The Art and Diversity of Approaches

Like almost every field in medicine, anesthesia has multiple ways of achieving the same outcome. For example, adequate anesthesia for an ankle surgery can be provided through peripheral nerve blocks, a spinal anesthetic, an epidural anesthetic, or a general anesthetic. Selecting the best technique is, for lack of a better cliche, the art of medicine. Most people, including other physicians and surgeons, don't think of anesthesia that way. It is easy to see it as a cookbook endeavor, with simple recipes to create surgical conditions for this or that. But over the last year, I realized some of the subtlety and nuance has to do with choosing, adapting, and refining the anesthetic technique for the patient, surgery, and surgeon. For example, I've had two pregnant patients who've had severe fetal bradycardias with epidurals in place requiring emergent C-section. For one, I induced general anesthesia and for the other, I bolused the epidural for a surgical block. Deciding to do one or the other was a real-time moment-to-moment decision in conversation with the obstetricians, looking at the overall patient and fetal circumstances. It's been a really good experience seeing how these anesthetics are chosen and administered. I've also been encouraged to step out of the box and try different approaches for the same circumstance. It's a good reminder that although now I can reasonably manage an anesthetic for most patients, I still have a lot to learn about alternate approaches and practices.