I honestly was a bit terrified before starting this rotation because I had weird problems that happened during sophomore and junior surgery (apnea- not breathing on their own, waking up while heading to the OR (operating room), and things of that nature). I actually have been enjoying my time even though there are times when my heart still races. It is not too bad of a rotation, but it does solidify the fact that I do not want to pursue this as a career for the future :) It is just way too much stress and responsibility resting in your hands.
I struggled in the core anesthesia class because I could not picture the microscopic phenomenon that occurs when a drug is given or when the blood pressure decreases or when heart rate increases or when the patient stops breathing all of a sudden and so forth. Going over all the lecture notes while taking this rotation greatly solidified some concepts that I could not grasp when just sitting in the classroom and taking notes. Sophomore and Junior Surgery was also great kinesthetic practice for preparing for this anesthesia rotation.
I have improved tremendously with doing drug calculations after taking this rotation! I loved that they give us a drug sheet with all the available anesthetic and analgesic drugs with their proper concentrations and drug administrations. It made the calculating process run more smoothly.
You will get a lot of hands-on experience. You give the injections such as the premedication drugs, induction drugs, and even pain therapy drugs like an epidural (injecting an analgesia, usually an opioid, into one of the layers just outside the spinal cord to help numb the area being treated). You also get all of the equipment and station ready for the patient, place the catheter in the cephalic vein found on the dorsal-medial aspect of the antebrachium which is distal to the elbow of the front limbs or in the saphenous vein found in the lateral aspect of the hind limbs, and intubate the patient. A lot of doctor–related decisions for when problems arise occurs very frequently. Be ready and prepared for those situations by reviewing past anesthesia lectures and notes from rounds because changes within a patient (ex: apnea, tachycardia, hypotension, hypothermia, hemorrhage, etc.) can happen very fast.
On occasions, you will be monitoring alone with the patient having a procedure. Do not panic though! You will always have a technician pairing up with you for a case. During the first week, they will be in the room with you and will rarely leave. Later on, they begin to trust that you are getting used to monitoring the patient on your own and will leave for longer periods of time but always will check back with you to make sure everything is fine. Technicians are extremely helpful and patient. They will either be people who work here at the hospital, or they may be your classmate who took this rotation already and is now considered as the tech. I was so surprised and encouraged for how much my classmates knew after taking this rotation for only 3 weeks!
Making the best drug protocol for a patient is still a bit of a challenge for me. There is so much to consider before sticking with a drug. What is the patient’s major health concerns, and will this drug make the patient worse while under anesthesia? Once you feel comfortable that the drug’s contraindications will not affect the patient, it should be safe to administer. Just remember that there will never be a perfect drug.
Here’s what other people had to say about it!
(What was Orientation Day like?)
-Met in the prep room (huge, long room by Imaging services) at 7AM to get a quick introduction for how they operate and where supplies are located. We received a laminated drug sheet first day that is extremely helpful for the rotation and future. Try not to lose this handy tool.
(Average Daily hours on duty?)
-7:30AM-5:30/6PM (including AM and PM rounds)
-7:30AM-6/6:30PM With one doctor, morning rounds @ 8A, evening rounds @ 5PM
(What is the attire? When do you change into scrubs?)
-scrubs and white coat (supposed to change into scrubs once in building to keep them “clean”)
-make sure to always put your white coat back on after leaving the OR area. It is easy to forget, but it is to prevent any hair or blood to land on your scrubs before going back to the OR for another procedure. Have one extra pair of scrubs in your locker.
(What do doctors/residents/techs constantly harp on?)
-Have all your stuff and be prepared. Morning rounds is exactly 8AM (some doctors hate latecomers), but you need to have your stations set up for your patients by then (so get there 7:30AM or earlier).
-Know your differential diagnosis for CBC or Chemistry abnormalities. You will some times be asked to explain what causes elevated sodium levels or decreased anion gap and so forth.
-Don’t forget to give Cefazolin (an antibiotic) via IV to your patient undergoing surgery every 90 minutes. This one takes 10 minutes to administer, so it is easy to forget to re-administer this drug and to give it very slowly also.
(What are some struggles to watch out for?)
-Inconsistent lunch breaks (have snack bars on you at all times to eat in the changing room!). People on-call have been there up to 1-3AM, be ready to be there if you’re on-call (whether it’s primary or secondary on-call)
-You may finally be able to do an epidural without assistance, but then you notice the administration was still unsuccessful because the patient is tachycardic and hypertensive during the surgery (meaning the patient is painful). Don’t beat yourself up if it did not work. Just make sure you have other pain meds such as Hydromorphone or Fentanyl to help facilitate the problem.
-Some times, students in other services forget to write where the patient is located, so you have to walk a lot to try and find where the student or the patient is to get more information about the particular case. If you ever have to write up an anesthesia form, please write where the patient is. It will help us out greatly.
(Words of encouragement)
-It can be very overwhelming and nerve-wrecking, but really rewarding. You get the chance to do and learn a lot with direct supervision and guidance (lk epidurals, brachial plexus blocks, lots of intubation/ catheterization). The more work/ effort you put into it, the more you’ll get out of it! Also, teamwork is a must!
(Difficulty Level (1-3)? 1= It’s a breeze/ 3= really difficult workload)
2 out of 3
3- our block was constantly busy and would sometimes have up to 12 requests to work up for the next day (good news is that you never have to write up discharges or put in any requests for tests or imaging)
1 Corinthians 6:19-20= “Or do you not know that your body is a temple of the Holy Spirit within you, whom you have from God? You are not your own, for you were bought with a price. So glorify God in your body.”