A Family Doctor's Tale - A TALE OF 2 ANESTHETISTS

A TALE OF 2 ANESTHETISTS

There are 2 types of anesthetists:
1.confident and hardworking
2.relaxed and too easy going


The first group is
1.conscientious,
2.do a proper  pre-operation examination of the patient the day before,
3.check that he is the correct patient.
4.make sure that he is not taking medications which may clash with the anesthesia
5.check that he has not taken any food or fluid at least 6 hours before the operation
6.reassure the patient before putting under general or regional anesthesia
7.continue to check his vital signs(blood pressure, heart beat, respiratory rate) during his surgery
8.make sure that the levels of oxygen and nitrous oxide are correct
9.check the intravenous drip does not run dry
10.make sure the patient was safe during the surgery(there are times when patients wake up during the operation because the anesthesia was not deep enough)
11.reverse the anesthesia carefully
12.make sure that the patient was well after waking up


The second type of anesthetist is very easy going:
1.ask the patient a few questions just before the operation
2.induce the general anesthesia
3.leave the patient in the hands of his nurse during the operation to monitor the vital signs, gases and drip
while he goes for a break in the surgical tea room
4.when the operation is over, he will turn off the anesthetic gases and reverse the anesthesia
5.Once the patient is awake he will go for another break until the next operation


I was taught by both types of anesthetists. 
I learn to be the first type of anesthetist because I want to be good doctor who takes care of his patient and not just do his work routinely.
Besides I do not wish any of my patients ends up as one of the fatality from anesthesia.
So I was constantly with the patient from induction of anesthesia to reversing the anesthesia.
The danger of general anesthesia has been greatly exaggerated.
There is always a risk of 3 fatalities in a million due to anesthesia not 1 per cent as sometimes stated.
It is very important that a proper examination is done before the general anesthesia as medication such as Viagra may clash with some anesthetic. 
If the patient is not fit for general anesthesia, he should undergo some other form of anesthesia for the surgery instead of general anesthesia.
It is also important to have an empty stomach for at least 6 hours before general anesthesia because of the risk of vomiting or regurgitation of fluid or food entering the windpipe.
There is also the danger of muscle relaxant reversal where the patient's anticholinesterase enzyme were insufficient to help reverse the muscle relaxant.


I remember a surgery where the anesthetist was a new trainee anesthetist. It was his first general anesthesia done under the instruction of the Head of the Anesthetic Department. Everything went well until after the surgery. When he tried to reverse the muscle relaxant, he was horrified to find that the patient was unable to wake up. She was one of the patient who had this enzyme insufficiency.She had to be put on a respirator and intravenous drip for 2 days in the ward until the muscle relaxant was flushed out of her body.

It was one of the complications of general anesthesia.


General anesthesia can be administered with endotracheal intubation or without intubation. For short operations of less than 30 minutes or diagnostic operations such as biopsy, general anesthesia may be given after sedation with a short dose of thiopentone using nitrous oxide and oxygen gases. 
An oropharyngeal air way is inserted to prevent the tongue from falling back and blocking the passage.


Regional anesthesia is preferred to general anesthesia because of less risks of complications associated with general anesthesia.
Spinal anesthesia is given by a needle into the epidural space below the spinal cord for operations requiring paralysis of the lower half of the body such as appendicectomy, operation of lower intestine, ovaries and womb.
Epidural anesthesia is given to relieve pain during delivery of babies, caesarean section.


Caudal  anesthesia is given to paralyse the lower perineal region for operation of the cervix, womb, hemorrhoid and anal operations. It last for 1-2 hours. 
In the Obstretic and gynecological hospital (KKMH)of Singapore, I had to do caudal anesthesia for almost 20 patients over a period of 3 hours straight in order for them to undergo dilation and curettage of their wombs.


Regional anesthesia of a particular limb allows the surgeon to operate in cases where general anesthesia is dangerous or unnecessary (in elderly people or uncontrolled diabetic patients who needs amputations or treatment of fractures of the hips, legs and feet).



All told, the Anesthetic department was a short stint of 3 months which I enjoyed and learned.
I also found out all I can about the operations done, the conduct of some surgeons in the operation theater and the use of the surgical tea room for sleep.