Surgeon Anesthesia Training?

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Billabong911

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First time long time.

I was asked today how much training a surgeon may get in residency or medical school in anesthesia... I have no idea and get multiple different answers.

Anyone know?
 
Does SICU count? Otherwise zero where I trained. Never saw a surgery resident doing an anesthesia rotation.
 
I would be excluding any time spend as a medical student in an elective anesthesia rotation... but i would assume they get SOME in residency to learn what options they have etc?
 
Billabong911 said:
I would be excluding any time spend as a medical student in an elective anesthesia rotation... but i would assume they get SOME in residency to learn what options they have etc?
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My hospital, surgical interns get a week.... categoricals usually don’t care for it.
 
At the home program for my school, I know surgery interns did an anesthesia rotation - don’t remember if it was two weeks or a little more. It was extremely popular with the residents, but I gather this is mostly because they were dismissed around 3 on most days! As a PGY4, I would say I have a general understanding of anesthesia concepts - we do have to study anesthesia to some extent for our in service exams - but I wouldn’t claim any in depth knowledge or experience by any means.
 
Where I did residency, general surgery interns did either two or four weeks with us, oral surgery residents spent six months. No other surgical residents spent any time with us. The military's medical school used to have a mandatory two weeks of anesthesia during their surgery rotations, but I think that got nixed a few years ago.
 
Gen surgery spends 1 month on anesthesia just for airway experience. They get paired with crnas and put tubes in until ~noon M-F for that month.

OMFS here has it bad on anesthesia, 6 months of M-F long days. They're not in the call pool, so while they don't have any weekends, they also don't have early out days or post call days and it's very very common for them to have their whole week be 5 x 12-15 hour days in the OR which can just suck life out of you.
 
None... However our SICU and CVICUs were anesthesia critical care run so we would rotate alongside surgical residents. We're on good terms with them in ICU and the residents respected the intensivists and the breadth of their skills\knowledge but back in the OR it's "hey Anesthesia!" Not much appreciation
 
Our gen surg interns have a 2 week anesthesia rotation. No one goes and they generally prep/take step 3 during it.
 
I did a month on anesthesia in general surgery residency. Most used that rotation to tube a bunch in all the rooms then leave early but I actually stayed in a room and did cases with my anesthesiologist teaching me stuff (had a lot of tubing by the time I did the rotation so I figured why not learn more about the drugs and stuff).
 
Had a PGY5 surgical resident during a lap case, thing went forever, after a couple hours diagphram moved, resident complains and says “can’t you tell if they are getting light by their heart rate and BP”

So, no I don’t think they get any anesthesia training.
 
Zero point zero months of anesthesiology training.


tenor.gif
 
We did 1 month in my residency. It was primarily to learn about airway management. FWIW I enjoyed training alongside anesthesiologists in my critical care fellowship and felt it was always a good exchange of information, a two way street
 
dipriMAN said:
Had a PGY5 surgical resident during a lap case, thing went forever, after a couple hours diagphram moved, resident complains and says “can’t you tell if they are getting light by their heart rate and BP”

So, no I don’t think they get any anesthesia training.
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This is a combination of ignorance and being a dick. It is a learned thing unfortunately. I try to approach things differently but until some of the old stereotypical characters quit being the ones teaching it will persist. But if I notice the patient is taking a deep breath, hiccuping, coughing, whatever that is making it difficult to do my operation and I politely inform my anesthesiologist, usually they rapidly correct the issue. No drama on my side means no defensiveness on theirs.
 
kemper6036 said:
We did 1 month in my residency. It was primarily to learn about airway management. FWIW I enjoyed training alongside anesthesiologists in my critical care fellowship and felt it was always a good exchange of information, a two way street
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Question is, when you are back in the OR, are you going to forget your experiences and go back to "hey anesthesia!" mode or know that the person behind the drape is also the kind of person who you worked alongside?
 
dpmd said:
This is a combination of ignorance and being a dick. It is a learned thing unfortunately. I try to approach things differently but until some of the old stereotypical characters quit being the ones teaching it will persist. But if I notice the patient is taking a deep breath, hiccuping, coughing, whatever that is making it difficult to do my operation and I politely inform my anesthesiologist, usually they rapidly correct the issue. No drama on my side means no defensiveness on theirs.
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Wish more were like you! The ones that make us roll our eyes and lose respect for are the ones that think they know more about our field when they don't even know the mechanism of action of anything we use or ever read a book. Had a surgeon tell me the patient is waking up because the patient moved while pulling the specimen out of the laparoscopic port and I gave it back to him saying the patient is far from awake. He yelled at me saying the patient is awake because he (surgeon) said so. And he said doesn't understand why "you anesthesiologists" say patient is asleep when they move so clearly they are all wrong. For a lap appy none the less. Lol. Please teach your residents and colleagues to let us worry about if the patient is relaxed or awake, we might know what we're doing 🙄
 
