One day in equine anaesthesia ...
It's always fun to show people around my school :-) A vet hospital can be full of surprises !
Let me give you a little peek into the equine anaesthesia department in which I am working this week ... most of the surgeries performed here are laparotomies for colics (open up, see what's wrong and hopefully do something about it !!) and arthroscopies (little camera inside joint, most often to go and get some unwelcome bone chips out of there - we call it DOC - dissecans osteochondritis).
8:AM : We start by putting a sterile catheter in one of the jugular veins, and we suture it into the skin to be sure it'll stay in place, even if the horse starts crashing around (especially when waking up).
8:30 : Horse is tranquilized, groomed, recieves pre-op antibiotics and anti-inflammatories. We spray some smelly blue stuff on it's hooves so they stay clean and won't get slippery.
8:35 : Horse is brought into the induction room, and is squeezed between a matress and the wall. At that point, when he starts relaxing, we inject the drugs to knock him out. Usually, it takes about 10 seconds to 1 minute depending on the agents we chose and the horse's previous state of sedation. We usually manage to get the horse to sit like a dog and then go down smoothly.
8:40 : Horse is down. We stretch out his neck, open his mouth and put a metal cylinder between his front teeth. Then we pass a lubrified endotracheal tube through the cylinder and with a little twistin' , it usually goes down like a charm. We tape the tube to the jaw to keep it in place, and pump some air into the tube's wall to make it air-tight. At that point, the horse is ready to be moved into the OR.
8:45 : the horse's legs are tied up to a machine that lifts him up onto a wheeled mattress that we drive quickly into the OR, where we hook him up right away to a ventilator with oxygen and isoflurane (an anesthetic volatile) and another gazillion monitors including an electrocardiogram, a direct arterial blood pressure, a pulse oximeter (shows how much oxygen is in the blood), an expiration gaz analyzer and an oesophagal temperature monitor. All these wonderful parameters are summed up on one very colorful and beeping screen, that becomes your very own favorite TV show for the next 2 to ... ughhh hours :-). In the meanwhile, the surgery crew is clipping and prepping the surgery site. Local anaesthetics are given if required by the type of surgery. Masks and hats come on, the surgeons come out of their scrubbing room and the blue ballet begins. Sterile drapes fly, instruments clatter ... we're on :-)
9:15 (at best) : "First incision" says the surgeon, as we anxiously check our monitors and the horses reflexes to make sure he's sleeping tight and doesn't feel a thing. The next hours will be spent making sure the horse stays stable. We have our monitors to help us with that, plus blood gas analysis in order to have direct insight into what's going on inside. Fluids and drugs are constantly adjusted.
Later (much later) : "End of surgery" says the surgeon (or usually the intern, because they get to do the stitching while the surgeon moves on to more exciting things - ) and the ballet starts again, the other way around. Everyone is pretty pleased to take hats and masks of, it gets pretty stuffy underthere. It's the best way to get a pimple to bloom, though. ;-) We get the horse "lighter" so he doesn't take forever to wake up (we decrease the amount of anaesthetic gas he recieves) and take all the monitors off before transfering him into the "wake up" room. We leave the tube in, keep him under oxygen, and check him for any signs of incoordination (starts with rapid eye movements) so we can tranq him again if necessary. We don't want him to try and get up while his motor coordination is down, he could get badly hurt. This phase usually takes 20 minutes but can last up to 1 hour, depending on the horse, how long he was under, how incoordinated he is, and so on. When he starts moving his limbs, we get out (mamma mia) and observe him as he tries to get up; we can help with cables if necessary. It usually takes 2 or 3 tries, the wiser the horse the lesser the falls, and we go and get that tube out of his trachea when he starts chewing on it. This way, we are sure he won't be fighing for air while he's straining to get up. He's usually a little hung over but ready to go back to his stall about 15 minutes later ... and by that time, we're more than ready for lunch, and the OR has already been cleaned for the afternoon procedures :-)
So it's busy but fun ... sometimes it's hard to stay awake especially when they dim the lights and the beeping of the monitors slowly numbs your brain ... I'm on call 24-7 for 2 weeks during this rotation, so when you've taken a night emergency, it's even more challenging ... but there are several of us, and we team-work it out :-) Brownies, anyone ?
OK ... that's plenty for now ... you never know when your next chance for a meal will come up so I'd better get started on something !
Internship matching results will be coming out soon ... da dice are rollin' !
California dreaming, on such a winter's day ...
xxx Ali - your very own drug dealer
posted by aLi at
8:20 PM
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