A fresh breath of anesthesia

So the last week has been a good change of pace--I'm on outpatient pulmonary medicine in September, but since clinic doesn't start until 9:00, I've been able to spend time daily with the anesthesiologists from 7:00-9:00, starting cases, intubating, and starting i.v.'s.

One thing I appreciate about anesthesiology is how laid back the anesthesiologists are. They love their job, and their feathers almost never become ruffled. One day last week, the anesthesiologist handed me the syringe of Ancef (an antibiotic) to inject into the patient's i.v. line. I proceeded to inject half of it before he calmly said, "Now this patient is penicillin-allergic, so let's hold off on the rest of that and just watch the blood pressure a bit." (Sometimes patients allergic to pencillin react to the "cousin" cephalosporins, and one complication is a critical drop in blood pressure.)

In another case with a different doctor, I was holding the oxygen mask over the patient's nose and mouth waiting for induction. Suddenly I noticed the beeps of the monitor getting lower in pitch, indicating a drop in oxygen saturation. Sure enough, within seconds I saw it drop from 92% to 88%. Quickly, I looked for the patient's finger to see if the monitor had fallen off. It was obscured under a blanket. Another second later--85%. I turned to the anesthesiologist as the oxygen saturation was dipping close to the 70's, but before I could say anything, he gently suggested, "Why don't you go ahead and ventilate the patient?" He'd pushed the induction drugs without my noticing, and there was the patient: apneic, and rapidly desaturating!

Fortunately, both patients did fine. The first one did not react to the Ancef, and the second patient rapidly re-saturated when I began ventilating her. Lessons learned.