kill someone. It’s easy to bag until it’s not. Large tongue, beard, heavy set, edentulous etc can all make it very difficult to bag certain patients. And just wait until you have to bag mid case and you push blood until the larynx causing a laryngospasm.

 

[MightyMeeko]

Bagging is the hardest skill, intubation is straightforward in comparison. If you can bag the patient, you will keep them alive. I have yet to meet an anesthesiology attending who thinks it is easy.

Edit: I agree with the reply above. You need to change that mindset. It is dangerous to underestimate the importance and difficulty of bagging.

 

[carabelliscusp]

Ok clearly I know nothing about what bagging actually entails

 

[SuxDrugs&Rocuronium]

Ok clearly I know nothing about what bagging actually entails

The concept is easy, the execution.. not so much

 

[OMSDoc]

What is being discussed here is ventilating a patient, and this is the most important skill to learn in your medical anesthesia rotation. At the outset of every case in the OR in which there is endotracheal intubation, the patient is first anesthetized to the point of apnea, and then the anesthesia team checks to ensure supported ventilation is possible, before the patient is paralyzed for the intubation.

Most intravenous medications used in anesthesia for oral surgery can suppress respiration and cause apnea, so it is imperative that the operator/anesthetist be able to support the patient’s respiration instantaneously via a bag/mask system.

Personally, I am not comfortable with the term “bagging the patient”, because you can have the mask on the face and be squeezing the bag, but you may not be ventilating the patient. This lack of ventilation, or lack of respiratory exchange, can be due to the things listed by SuxDrugs&Roc…large tongue, beard, high BMI, edentulous, and laryngospam. It is important to have lots of experience in mask ventilation.

 

[amali]

Not too sound like a pretentious intern whose bagged a small handful of people, but this seems like the easiest skill in the world to learn lol

Thanks for the advice

You’re gonna be a dangerous oral surgeon

 

[dratc]

My anesthesia rotation included scheduled time in ECT where all we do is bag patients for hours. It’s exhausting. I thought it was a waste of time when I walked in my first day, but quickly learned there is a skill associated with it that must be practiced. It turned out to be one of the most helpful parts of the anesthesia time.

 

[Contach]

You’re gonna be a dangerous oral surgeon

He likes to live life on the cusp

 

[Contach]

That’s the mindset that will kill someone. It’s easy to bag until it’s not. Large tongue, beard, heavy set, edentulous etc can all make it very difficult to bag certain patients. And just wait until you have to bag mid case and you push blood until the larynx causing a laryngospasm.

I agree, when I go to the OR, I ask the anesthesiology team to let me BVM to keep up with these skills, and it always feels so easy. But the few times I've had to use an ambu-bag in an emergency setting during a sedation, it feels so different/awkard/clunky/hard, and I can't really understand why, my best guess is that during induction, patients are deeper, and muscles are more relaxed so there is less resistance, but these other factors may also be at play:
- patient positioning: in OR they are flat, and at the level of your belly
- an ambu bag is harder to use than a ventilator circuit
- maybe it's the pressure of just being all alone in the clinic
- not sure to be honest

 

[Contach]

My anesthesia rotation included scheduled time in ECT where all we do is bag patients for hours. It’s exhausting. I thought it was a waste of time when I walked in my first day, but quickly learned there is a skill associated with it that must be practiced. It turned out to be one of the most helpful parts of the anesthesia time.

Why would they bag for hours? Why don't they intubate? this is super interesting to me....

 

[dratc]

Why would they bag for hours? Why don't they intubate? this is super interesting to me....

Sorry that was a bit confusing. We would be there for multiple hours but be bagging a bunch of different patients during that time. At least at my institution ect is done with methohexitol and succinylcholine. We would bag them through the ect and until they recovered. Pretty short duration for each patient. But quite a bit of bagging cumulatively on a bunch of different size and shape of people.

 

[Contach]

Sorry that was a bit confusing. We would be there for multiple hours but be bagging a bunch of different patients during that time. At least at my institution ect is done with methohexitol and succinylcholine. We would bag them through the ect and until they recovered. Pretty short duration for each patient. But quite a bit of bagging cumulatively on a bunch of different size and shape of people.

That is an amazing experience! Invaluable practice of BVM'ing. I wish we, practicing OMS, could rotate through a site like that once every few years.
AAOMS hosts an OBEAM course (Office-based emergency airway management) using high fidelity dummies, but it just isn't the same.