Tuesday, January 31, 2012

How To Get The Anesthesiologist To Listen To You



Here you are in a thin ugly gown, on a gurney, in Pre Op Holding. The blanket full of hot air is on you to warm you up. Your i.v. is in and the Pre-Op Nurse and O.R. Nurse have introduced themselves. You anxiously await the person you are going to meet who will take you through your surgery, your anesthesiologist.

They breeze in through the curtains with a smile. They may have a syringe or two in their pocket. You sense an urgency or rush to them, but when they smile and look you in the eye they make you feel like they have all the time in the world for you.

Your mind goes blank. You answer questions. If you are lucky, they will actually look I your mouth, listen to your lungs, and heart. Many of my colleagues do not listen, not even after intubation for bilateral breath sounds. They just look at the chest for even rise on both sides, mist in the tube, and end-tidal CO2.

Now is not the time to blather on and on about your feelings about anesthesia and surgery. You are scheduled for surgery, the entire room is set up full of instruments, and you are going to go under anesthesia. Now is the time to be present. Muster up all the courage you have, look the anesthesiologist in the eye, and let them know what is most important to you for this surgery.

"I puked like crazy the last surgery and I don't want to throw up like that again."

"I don't want to remember anything, not even the trip from here to the OR."

"that tape make my skin blister and react."

"last time it took me forever to wake up." ( but were you comfortable?)

"I am afraid of the pain" or "I party a lot" or "I think I might need more than usual"

These statements enlist an anestheiologist's help to get you through your experience. Some things may have a preference and affect the anesthesia care a lot. "I don't want to go to sleep" well in some cases you can get a regional, and let a little sedation be used instead. Usually lower body surgery, or perhaps shoulder or arm. Know that there are options.

If an anesthesiologist encourages you for regional, take it. You will feel better in the long run. Just ask for them to snow you through everything so you don't remember. That is easy to do.

Your surgeon has a preference for type of anesthesia, and also for the anesthesiologist. They won't work with certain people. Try to think of it not as two against one, but a well-oiled team working smoothly to get you your care.

If you are fat, old, or have a very small chin, your entire team, including your anesthesiologist, is working very hard to take care of you. Anesthesia for you is risky. Give your anesthesiologist the time to check you out, make a plan, and go get the special equipment before you go in the room. You are not going to die, but your anesthesiologist is going to use more of their skills to get you through. Far? You use more oxygen and have less lung volume, and possibly a difficult airway. There is so much fat inside your throat we can't always see the vocal cords when we look. In the old days we used to do an awake fiberoptic intubation, but now we use a video equipment the 'Glide Scope' to help us intubate you fast when you are asleep and not breathing. Our equipment doesn't always fit well to monitor your blood pressure. Old? Just know there is a lot of mileage on your ticker. It won't like anesthesia, and will need careful support until anesthesia is out of your system. Small chin makes it hard to get int the breathing tube, there is not enough room for the tongue to move out of the way to let us see the vocal cords when we look.

What not to say to your anesthesiologist:

"I am sensitive to medicines" Our anesthesia meds are different from all other kinds of medication. You wouldn't want to wake up in surgery would you? More is better than enough or not enough in this situation.

"I am allergic to" and hand them a huge long list. We only want to know what makes your throat swell up or gives you a rash because the next time it makes your throat swell up.

" I am Jehovah Witness and I don't take blood." depending on the bleeding risk of your surgeon and operation, don't be surprise if an anesthesiologist excuses themselves from your care. Some will let a colleague who is less upset by watching you exsanguinate and taking care of you while you are in hypovolemic shock than others.

"I need pain meds now!" I have had people call me out of surgery to give them meds. If you need them that bad, bring your pills with you and ask the nurse to call and ask for permission for you to take them. The only thing that matters to us is that you let us know what you take and when because our drugs can mix with your medication and recreational mind-altering subtances.

Overly involved family member...please...unless your loved one is demented, let them talk for themselves. It is not about you.

If you are alone, don't stress, we will be family for you. And even hold your hand as you drift off to sleep...

Namaste,

Reiki Doc

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