Elective - days seven and eight

Day 7 - Thursday

Today I was in lower limb orthopaedic surgery. The consultant was very friendly and the SpR with her was the one whom i had been with to do the hip screwing on Wednesday. I did another 3 venflon drip insertions, two of which were successful first time, and one of which wasn't! I also spent a bit of time holding face masks and trying to insert the LMA breathing tubes, which is much trickier than you might think!

The theatre being used today was up in the old part of the hospital and had a huge curved bay at one end with many windows, with a lovely view of the multi-storey car park and the back of the new building at the hospital. The operations were fairly simple, but the consultant surgeon still quizzed me about the nerves of the lower limb whilst he was blocking them with local anaesthetic. I doubt i will ever forget that the sagital nerve invervates the thigh and the femoral nerve innervates the lower leg through its two branches - common peroneal and tibial branches.

The regional anaesthetic idea is a good one, since injecting the anaesthetic into the nerve at the top of the leg gives complete pain relief (but also some loss of feeling a movement) for up to 2 days following the operation. this lessens the need for the patents to be on opiate painkillers, which can make them feel sick.

handily, this list was finished by 2.30pm, so i got an early finish.

Day 8 - Friday

Today I was with one of the SpR's for urology surgery. there were only two cases on the morning list, and the first lady was already anaesthetised when I arrived (on time) at 8.55am. Thus I got to see how the monitoring of her operation was different because she was having a kidney operation, and thus needed to lie on her front (prone). She was quite ill and had many previous operations, so when the surgeons discovered she had pus in her kidney, they decided to abort the planned procedure, give her antibiotics and wait until the infection cleared up before attempting the operation again.

The second man was very anxious. he was only having a spinal anaesthetic, because in the past he has reacted very badly to a general anaesthetic. The operation went off fine, with him feeling no pain. However, as we started to disconnect the monitoring, he complained of chest pain around the bottom of his ribs. His ECG and blood pressure were normal, so we could rule out a heart attack. the surgeons came back to check on his operation, but that was way down in his bladder, so it seems unlikely that it was connected to the pain. The man was also sick and sweating, but his blood sugar level was normal. An Chest X-Ray was inconclusive, and so the SpR ordered some blood tests. We then had a fun tutorial on fluid balance, acid-base balance, heart conditions, and muscle relaxant drugs. the patient had still not improved, so I was sent home as there was no afternoon list, and no obvious 'medical' or 'surgical' cause of the pain, so the man was just on close observation.