After a 4+ month hiatus, I returned to the operating room and had a blast! I spent the day shadowing an awesome anesthesiology resident in the neurosurgery O.R. who explained everything from pre-op and ventilation to induction and reversal. He also walked me through the common agents used in general anesthesia as well as the instrumentation. I learned a lot for my first day. 🙂
General anesthesia boils down to four things: hypnosis, amnesia, analgesia, and muscle relaxation. The volatile anesthetics (sevoflurane, desflurane, isoflurane, etc.) contribute a little to each of the aforementioned categories, but other drugs are used to attain optimal levels. For example, we used fentanyl to enhance analgesia and rocuronium, a non-depolarizing neuromuscular junction (NMJ) blocker, for muscular relaxation.
As with any drug, side effects must always be considered. Depolarizing NMJ blockers like succinylcholine are not only associated with malignant hyperthermia but hyperkalemia. Halothane can cause massive hepatic necrosis. These considerations must be weighed in light of the patient’s comorbidities and the nature of the procedure.
Looking forward to my second day tomorrow!