This was my second OR observation day of the semester at INOVA Fairfax. My first observation day was ok, I didn't get to do much, it held true to name-Observation. However, today was different. I was with a CRNA who let me do it all. I walked into the OR and she immediately said, "Ok this is your patient, what's your plan?" After picking my jaw up off the floor, I started doing the things I knew how to do, and followed her instructions the rest of the time.
First case...
She asked me, "have you ever intubated before?" I said, "No but I'm ready to try". So we brought the patient back (an obese patient, with a thousand co-morbidities, and an anterior airway), I went through the first steps of my induction sequence without any difficulty, I mean that part is really no different with a real patient. Now we're pushing drugs, lidocaine, propofol, roc... Now I'm ventilating the patient ready for the big event, the INTUBATION. So, here goes I scissored, I inserted the Mac and I can't see cords. The anesthesiologist guided my hand on the laryngoscope until I could see arytenoids, and in went the tube. So that was great, but can't be considered a complete success because I was heavily assisted by the anesthesiologist. However, after we finished the CRNA informed me that he was a difficult airway and she would have just used a glide scope, but I have to learn first before I can use fancy scopes. I'll count that a semi-victory, I definately started to integrate my knowledge. However, I also assisted with my first wake-up, including extubation, which they say is the "true art of anesthesia" (they being my professors).
Second case...
After assisting me "too much" on the first case, my CRNA allowed me to do much more on my own in the second case. I brought the patient back to the OR, moved him to the bed ("everything's on your count" she told me), put him on the monitors (pulse ox, BP, EKG, cycle cuff), pre-oxygenate, drugs, lidocaine, propofol, roc, here we are again, it's time for DVL. I'm thinking "just like lab, I know what to do". And with the anesthesiologist by my side scissor, insert blade, visualize the cords, pass the tube, inflate the cuff, look, listen, and assess ETCO2... It's done, I just did my first independently successful intubation! I even remembered to keep breathing for the patient until I switched him to the vent. I also got to place an IV, which I still remember how to do, but could barely do because I was shaking so profusely from the adrenaline that was still coursing through my body.