2Fast2Des said:
Wish more were like you! The ones that make us roll our eyes and lose respect for are the ones that think they know more about our field when they don't even know the mechanism of action of anything we use or ever read a book. Had a surgeon tell me the patient is waking up because the patient moved while pulling the specimen out of the laparoscopic port and I gave it back to him saying the patient is far from awake. He yelled at me saying the patient is awake because he (surgeon) said so. And he said doesn't understand why "you anesthesiologists" say patient is asleep when they move so clearly they are all wrong. For a lap appy none the less. Lol. Please teach your residents and colleagues to let us worry about if the patient is relaxed or awake, we might know what we're doing 🙄
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The folks who can't distinguish between someone being asleep but not paralyzed versus being awake drive me nuts. Some movement towards the end of a case is probably fine. If their omentum is eviscerating out the umbilical port then I might ask them to make the patient quit pushing (unless they are skinny and I can see enough to push it back in while I close the fascia and be sure I am not catching it in my stitch) but otherwise I can hit a moving target as long as they aren't trying to escape from the bed.
 
If you never have a little movement at the end of the case, it means your wake ups are too slow. Obviously this is a different story for transsphenoidal surgery, or anything similar where a perfectly quiet surgical field until the very end is paramount... but in general, our drugs are imprecise and there’s variability in the dose response curves (even with the most skilled operator). A little patient movement at the end of the case doesn’t mean your anesthesiologist is lazy, more likely it means he/she is paying attention and trying to keep the day moving.
 
Hork Bajir said:
A little patient movement at the end of the case doesn’t mean your anesthesiologist is lazy, more likely it means he/she is paying attention and trying to keep the day moving.
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Or it means you’re a ****ty surgeon when your colleagues can close in 5 mins when you took 15!
“Patient is moving...”
yes it means the patient is still alive, thank you for letting me know.
 
Hork Bajir said:
If you never have a little movement at the end of the case, it means your wake ups are too slow. Obviously this is a different story for transsphenoidal surgery, or anything similar where a perfectly quiet surgical field until the very end is paramount... but in general, our drugs are imprecise and there’s variability in the dose response curves (even with the most skilled operator). A little patient movement at the end of the case doesn’t mean your anesthesiologist is lazy, more likely it means he/she is paying attention and trying to keep the day moving.
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Most of my cases are appys and choles so I know it is extra hard because the cases are super short and the time where stillness really helps is very close to the time when I will be finished. Add in the "large volume of distribution" for a lot of my patients (aka they are fat) and it is even harder.

I do sometimes use the "anesthesia" rather than their real name thing but just as a joke with the ones i am friendly with, or if i don't know who is behind the drape (occasionally when i come in the drapes are set so high that you can't see past it especially if they are sitting)
 
dpmd said:
Most of my cases are appys and choles so I know it is extra hard because the cases are super short and the time where stillness really helps is very close to the time when I will be finished. Add in the "large volume of distribution" for a lot of my patients (aka they are fat) and it is even harder.

I do sometimes use the "anesthesia" rather than their real name thing but just as a joke with the ones i am friendly with, or if i don't know who is behind the drape (occasionally when i come in the drapes are set so high that you can't see past it especially if they are sitting)
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It’s not hard any more with sugammadex. That drug has changed everything.

And I can’t say on this forum what my surgeons call me.
 
dpmd said:
Most of my cases are appys and choles so I know it is extra hard because the cases are super short and the time where stillness really helps is very close to the time when I will be finished. Add in the "large volume of distribution" for a lot of my patients (aka they are fat) and it is even harder.

I do sometimes use the "anesthesia" rather than their real name thing but just as a joke with the ones i am friendly with, or if i don't know who is behind the drape (occasionally when i come in the drapes are set so high that you can't see past it especially if they are sitting)
Click to expand...

But how would you feel if we or others called you "hey surgery" instead of by your name or "hey doc". We don't call the nurses, transport, secretaries, by their role, why is it only anesthesiologists are nameless? Or in other aspects of your life, don't most people say "excuse me, we haven't met, what's your name?"
 
