Working with med students today was fun, and pointed them about the way of anaesthesia education by looking things in an integration way, instead of thinking of anaesthesia rotation as a hand skill learning to do those and these. Explained them, why don't they look that what we are doing in every single day in the operating theatres, in Surgical ICU, in Pain clinic, acute pain services and Pre-anaesthetic clinic is really the things they have been learnt, taught, and practiced for years.
Nothing new has been taught, I am afraid, is what we have discussed in the OR.
It is just Anatomy : when the laryngoscopic view was asked after they just put an endotracheal tube in place, when you just inserted the iv cannula wasn't that Anatomy?, told me where the brachial plexus is? and explain how the spinal cord ends?
It is Physiology : it displays on your monitoring screen, it is really the clinical application of monitoring, from an ECG, oxygen saturation, end-tidal CO2 tension, arterial blood pressure, airway pressure. You have to know what goes on from the surgical side or the other side of the OR border, such as you see an episode of hypoxaemia in a lady who underwent Sentinel Lymph node dissection, can you explain how this happens? Thinking of oxygen-haemoglobin dissociation curve, then apply it in real life, if all your patient have 100 % oxygen saturation, does it really mean that everyone has a really good or perfect lung function?
It is Pharmacology : it is just in our magic box, induction agent, pain killers, or a nail to pin your patient not to move during surgical procedure. In a vascular suite, there was a patient scheduled for vascular access, he does not have any urine for ages, what the first thing reaches your mind right now besides the diagnosis of a plain ESRD. A guy on the table has 4 kinds of antihypertensive agents, so can you explain why he developed hypotensive after an induction dose of propofol and even the endotracheal was placed in his trachea which should have been a painful stimulus.
It is also Pathology : a very closed friend to anaesthetists, we share many similar things, we know everything from head to toe. In the hypertensive guy, can you explain what really happens in hypertensive patient, the SVR, any change in circulating blood volume from normotensive changed to hypertensive patient.
Happy Holiday would be fading away, Welcome your new life with a New Mind-Set.
Nothing new has been taught, I am afraid, is what we have discussed in the OR.
It is just Anatomy : when the laryngoscopic view was asked after they just put an endotracheal tube in place, when you just inserted the iv cannula wasn't that Anatomy?, told me where the brachial plexus is? and explain how the spinal cord ends?
It is Physiology : it displays on your monitoring screen, it is really the clinical application of monitoring, from an ECG, oxygen saturation, end-tidal CO2 tension, arterial blood pressure, airway pressure. You have to know what goes on from the surgical side or the other side of the OR border, such as you see an episode of hypoxaemia in a lady who underwent Sentinel Lymph node dissection, can you explain how this happens? Thinking of oxygen-haemoglobin dissociation curve, then apply it in real life, if all your patient have 100 % oxygen saturation, does it really mean that everyone has a really good or perfect lung function?
It is Pharmacology : it is just in our magic box, induction agent, pain killers, or a nail to pin your patient not to move during surgical procedure. In a vascular suite, there was a patient scheduled for vascular access, he does not have any urine for ages, what the first thing reaches your mind right now besides the diagnosis of a plain ESRD. A guy on the table has 4 kinds of antihypertensive agents, so can you explain why he developed hypotensive after an induction dose of propofol and even the endotracheal was placed in his trachea which should have been a painful stimulus.
It is also Pathology : a very closed friend to anaesthetists, we share many similar things, we know everything from head to toe. In the hypertensive guy, can you explain what really happens in hypertensive patient, the SVR, any change in circulating blood volume from normotensive changed to hypertensive patient.
Happy Holiday would be fading away, Welcome your new life with a New Mind-Set.
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