Elective - days five & six

Day Five - Tuesday

This morning I was in theatre with my supervisor. The first case was a very large lady, on whom there were no veins visible at the wrist or indeed anywhere on the forearms. Thus I git to see a recent development - the use of ultrasound in anaesthesia - to locate the vein before putting the cannula into the vein. All in all it meant that it took about 90 minutes just to anaesthetise the patient and get them onto the operating table. there was also an issue of whether the lady would be too heavy for the operating table.

This gave my supervisor a nice opportunity to give me a tutorial on obesity, its effects on body systems, and the difficulty it causes in operations. We then went on to cover fluid balance and blood products and transfusion.

In the afternoon, I was with another SpR and we were again doing the plastic surgery list. These cases were thankfully more straightforward - some were as short as 30 minutes. The SpR explained a bit about the different types of anaesthetic drugs and also allowed me to do my first venflon.....sticking needles into people is quite scary....and also to put some of the airway tubes in. Apparently my main problem is one common to most students - I was too gentle and didn't push the tube hard enough. My venflon was also too hesitant and I wasn't confident enough pushing it in. I assume this confidence comes with the more that you do.

Day Six - Wednesday

Today I was in the emergency / trauma theatre which deals mainly in orthopaedics. There are two trauma theatres and I got to spend time in both theatres. I spent most of the day with the Duty SHO. Two of the cases today didn't have general anaesthetic (where they are put to sleep) but instead had a local block, which again is done under ultrasound. Both cases involved hand surgery. Thus the anaesthatist had to identify the brachial plexus of nerves in the top of the arm and inject the anaesthetic there to block the impulses coming up from the pain sensors in the hand / arm. I was very surprised at how the patients were so calm, oblivious to the procedures they were undergoing which all looked painful.

The regional block method takes longer than just putting the patient to sleep under a general anaesthetic but had less side effects, and less risk than the general anaesthetic would have.

I also got to see a hip screwing in the emergency orthopaedic theatre, which was a bit more brutal than I was expecting - orthopaedic surgeons do use tools which look too much like my school woodworking workshop.