2Fast2Des said:
But how would you feel if we or others called you "hey surgery" instead of by your name or "hey doc". We don't call the nurses, transport, secretaries, by their role, why is it only anesthesiologists are nameless? Or in other aspects of your life, don't most people say "excuse me, we haven't met, what's your name?"
Click to expand...
I get called hey doc all the time and it bothers me not even a bit, but i get how it could bother others. I don't use the names of any of those other folks you mentioned because I usually have no idea what it is (I am terrible with names). I just say hello or hey and then ask for what I need from them. We get a fair amount of locums here and they usually introduce themselves before the case. The non teasing times they remain nameless is because they literally don't say a word to me before I need to ask for something from them while they are behind a drape. Because a word is all it would take for me to recognize their voice because I know all the regulars. But having no idea who the hell is back there thing isn't common, either because I come in before the draping, they happen to be standing when I come in, or they say hi.
 
dpmd said:
I get called hey doc all the time and it bothers me not even a bit, but i get how it could bother others. I don't use the names of any of those other folks you mentioned because I usually have no idea what it is (I am terrible with names). I just say hello or hey and then ask for what I need from them. We get a fair amount of locums here and they usually introduce themselves before the case. The non teasing times they remain nameless is because they literally don't say a word to me before I need to ask for something from them while they are behind a drape. Because a word is all it would take for me to recognize their voice because I know all the regulars. But having no idea who the hell is back there thing isn't common, either because I come in before the draping, they happen to be standing when I come in, or they say hi.
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I think you misunderstood. Why not say “hey doc” to them instead of “hey anesthesia”.

Of course, this would be inaccurate in many cases where there are midlevels especially if you walk in when drapes are already up after induction.

We hate “hey anesthesia” instead of our names. It comes off disrespectful like people aren’t bothered enough to learn our names.
 
chocomorsel said:
I think you misunderstood. Why not say “hey doc” to them instead of “hey anesthesia”.

Of course, this would be inaccurate in many cases where there are midlevels especially if you walk in when drapes are already up after induction.

We hate “hey anesthesia” instead of our names. It comes off disrespectful like people aren’t bothered enough to learn our names.
Click to expand...

I wonder if when people say "hey anesthesia" are they saying it with an intent of disrespect/lack of respect or just ignorance? Nurses call us anesthesia in front of patients and then tell them that their doctor (surgeon) will be there, as if we're just a character named anesthesia
 
chocomorsel said:
I think you misunderstood. Why not say “hey doc” to them instead of “hey anesthesia”.

Of course, this would be inaccurate in many cases where there are midlevels especially if you walk in when drapes are already up after induction.

We hate “hey anesthesia” instead of our names. It comes off disrespectful like people aren’t bothered enough to learn our names.
Click to expand...
This is one reason. Though I can avoid it by saying stuff like "can I get position please" when I don't know a name and/or don't care who accomplishes the task. Now if I don't get a response then a generic hey to the room won't be helpful and in have to get specific in some way so I pick role (have also been known to say hey where is our circulator when the situation arises). That way if a personnel change has happened I am covered too (sometimes I am focused enough I don't notice when my tech changes let alone anyone else)
 
2Fast2Des said:
Question is, when you are back in the OR, are you going to forget your experiences and go back to "hey anesthesia!" mode or know that the person behind the drape is also the kind of person who you worked alongside?
Click to expand...

pretty sure its the latter. have seen some pretty atrocious behavior over the years and try not to perpetuate it. i will admit though, due to the nature of my business and being new at my place its been a challenge to learn names
 
dpmd said:
This is one reason. Though I can avoid it by saying stuff like "can I get position please" when I don't know a name and/or don't care who accomplishes the task. Now if I don't get a response then a generic hey to the room won't be helpful and in have to get specific in some way so I pick role (have also been known to say hey where is our circulator when the situation arises). That way if a personnel change has happened I am covered too (sometimes I am focused enough I don't notice when my tech changes let alone anyone else)
Click to expand...

I'm just saying, if it was any other physician specialist you would be interacting with, I'm pretty sure you wouldn't address them by what they do. Let's say you were in the ER or ICU and you wanted to speak to the doc in charge you don't say "hey ER or hey ICU", just trying to understand the double standard.

Now that I'm not a resident, I wonder if I would get in trouble if I start giving people **** or call them back by their role if they call me be that...
 
nimbus said:
Sounds like BS. When we looked, the cost difference was $10. We use sugammadex like water.
Click to expand...


A A Pract. 2019 Jan 1;12(1):22-24. doi: 10.1213/XAA.0000000000000834.
Profound Bradycardia and Cardiac Arrest After Sugammadex Administration in a Previously Healthy Patient: A Case Report.
Sanoja IA1, Toth KS.
Author information

Abstract
We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. The patient was given sugammadex for reversal of neuromuscular blockade and, within 1 minute, developed severe, drug-resistant bradycardia followed by pulseless electrical activity arrest. Advanced cardiac life support was initiated and continued for 15 minutes before the return of spontaneous circulation. Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, considering the time of administration, the absence of cardiac disease, and stable operative course.
 
Actual adverse effects that have been reported in association with sugammadex are rare. The most common adverse reactions are vomiting, dry mouth, tachycardia, dizziness and hypotension [3].

