Mornings start pretty early in anesthesia and I have been making that observation a lot. But, after saying hello (I think I actually chuckled more than saying hello) to my M3 neighbor as he walked up to his door after a full night of call, I realized that most days of M3 start MUCH earlier than anesthesia. It is just that anesthesia starts much earlier than most of the M4 rotations. Internship is really going to be a slap in the face!
These days start with a 06:30 (military time, oh yea!) meeting--including students, first year residences and a faculty member--which is basically a recap of interesting cases from the previous day and discussion of the drug of the day. (To all those rising students: don't forget the difference between an opiate and opioid, it may come in handy.) 07:00, go find the resident you're working with and the patient of the first case of the day. Meet and introduce yourself to the patient and ask them how they are doing, attempt helpfulness by offering to place an IV or an arterial line which has usually been done long before you arrived, and smile and look pretty. That last part is the most challenging for me. 07:21, take the steering position of the front of the gurney and desperately try to remember where OR x is in the maze. No, they are NOT ordered by number but they are referred to by number. Very helpful! Try not to hit anyone in the hallway as you are transporting the patient and be sure not to steer from the side of the bed or you will invariably be clipped off by some enormous--gazillion dollar piece of equipment positioned in the hallway. All the while, make small-talk with the patient to help comfort them because they are about to place their life in your hands. Attempt to recall which end of the patient should be taken into the room first because, after all, you were in that OR for one day about a year and a half ago. Grab and apply a facial mask before entering the room: this often requires me saying, "Wait a moment, please, I need a mask." Wheel the patient into the room without knocking over anything or hitting any cords that might be on the floor. Make sure you do not touch the sterile field with any part of your person! That is one sure way to make MANY people in the room upset, and rightfully so. And, if you do, tell the nurses right away. They would rather have you fess up to it than not to say anything and have to call you on it.
07:24, once in the room, position the gurney next to the OR table and match heights without overlapping the two. Once the patient is positioned, start attaching a maze of wires and tubes and gather equipment for intubation. Perform a Time Out: ask the patient their name, birthday, what is going to be done to them and where it is going to be done. (This is actually performed first in the pre-op, but performed again in the OR (a couple of times).) 07:35, pre-oxygenate the patient and administer drugs for rapid induction (put the patient to sleep and induce paralysis). Keep in mind, I'm doing this from memory and I have not tried to really memorize this, so if I'm missing a step or three, that's why! 07:38 (three minutes of preoxygenation is the key), tilt the patient's head back, take the laryngoscope in left hand, sweep it from right to left, life toward the upper-opposite corner of the room (assuming the OR bed is square with respect to the room) and desperately try to see vocal cords (little white things). After a few moment of silent searching, someone (either the resident or the attending) applies pressure to the neck and then sometimes you can see the base of the cords and the posterior arch of the tracheal opening. You see it until you take the tube and get it close. It invariably blocks your field of vision. (Did I mention that the attending is asking you what you see to which all I can usually muster is, "I see it.") Try to gently finesse the tube through the opening couple of times before requesting the boogie (a thin plastic rod). All the while, you hear the lowering pitch of the oxygen saturation monitor telling you that the patient is starting to run low on oxygen (but not really dangerously low, it really serves to increase your blood pressure). You slip the boogie in because it is easier to manipulate and to see around. 07:38.30, the resident starts sliding the intubation tube over top of the boogie as you hold it into place. The tube is fed in, boogie removed, tube is secured, connected to the ventilator, you squeeze the bag, the chest rises, mist fills the tube, the end-title CO2 gives a reading, air can be heard going into the lungs but not into the stomach, and the pitch of the oxygen-saturation monitor gets higher. All the while, you must continue to LOOK PRETTY!
The rest of the procedure is making fine adjustments to the various drugs based on heart rate, blood pressure, oxygen saturation, response to electrical stimuli, urine output, end-tidal CO2, SPV (has to do with blood pressure differences while breathing), the amount of inhalant in the expired gasses, and the amount of blood loss from the procedure. I'm probably missing a few parameters, but these are the things you continually scan during a procedure to make appropriate adjustments. There's also a considerable amount of record keeping, cleaning up, and preparing for the rest of the case and the next case.
I think anesthesiologists are the unsung hero's of the OR, which I kinda' already knew. It is rare for the anesthesiologist to be called by name, let alone doctor. (Although, several of the staff are not doctors, they are CNRA's.) And the patients don't typically praise the anesthesiologists for their fine work. Alas, the anesthesiologist does not fix the patient; they only keep the patient alive. Don't get me wrong, I think the surgeons do great things. However, I think the anesthesiologists are equally important. Although, the anesthesia is optional I suppose. You could have a liver transplant and be awake for the whole procedure feeling every cut and stitch, not to mention how they stretch open the abdomen. You could…if you wanted.
