The Post-Op Patient

The medical ICU takes a few types of surgical patients, mostly neurosurgery and ENT. For the most part, the management of these patients is pretty simple; the neurosurgical patients get hourly neurologic exams and the ENT patients are admitted to watch their airway and breathing. If all goes smoothly, they go to the floor the following day. But sometimes things don't go that well. We have a neurosurgery patient status post clipping of an aneurysm who has since developed intractable seizures. He's spent almost a month in the ICU, and the neurologists have struggled to get his seizures under control. Finally, with six antiepileptic agents, he's stopped seizing, but with all these medications, he's comatose. We're trying hard to find that balance (if it exists) where his seizures are manageable but he is awake and interactive. We also had an ear-nose-throat patient who in the middle of the night developed severe throat swelling that started to compromise his breathing. Three anesthesiologists, with all our tricks and rescue devices, could not get a breathing tube in, and so the general surgeons had to come and do an emergent "slash" tracheostomy. So while post-operative patients usually do well, it's a good thing we keep an eye on them.