On the other hand, there has been report of severe hypotension following the administration of sugammadex, with systolic blood pressure falling to 50 mmHg or below [4].

In addition, Pühringer et al. [5] reported a relationship between sugammadex and QT interval prolongation. Many nonantiarrhythmic drugs have the adverse effect of delaying cardiac repolarization. As such, it is important to assess whether new drugs have the potential to cause QT prolongation before they go to market. However, Dahl's randomized placebo-controlled safety study of 116 patients in 2009 found that there was no relationship between sugammadex and QTc prolongation [6]. Furthermore, in de Kam et al. [7]'s randomized, double-blind, placebo-controlled trial of 84 volunteers, it was observed that there was no relationship between QT/QTc prolongation and doses of sugammadex up to 32 mg/kg.

Another adverse effect of sugammadex is severe bradycardia [8]. Consequently, the FDA recommended that patients be closely monitored for hemodynamic changes during and after its administration. Also, Saito et al. [9] reported the occurrence of transient third-degree AV block following 200 mg of sugammadex.

Another undesirable event observed in association with sugammadex administration was the development of negative pressure pulmonary edema. To explain this event, it was hypothesized that the inspiratory force created by the diaphragm may have overcome pharyngeal muscle tone and pharyngeal patency, despite a train-of-four recovery > 0.9 [10].

Additionally, Palanca et al. [11] investigated the toxicity of sugammadex on primary nerve cell cultures in rats and observed sugammadex-induced activation of mitochondria-dependent apoptosis. Although the authors pointed out that penetration of the blood-brain barrier by sugammadex was usually poor (< 3%), the results suggest potentially severe consequences in cases of inadvertent intrathecal application of sugammadex.

Sugammadex: watch out for new side effects
 
BLADEMDA said:
A A Pract. 2019 Jan 1;12(1):22-24. doi: 10.1213/XAA.0000000000000834.
Profound Bradycardia and Cardiac Arrest After Sugammadex Administration in a Previously Healthy Patient: A Case Report.
Sanoja IA1, Toth KS.
Author information

Abstract
We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. The patient was given sugammadex for reversal of neuromuscular blockade and, within 1 minute, developed severe, drug-resistant bradycardia followed by pulseless electrical activity arrest. Advanced cardiac life support was initiated and continued for 15 minutes before the return of spontaneous circulation. Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, considering the time of administration, the absence of cardiac disease, and stable operative course.
Click to expand...

I've also had a case of either profound bradycardia or cardiac arrest that required brief CPR from using neo\glyco...
 
2Fast2Des said:
I've also had a case of either profound bradycardia or cardiac arrest that required brief CPR from using neo\glyco...
Click to expand...

I like Sugammadex. I use it all the time. I just wanted to post that Sh.T happens. Hypotension and/or Bradycardia can be lethal if it occurs in a certain patient with advanced age and CAD. It's dangerous out there.

I have seen the Bradycardia but not the hypotension...yet. Probably, this is because I give Sugammadex at the very end of the case unlike Neo/Glyco. Sugammadex works within 1 minute clinically so that means no need to give it early. The sympathetic response during "wake up" likely limits any hypotension 99%+ of the time.
 
2Fast2Des said:
I'm just saying, if it was any other physician specialist you would be interacting with, I'm pretty sure you wouldn't address them by what they do. Let's say you were in the ER or ICU and you wanted to speak to the doc in charge you don't say "hey ER or hey ICU", just trying to understand the double standard.

Now that I'm not a resident, I wonder if I would get in trouble if I start giving people **** or call them back by their role if they call me be that...
Click to expand...
Or you could try being friendly and saying hey I am so and so before each case with a new person. I don't know what to tell you. It is a different setting in the OR where you can't tap someone on the shoulder or just hover right behind them until they acknowledge you to start a conversation. Same stuff happens during bedside procedures. Hey nurse grab me such and such or hey rt I need a different trach. It isn't so much a double standard as it is that I don't need something immediate from any other specialty like I might from anesthesia so I can use other methods and hide forgetting their name. Maybe others mean offense by it, but i doubt it. I think it is more that it is sort of tradition for whatever reason and they don't realize it may upset some.
 
Thank you

So from what i can tell there is no actual requirement for a surgeon (other than OMFS) to do ANY anesthesia training but some will have between 1-4 weeks in the OR with Anesthesiologists. Is that accurate?
 
Billabong911 said:
Thank you

So from what i can tell there is no actual requirement for a surgeon (other than OMFS) to do ANY anesthesia training but some will have between 1-4 weeks in the OR with Anesthesiologists. Is that accurate?
Click to expand...

Correct. No training or any knowledge given. But they know more about it than us somehow 😀
 
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