Medicine in the Operating Room

Sometimes anesthesia is characterized as "medicine in the operating room," and this is not far from the truth. While much of anesthesia is intubation, etc., a lot of it is also a secure understanding of a patient's medical conditions and how the stress of surgery impacts these underlying disease states. For example, many of the veterans I see have a lengthy past medical history, which can change the anesthetic plan. The intubation strategy changes with obesity or reflux disease or a history of neck radiation; the paralytic I choose differs if someone is bedbound or has hyperkalemia or has chronic kidney disease; the emergence changes if someone has severe coronary artery disease and is on a beta blocker. Understanding coronary valve diseases helps me decide intraoperatively how to manage blood pressure and fluid status, and putting someone on a ventilator can be much more difficult if the patient's pulmonary compliance is poor. Anesthesia is about weathering a sick patient with many comorbidities through a surgery where a large incision may be made, an organ resected, and blood lost. I really do think it is the practice of acute care medicine perioperatively.