When I first started learning about anaesthesia I was worried about if the patient would wake up or even survive the surgery. I was thinking about this today and realised that my thinking about anaesthesia has evolved since then. It used to be that I was grateful no one died when I was doing anaesthesia as that would be bad, I would have failed, and it would have taken a life because of my failure.
Today however I realised that it is not just enough that my patient survives any longer; it is how they survive that is more important. It is the quality of the anaesthesia, the maintenance of the depth of anaesthesia and the quality of the recovery from anaesthesia. All of these can be managed with an understanding of physiology, the effects of drugs, and with the correct monitoring. There are specialists in anaesthesia and whilst previously they mainly resided within universities there are many that are moving to private practices and referral hospitals. This means that the quality of anaesthesia is increasing – and in some places is done by specialists that only do anaesthesia which allows a higher standard to be provided.
Something that has always been a big problem here in Slovakia is maintaining temperature as the heating in the hospital is not great, the weather regularly drops below freezing in winter and we do not have warming blankets or systems apart from microwave heat pads which tend to go cold on a long surgery. In addition our monitor does not include an esophageal thermometer so we do not have any continuous monitoring of the body temperature once the patient is under drapes.
Once surgery finished instead of the recovery being as fast as it should the decreased body temperature and hypothermia increased the time that patients took to wake up. This was not so great for the patient however in terms for learning it was something that increased my experience and understanding of the physiology of the body system. It gave me experience in how quickly the temperature of an animal can change and the importance of body surface to volume ratio. Hopefully in the new surgical hospital now it will hopefully be less of a problem with new heating systems.
This is not the only factor that is important when it comes to anaesthesia, one of the things that I find important and I do not like to be without is a cannula which is an injection port into a vein. Normally I would also include fluids here at a low maintenance rate so that if I get problems I can then increase the fluid within the vascular system quickly in response.
It seems that things always come in bunches and so last week we had a few patients that had unwanted heart rhythms during their surgeries. Emergencies can and do occur and in this case from seeing the rhythm on the monitor it took just a minute to prepare the medications needed and get them into the patients because there was an IV cannula in place giving us access.
Thinking forwards I see anaesthesia becoming more about the big picture of pain management to ensure a smoother anaesthesia and recovery without the patient experiencing pain. And that is the entire point of anaesthesia – to allow operations without pain.