The Most Important Person In The Operating Room

As a fellow, I’m often privileged to work with medical students and anesthesiology residents in the cardiothoracic operating rooms. Many of these individuals I’ve come to know through the ICU, but some of them are very junior and haven’t spent much time doing cardiac anesthesia (let alone, in any operating room). Before I introduce them to the OR staff and get our duties underway, I ask them to tell me how many people they see around the room:

“Rishi, I think those two over there are nurses, that’s one of the surgical residents, that’s the perfusion team with a student, here’s a research coordinator, the surgical attending is outside scrubbing, the surgical scrub tech is counting instruments with one of the nurses, and then of course there’s you and me. I see ten people. Maybe there will be more?”

I smile – it’s time to impart some clinical wisdom. Not the pathophysiologic, pharmacologic, or surgical considerations inherent to the operating room, but instead, I proceed to step towards the head of our anesthetized patient.

“You forgot the most important person – the patient.”

If you walk into an ongoing surgery, it’s easy to forget about the patient. They’re often covered from head-to-toe with sterile surgical drapes. They’re motionless. They don’t respond to commands. They’re the silent figure who is the most important individual in the operating room.

Often times very junior trainees are taken back by how profound the responsibilities as an anesthesiologist are. Just around the patient’s face, one can find an endotracheal tube, bite blocks, temperature probe, transesophageal echo ultrasound probe, BIS monitor, pulse oximeter, cerebral oximeter, and a myriad of lines and cables that allow me to continuously monitor the patient to keep him/her safe.

During cardiac surgery, there’s a careful interplay between the surgeons, anesthesiologists, nurses, perfusionists, respiratory therapists, pharmacists, blood bank, etc. We are all there working for the patient rather than on them. Patient safety is our priority as a perioperative team, and something that I will always defend.

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  1. I agree, everyone works together, and very grateful for them all. My second dog I adopted with TVD and had her for 4 months had open heart surgery 10/2021 at the only place basically in the world that does TVD Repair. My first dog had it 7/2019, at 17 mo, he is now 4.5, they are Weimaraner’s. We knowingly adopted her to give her a chance she was 17 mo as well. Soon after anesthetic induction, she developed a junctional tachycardia with AV dissociation and was thought to ne a benign arrhythmia and it was determined to proceed with surgery. They stated once rolled into the OR , she returned to a sinus rhythm. She was placed on cardiopulmonary bypass, during which the PFO was closed, the leaflets were separated from the septal and free walls, artificial chordae tendineae (neochordae) were placed, and a partial ring annuloplasty was performed to correct annular dilation (see surgery report for full details). Upon weaning from bypass, patient struggled with hypotension and desaturation. Even with cardiac massage, she was noted to have minimal forward flow. Multiple attempts were made to wean her off bypass, but were unsuccessful and she passed on her own. Although I am very grateful for them all, I can’t get it out of my head that anesthesia played a huge role in cardiac output. We donated her heart to research. I also read in the Vet Journals that some breeds dont tolerate certain anesthesias. All Cardiac Personnel are important, but I think the Anesthesiologist is the most vital….as he/she is to react in a moments notice…too much of this not enough of that can be lethal.
    I have surgery notes if you’re interested. My 4.5 dog (not human I know but same idea) has to go under 7/14 because he had a cryptorchidism (right testicle) neuter at 7 mo old and thought all was removed, but now he has Sertoli cell tumor Testicular cancer of the right testicle which was the one that was undescended. Now I am nervous for him to go under as he hasn’t been under since 12/19 when he had cardio conversion 12/2019 when he was at UC Davis and was in Afib. His open heart surgery was 7/31/19. His cardio conversion lasted until 9/2020 and has been in afib ever since and is very well controlled with his meds. In a stressed situation at his UC Davis visit for his echo, ekg, etc, his heart rate was 85. But I feel the need after my prior experience that I need to have a convo with the Board Cert Anesthesiologist and ask what he is going to use, and that my boy is a light weight even at 117lbs etc lol. I am super nervous with anesthesia even though its not like when he had his open heart surgery.


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