Always Learning

As the end of residency starts becoming a reality, I think of my last few months as opportunities to learn as much as I can. After July, the next time I'm in the operating room, I'll be by myself. In this way, I think that it's great to have a few months in the general adult operating rooms doing a hodgepodge of cases. Every day, I have a new mix of anesthetics, similar to what I might encounter in the private practice world. From robotic gynecologic cases to parathyroidectomies to hardware removal to dermatologic tumor excisions, I've become quite comfortable with being thrown something new every day. I've noticed that I'm much more independent in coming up with an executing an anesthetic plan and that I rarely need to invoke my supervising attending.

Nevertheless, it's important to keep learning. One very fun and fascinating anesthetic I'm learning is the adult inhalational induction. Although we routinely do inhalational inductions in pediatrics for children who won't let us place an IV, we rarely perform it in adults. Almost always we can place a pre-operative IV, and an IV induction is quicker. But there are those exceedingly rare cases where we cannot obtain IV access and choose not to place a central or intraosseous line. In the same way that we cannot translate adult medicine to pediatrics, we cannot simply apply the principles of pediatric mask inductions to adults. But with the help of an attending who used to do these routinely, I've learned the very slow, stable, and surprisingly reliable process of putting someone to sleep by mask. I've learned how to minimize risks and avoid dangers, and it's been amazing. I've intubated patients with nothing but sevoflurane and kept them spontaneously breathing after intubation, all with amazingly stable hemodynamics. True, the anesthesia is quicker with propofol and muscle relaxants, but residency is about adding more tools and techniques to one's armamentarium. This has taught me there are a lot of different and safe ways of anesthetizing a patient.