Sunday, July 31, 2011

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.

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