“Anesthesia Is More Complicated Than I Thought”

Anesthesiology has a notorious reputation about being a “lifestyle” specialty where providers simply throw in a breathing tube, switch on some gas, and then pull up a chair and play on their tablets while waiting for the surgery to finish. Admittedly, when I first got started with medicine, I shared similar views; however, after going through my training alongside outside rotators from surgical specialities (ENT and oral/maxillofacial surgery residents have anesthesia rotations), it’s amazing how quickly perspectives change.

I can’t begin to count the number of times medical students or surgical residents rotating on anesthesia have expressed that anesthesia is far more complicated than it gets credit for. Surgeons often don’t understand what’s involved in turning over an operating room and keeping a patient safe during surgery. At our program, the oral and maxillofacial surgery (OMFS) residents spend four months doing anesthesiology, and there’s a noticeable difference when they return back to the operative side of the curtain. They don’t try to do the “operative time out” during our anesthesia induction. They don’t detract from our focus during emergence. They facilitate the patient’s safety by constantly communicating with us about issues they’re dealing with and are very receptive to our concerns from the anesthetic standpoint.

These residents really understand how steep the learning curve can be, how difficult it can be to “diagnose” problems in the O.R., just how much pharmacology and physiology are involved in tailoring an anesthetic, and the fact that a patient’s vital signs aren’t on a knob we can tune at a moment’s notice.

I wish every surgical discipline did even one month of anesthesia during their residencies. Typically, our outside rotators get paired with anesthesia residents for three weeks (“mentor mode”), and then they’re on their own for the last week. It’s during this last week which their anxiety often skyrockets, but they have to quickly find a way to be efficient and independent. Yeah, those first days off mentor mode are fun for the attending anesthesiologists who have to oversee the chaos. 😉

Many cases can be very straight-forward, but the more complex anesthetics we perform in cardiothoracic surgery, neurosurgery, and trauma are often overlooked. Only by rotating through anesthesia can others understand, in part, what our job really entails.

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