What is anesthesiology like?

[plsfoldthx]

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Can someone explain to me what is behind the sayings "hours of boredom, few moments of sheer terror"

Can someone describe to me what you are doing/keeping track of in those short moments of terror?

 

[Jeff05]

can someone describe what it's like to dive out of a plane?
or see your child for the first time?
tough moments in anesthesia are kind of like that.
you just have to be there.

Can someone explain to me what is behind the sayings "hours of boredom, few moments of sheer terror"

Can someone describe to me what you are doing/keeping track of in those short moments of terror?

 

[GoodmanBrown]

Can someone explain to me what is behind the sayings "hours of boredom, few moments of sheer terror"

Can someone describe to me what you are doing/keeping track of in those short moments of terror?

Though as my title indicates, I'm a pre-med, I'll try to chime in with one situation I witnessed. It will obviously lack some key details as they went over my head.

The surgery was a bypass of some variety, where the patient's arteries supplying the heart had become blocked, and new routes were being sewn on by the surgeon. Surgery was progressing smoothly, and the resident (CA-3) and I were chatting a bit while he kept up his work and monitored stuff. The "boredom" in this case is when the surgery is progressing smoothly and the anesthesiologist's main job is just keeping the vent at the right settings and monitoring fluid loss, EKG, etc.

However, at one point, the surgeon had to re-position the heart to keep sewing. It was an "off pump" surgery meaning the heart was beating the entire time. The surgeon would simply clamp one small portion of the heart to immobilize it, while the heart beat beneath that portion.

So, anyway, the surgeon moves the heart to get to a new area, and it goes into a funky rhythm (v-tach, I think.). The anesthesiologist sees the change on his monitors before the surgeon notices anything. Suddenly, it's become a bad situation because if the heart stays this way or gets worse, the patient loses blood delivery to the brain. This would be bad. So, the ensuing several minutes are quite frantic as the anesthesiologist makes the surgeon stop working and release the heart, starts pushing meds as quickly as he can and calls for a bit of attending back-up. Before they even show up, the resident has the heart back in a proper rhythm and after a minute or two, gives the go-ahead for the surgeon to continue.

After a few more minutes of diligence, the anesthesiologist and I resume our conversation where we left off. Things proceed smoothly from there until it was time for me to head out about an hour later.

 

[bigeyedfish]

What I usually tell med students is that its like being on a road trip with a poisonous snake somewhere in the car.

 

[NavyFlightDoc]

I hear it described similarly to piloting an aircraft. Once your in the air, it's usually pretty straightforward (with the rare in-flight emergency). Takeoff and landing ALWAYS require a bit more concentration, and are occasionally pretty hairy.

Pretty reasonable analogy IMO.

 

[plsfoldthx]

Though as my title indicates, I'm a pre-med, I'll try to chime in with one situation I witnessed. It will obviously lack some key details as they went over my head.

The surgery was a bypass of some variety, where the patient's arteries supplying the heart had become blocked, and new routes were being sewn on by the surgeon. Surgery was progressing smoothly, and the resident (CA-3) and I were chatting a bit while he kept up his work and monitored stuff. The "boredom" in this case is when the surgery is progressing smoothly and the anesthesiologist's main job is just keeping the vent at the right settings and monitoring fluid loss, EKG, etc.

However, at one point, the surgeon had to re-position the heart to keep sewing. It was an "off pump" surgery meaning the heart was beating the entire time. The surgeon would simply clamp one small portion of the heart to immobilize it, while the heart beat beneath that portion.

So, anyway, the surgeon moves the heart to get to a new area, and it goes into a funky rhythm (v-tach, I think.). The anesthesiologist sees the change on his monitors before the surgeon notices anything. Suddenly, it's become a bad situation because if the heart stays this way or gets worse, the patient loses blood delivery to the brain. This would be bad. So, the ensuing several minutes are quite frantic as the anesthesiologist makes the surgeon stop working and release the heart, starts pushing meds as quickly as he can and calls for a bit of attending back-up. Before they even show up, the resident has the heart back in a proper rhythm and after a minute or two, gives the go-ahead for the surgeon to continue.

After a few more minutes of diligence, the anesthesiologist and I resume our conversation where we left off. Things proceed smoothly from there until it was time for me to head out about an hour later.

holy **** thanks

i know thats not for me... id fall asleep on the monitor

 

[GoodmanBrown]

holy **** thanks

i know thats not for me... id fall asleep on the monitor

I don't know. I quite enjoyed the cardiac surgery, and really gained a huge appreciation for what the anesthesiologist does. I felt like the resident had to be constantly checking 2-3 things and working with the surgeon to be prepared at those critical moments when the surgeon is pushing and pulling the heart. It was at those times that rhythms went all over and the anesthesiologist was on his toes. The bypass was a real feat of teamwork in my eyes, and the anesthesiologist always had to be 2 steps ahead of the surgeon to be prepared for what might come up. There was nothing boring about that surgery to me.

I also shadowed a Whipple which is a major abdominal surgery. That seemed much slower to me. The surgeons weren't really near the heart, and as far as I could tell, catastrophic complications were rare. I stayed for about 1 hour, and the anesthesiologist only intervened once to raise the blood pressure a smidge and didn't even speak to the surgeons except to raise the bed once. That surgery was much less exciting...

 

[proman]

I also shadowed a Whipple which is a major abdominal surgery. That seemed much slower to me. The surgeons weren't really near the heart, and as far as I could tell, catastrophic complications were rare. I stayed for about 1 hour, and the anesthesiologist only intervened once to raise the blood pressure a smidge and didn't even speak to the surgeons except to raise the bed once. That surgery was much less exciting...

Until the surgeons put a hole in the portal vein, have a suture come off an artery and have 10% of hepatic blood flow coming out, cut the IVC, rip the spleen, etc. That's exciting.

We have to always be prepared for that kind of stuff. It just happens more often with cardiac cases. But what is also rewarding is doing an all day Whipple, having nothing bad happen, extubating the patient and going to the ICU with a comfortable patient with great hemodynamics.

 

[GoodmanBrown]

Until the surgeons put a hole in the portal vein, have a suture come off an artery and have 10% of hepatic blood flow coming out, cut the IVC, rip the spleen, etc. That's exciting.

We have to always be prepared for that kind of stuff. It just happens more often with cardiac cases. But what is also rewarding is doing an all day Whipple, having nothing bad happen, extubating the patient and going to the ICU with a comfortable patient with great hemodynamics.

Didn't mean to imply there weren't any. I can only give my observations as a relatively uninformed observer. Seems to me the more you know about what the anesthesiologist is doing, the more exciting it is.