Challenge

An attending challenged me to come up with two anesthetic plans for the same type of case. So for two ear surgeries, I designed one anesthetic based entirely on intravenous agents and one with inhaled anesthetics. I usually do these cases with one technique, but the attending believed that no technique had an absolute clear advantage in the uncomplicated case, and indeed, the unconventional approach has its own benefits. I was surprised to find this to be true. The ENT surgeon thanked us for using nitrous oxide as it helped his visualization of the middle ear. With careful planning to attenuate the side effects of the volatile anesthetic approach, I found that what I feared - nausea and a slow wake-up - did not happen at all. In fact, I felt that the unconventional anesthetic performed superior to the standard technique.

There are many ways to achieve a successful anesthetic to some surgeries. While everyone at one institution may do it one way, this reminds me that other approaches, if planned, designed, and executed well, can achieve the same or better outcome. There are always ongoing drug shortages and the possibility of equipment failure, and this makes me more comfortable that I can continue treating patients even in the event that my hands are tied by one thing or another.