Drugs

Part of the early learning in anesthesia is familiarizing myself with perioperative medications. Many of these are new - etomidate, succinylcholine, neostigmine - and a few are ones I've used before - phenylephrine, fentanyl, midazolam. But learning a dozen new medications is one of the challenges of starting a new specialty. Furthermore, many anesthetics are dosed based on ideal body weight, and so getting a feel of the right dose for each patient also takes times (it took me all of intern year to start estimating successfully doses of vancomycin and piperacillin/tazobactam for patients based on their age, weight, and renal function). No matter how much we like pharmacology (and all applicants applying to anesthesia say they like pharmacology), learning the drugs is hard. Not only that, we are responsible for knowing the pharmacokinetics, pharmacodynamics, duration, interactions, indications, and side effects for these medications. How do we choose between them? What do we see when they are administered?

Even more than that, we have to give the medications ourselves. Medicine was one step removed; I would write an order and expect the medication to be administered. Now, I push the drugs into the IV. So some of my learning is acquiring the manual dexterity to draw up drugs quickly, memorizing the concentration of each drug, and learning to dilute drugs. It helps me remember not to take for granted the time needed to prepare and give medications.