Sunday, 7 July 2013

99% Boredom 1% risk

What am I talking about..... Anaesthesia = 99% Boredom 1% Risk

An old boss of mine told me this quirky quote quite a few years ago, but how true is it! For those that are used to doing them day in day out I'm sure will relate to this quote somewhat. Genuinely 99% of the time nothing happens, the animal is settled and everything is running smoothly. However how true is it also regarding that 1% of risk!

This is a very good thing to learn early on, because in that 1% so much can happen and go wrong. Concentration is the name of the game and don't get complaisant. I recently worked with a student who had been training well over a year now, but who just couldn't grasp this concept. Anaesthesia is like driving a car, when you start off learning the whole experience is very scary - 'what things do I set up', 'what do I do if something goes wrong.' The more you get used to them however the more natural they become, until you can't remember how you got to work in your just did.

It really does become second nature, my animals eye is up but it has a slight blink reflex = ok I need to deepen my anaesthetic slightly. Also a lot has to be said for getting to know your surgeon, i.e. do they do intra-dermal sutures or use nylon for the skin? Knowing this can help you start to reduce the anaesthetic at the appropriate time. I guess what I have also learnt over the years especially from locuming is that unfortunately some students have it and some just don't. Some just can't put all of the observations and skills together to create a smooth anaesthetic. However if your reading this and think I just don't get it yet, don't worry most of the time it will suddenly just 'Click' into place and you'll go ahhh I get it now why I have to do that! Just don't become complaisant and if in doubt ask.

When that 1% does happen, don't worry even the experienced hand panics for the first split second. Regular critical care CPD can help with this. One of the best ones I undertook was at a referral centre where they had all the gadgets to best show you examples. I found this invaluable, like small tips about administering the adrenaline down the ET tube. Or with the aid of a capnograph seeing just how little you actually have to squeeze that bag during IPPV.

For all those students out there though, don't panic & if you are unsure or feel your not ready to be left in charge of an anaesthetic tell your supervisor and ask to be monitored. I can honestly remember being a timid student and being left with my first anaesthetic not even knowing if the eye up is good or bad!

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