Just for today I will keep this blog post short and sweet.
Over the course of my career as a full-time practicing anesthesiologist, I have seen three very major improvements which have enhanced the quality of patient care.
The first is propofol. When I began in the late 1990's, the induction drug available was sodium pentothal. It came in a big glass syringe you had to assemble. Although this drug worked well in causing anesthesia sleep at the beginning of the case, it had one big drawback--it was very high pH, it was very alkaline. If the i.v. 'blew' and the drug got into the local tissues outside the blood vessel serious damage would occur. The patient would then need to get a plastic surgeon and skin grafts to the area. Propofol, the milky white emulsion of anesthesia agent, revolutionized anesthesia care with it's portability, fast onset and faster emergence. You can run a drip or give small boluses to keep someone under Monitored Anesthesia Care (MAC) pretty much anywhere in the hospital.
If the vessel blows with propofol? It's just depot propofol, the body can absorb it over time, and no harm to tissues is done.
The second major advance is with regional blocks. Blocks were possible all through my training, with a special twitch monitor connected to a needle, which would cause the limb to move in synchrony with the beeps of the device when the tip was near the place it needed to go, the target nerve. What has revolutionized patient care is the application of ultrasound to visualize both the nerve and the needle tip. You can see the spread of the local anesthetic as it is injected. (Ultrasound also makes line placement safer for central lines--you can see the tip of the needle entering the target blood vessel, such as the internal jugular vein for large bore i.v. access).
The third is the Glide Scope. In my early career and training, the only way to manage a difficult intubation safely was an awake fiberoptic intubation. Although fiberoptic scopes are still needed for anesthesia for lung surgery (to verify placement of a double-lumen endotracheal tube) and some difficult intubations, the vast majority of the patients may be induced like easy to intubate patients, then the special adapted blade with a fiberoptic camera built into it used with a special more rigid stylet inside the breathing tube to pass the breathing tube into the vocal cords. The stylet is removed, the tube secured, and the patient connected to the circuit in a matter of seconds. Video laryngoscopy is a wonderful thing!
Some honorable mention would go to the LMA (laryngeal mask airway) which is a little less invasive than a breathing tube, BIS monitoring which measures the depth of anesthesia by reading the brain waves through a sticker applied to the forehead, and sugammedex, a rapid reversal for neuromuscular blockade with rocuronium or vecuronium.
The last thing is the hover mat. It's an inflatable air mattress that is placed underneath the patient. When the patient needs to be moved from bed to OR table or from OR table to bed or gurney, we snap two belts and connect the mattress to a special blower. Then the mattress inflates, and the patient is basically like the puck on an air-hockey table. It takes minimal effort to transfer because they are floating on a cushion of air. This alone has saved many an OR staff or floor nurse from major back injury.
I know many of our readers enjoy the more esoteric aspects of healing and medicine that Ross and I promote through our work. But every now and then, it's nice to reflect on the everyday profession Carla enjoys, and to share some general tips for those who are not in the profession but might undergo surgery as some point in the future.
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Aloha and Mahalos,
Namaste,
Peace,
Ross and Carla
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P.S. the countdown is now thirty-nine <3
