A Day in the Life of a Stanford Anesthesia Resident I

I get up at around 5:15 to make it to the hospital by 6am. Getting things going on time in the morning is incredibly important and a little stressful so I make a bee-line to pharmacy to check out my narcotics and then back to my room to set-up. After a quick survey to make sure all my emergency airway supplies (like an Ambu-Bag and O2 cylinder) are available, I set up the bed and machine the way I like it. The technician usually does the full machine check and I simply make sure the most important steps are working. I set up all my airway supplies, checking my largyngoscope blades and lightsources, making sure I have tape and a bougie handy, and testing my suction. It's usually 6:15 by now.

Then the tedious task of drawing up medications. I usually label all my syringes first, then draw up everything I need to start the first case: midazolam, fentanyl, lidocaine, several syringes of propofol, succinylcholine, rocuronium, cefazolin. I dilute my emergency phenylephrine and ephedrine, occasionally making atropine, esmolol, or nitroglycerin if I anticipate needing it. If I am early in time, I go ahead and draw my neostigmine, glycopyrrolate, and ondansetron. Some cases require preparing other medications like a propofol drip, hydromorphone, morphine, or bupivicaine. I usually have my IV start kit ready before I get to the hospital so at 6:35 I scurry out to meet the patient.

I meet the patient in the holding area and have just a few minutes to establish rapport, answer the patient's questions about anesthesia, review my pre-operative history and physical (which I researched the prior night), and consent the patient for the anesthetic. I then start an IV and fill out a quick note in the chart. After the patient is checked in by the nurse and meets their surgeon, then we're given clearance to roll back to the OR.

Once in the operating room, we get the patient positioned, hook up our monitors, perform a spinal or epidural if appropriate, and pre-oxygenate the patient. Then the pace slows down. The crux of the anesthetic, induction and intubation, demands attention to detail and care. While all of the foregoing things can be efficient and pared down, once we are ready for the start of anesthesia, we control the pace. I've written about intubation before, and right after the airway is secured, the speed of things returns to its prior intensity. Along with the surgeon, we position the patient, make sure pressure points are padded, start a warming blanket, and place any additional IVs, arterial lines, temperature monitors, or orogastric tubes. Then we're ready for the surgery.

Usually, the attending gets me out for a fifteen minute breakfast once the case is underway. Stanford anesthesia provides an amazing breakfast array with hardboiled eggs, english muffins, toast, cheese, nutella, bananas, yogurt, and other goodies. It's a short break to catch my breath, reflect on the morning, and prepare for the rest of the day.