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Typical Day

Page: http://healingfireisland.com/typical-day/
Healing Fire Island | Typical Day

at the helm!

at the helm!

 

============

I am the professional you forget if the job is done right. Anesthesiologists are the first and last one the patient sees in surgery, and the one in charge of the OR. Surgeons are regarded as the ones that are the important doctors because they save lives and cut out tumors and stop bleeding and sew up stab wounds and lacerations and fix motor vehicle accidents and so on. However they can’t do the first thing without the anesthesiologist. They leave the patient with their anesthesiologist and go to the recovery room and write orders and let the anesthesia doctors wake their patients and transfer them, and it is the anesthesiologists who watch over the patients in recovery. They manage their pain and other issues until they leave the hospital. They co-manage the patients with the surgeon until discharge. Pain issues often are handled by the anesthesia team until discharge and often are cared for in the pain clinic as needed on an outpatient basis.

Most days the anesthesiologist (MDA) arrives around 630 to dress out in scrubs and check the schedule and set up their room. They normally will have from 4-7 cases to do and will set up their own rooms between cases. Often a colleague will give them a break a few times during the day, but if not they will find time to get a coffee or lunch in between cases. Most times the turn over time is too fast to take any personal time in between cases. OR time is at a premium! The room must be cleaned, the supplies and equipment must be replaced for the next patient, and new drugs must be prepared. Then the MDA must interview the next patient for the planned procedure. Often a colleague has already done this, however it is imperative that the doctor or nurse who is doing the anesthetic does their own interview and is familiar with the patient and the procedure.

The most important details include the patient’s name, birthday, site and side, allergies, meds, medical problems, and airway. If the patient has a potential difficult airway certain precautions and preparations must be taken. If the patient has a risk for an anesthetic sensitivity of any kind other precautions must be taken, because they could be life-threatening. If the patient is going to need blood, that must be secured ahead of time. The IV site must be inspected and working well, because if an IV fails on induction, or at the start of the anesthetic, it could be critical and disastrous. If a block is to be done it is important to counsel the patient as to what to expect and how to care for the affected area postop. If a block has already been done it is important to check if it is working so an alternative plan can be ready if the block failed. So there are multiple details to check before taking a patient into surgery. It is inconvenient to have the surgeon pacing the room when things go awry while the anesthetic is falling apart as they expect to be making incision! And there is always another case waiting in holding!

Normally while the case is underway the MDA or CRNA (nurse anesthetist) is preparing drugs and supplies for the next case, allowing some time for a break or a phone call while the team is getting the room ready for the following case. Things always change, such as being reassigned to a different room or being sent to the ER to see an add on or up to the floor for a preop, or sent to holding to do a block. There are multiple duties that come up in any given day for an anesthesiologist. They have things going on all over the hospital. Besides the OR they cover the recovery room where other specialists come for procedures under IV sedation. Cardiologists show up for cardioversions where they have patients sedated with propofol in a RR bed fully monitored. Sometimes they also ask for sedation for a transesophageal echo. Anesthesiologists also go to the GI lab to sedate patients for endoscopies and colonoscopies.

The ICU is another place the anesthesia department is needed. Often those patients need arterial lines, central lines, and other procedures. When they need cardioversions, endoscopies, colonoscopies, or anything, anesthesia is called in. They are commonly taken to surgery so their preops are done there before hand, and they are brought there directly after surgery. Anesthesia is in the ICU every day. Same goes for the ER. I have been there for emergency airway management, once for an obese woman who had airway swelling because of a blood pressure med, and did a fiberoptic intubation. Another time was called emergently from home because of a child with a tumor who had suddenly stopped breathing. Noone in the ER felt comfortable intubating her, so I got the honor and saved the day.

Anesthesia has a huge role in OB, one that has a high risk. OB has us there day and night. Babies seem to be born in the middle of the night for some reason. Regional anesthesia is the safe mode, however because it is done for labor and is inserted in the spine, the obvious disadvantage is that the procedure is done using a long large needle directed at a moving screaming target. We use epidural anesthesia for labor and spinal anesthesia for C Sections, and general anesthesia for emergencies if spinal anesthesia is contraindicated. For most of us, a stat C Section is the most ominous call of our careers. I never lost one, but they were always scary.

They have all of the specialties including cardiac, neuro, pediatrics, ENT, ortho, urology, general surgery, pain management, bariatrics, ophthalmology, spine surgery, plastic surgery, podiatry, oncology, radiology, and GI. They all use anesthesia in some way. They give anesthesia for procedures and they consult on patients for pain management and for the optimal perioperative management in complex cases. Sometimes they have cases that are too risky for surgery. Sometimes there are ethical considerations and there are referrals to committees to work out significant issues.

In summary, there is no typical day, in the life of an anesthesiologist, most days are very challenging and interesting! I have had cases and colleagues and situations which I can think back on with satisfaction and a sense of accomplishment. And some that I can laugh about and smile over!  The only thing typical was that things changed!  I guess that’s life!

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