Surgical ICU

I spend my last month of fellowship on the surgical side. The last time I was in the SICU was as a second year resident, but in many ways it has not changed. I especially enjoy the SICU because it really benefits from an interdisciplinary structure. I learn an incredible amount from the surgeons, but feel that I can teach them a whole lot from the anesthesia or medical side.

The SICU usually averages fewer patients than a medical ICU service. The patients come in several flavors. Some undergo complex surgeries where an ICU stay is expected. We see all the post-operative liver transplants, and for me, it is great continuity as I see them pre-operatively in the medical ICU. Sometimes, patients undergoing large abdominal and vascular cases come to the ICU after their surgery. For the most part, these patients have scripted courses; we wake them up, take out the breathing tube, wean the blood pressure medicines, start their rehabilitation, and send them to the floor. These can be pretty satisfying as everyone is getting better. The second set of patients are those who have setbacks after their surgeries. They usually aren't doing so great on the floor, with persistent infections or complications. These patients have the courses of our medical ICU patients; they can be long, protracted ICU stays where we battle each complication one by one, trying to stave off setbacks. Here, nutrition, rehabilitation, and therapy are crucial to getting our patients better. Lastly, the SICU takes our sickest trauma patients. Often, when a trauma patient arrives, we don't even know their name, much less their other medical problems, medications, allergies, and issues. While Stanford gets a lot less trauma than other hospitals, we still get a handful of car crashes, assault cases, and falls-from-horses. Some of these patients are merely admitted for observation and leave the ICU quickly. Others, especially those with traumatic brain injury, have long and uneasy courses.

For an anesthesiologist, understanding the surgical concerns and seeing the patient's trajectory after the operating room is important. It's easy for us to simply focus on the snapshot of time when we anesthetize a patient. But as physicians, we need to engage in improving every part of the patient's experience. Similarly, working with the surgeons outside the operating room improves our relationships with them inside the O.R. As anesthesiologists, we have a deep and unique understanding of what happens to a patient during a surgery. The postoperative setting for a critically ill patient is simply an extension of the operating room.