Hodgepodge

Working in the general OR means that I get assigned to different cases each day, forcing me to think, plan, and learn about a variety of surgeries. I'm just starting to get over my fear of the spine. Spine surgeries are intimidating; they are long, can have large blood loss, and the patients are prone (on their belly). In prone cases, we have less access to the airway, there is a risk of damage to the eyes or nose, and flipping the patient is not as easy as it sounds. But after doing a cervical spine fusion and a couple lumbar laminectomies, I'm starting to feel a little better about spine cases. The cervical spine fusion was interesting; a neuro tech monitors specific muscle groups intraoperatively to ensure that the surgeons don't damage any nerves.

Of course I had my share of general surgery cases such as exploratory laparotomies, appendectomies, and cholecystectomies, but the most interesting cases were the sleeve gastrectomies. I spent one day providing anesthesia to morbidly obese patients getting weight-loss surgeries. These patients provide a unique anesthetic challenge because the dosing of our drugs doesn't scale linearly with weight; indeed, most medications aren't tested for patients above a certain weight. Thus, I had to learn about pharmacokinetic principles in the obese patient. Moreover, obese patients provide a challenge for intubation; there's less time because their lungs have less reserve, and there's more soft tissue that can get in the way of placing the breathing tube.

The other rooms I've been assigned to have been pretty typical: lymph node biopsies with ENT, breast biopsies with general surgery, more hips and knees with orthopedics, soft tissue mass excisions with plastic surgery. It's been a really good mix.

Image of spine dissection is shown under Creative Commons Attribution Share-Alike License, from Wikipedia.