Urology

I also spent two weeks doing anesthesia for urology cases. Similar to my orthopedic anesthesia rotation, the faculty have created a curriculum to teach the aspects of anesthesia that are specific to procedures like transurthetral resection of the prostate, robot-assisted radical prostatectomies, cystoscopies and ureteral stents, and kidney surgeries.

There were two urology surgeries that were particularly interesting. Both were surgeries for prostate cancer. For one, the patient had a recent severe heart attack with multiple cardiac stents placed. The ejection fraction of the heart, normally 55-70%, was merely 20%. In the second case, the patient had tetralogy of Fallot, a serious congenital heart defect that causes babies to be blue. He had this repaired as an infant when they had just started doing cardiac surgery for this anomaly. This, in fact, was his first surgery that didn't involve cardiopulmonary bypass.

I was paired with a cardiac anesthesiologist in both cases, and intraoperatively we examined the heart with a transesophageal echocardiogram (TEE), a probe placed into the esophagus that uses ultrasound waves to examine the heart from within the body. It was really fun and amazingly educational to see each chamber and valve. I always enjoyed learning about transthoracic echocardiograms (TTE) and this is an intraoperative analogue to help monitor the patient.

Diagram of TEE shown under Creative Commons Attribution License, from Wikipedia.