the Perks of the Anesthesia Rotation

Meant to be a methodical and smooth introduction to the anesthesia rotation, the first day for those of us with limited anesthesia experience was largely spent serving as an assistant to our more experienced classmates. Surgery case organization is centered around a scheduling grid. The daily procedures are placed on a game-show sized day-planner and the procedures are organized based on their surgery table time and the service performing the surgery (community, soft tissue, ortho, neuro etc). By 4 pm on a given day, the next day’s scheduled procedures are laid out for students to pick from.
Procedures that aren’t picked by students are assigned to students by the technicians or clinicians.

A very general overview of our anesthetic process involves the following:

Patient preparations for surgery begin 1-2 hours prior to the table time. A general examination is performed prior to administering premedication  (often times our patients were premedicated with hydromorphone and dexmedetomidine). Preparation for surgery begins after the patient is sedated, and includes placing a venous catheter and performing a clip & scrub of the surgical site. Particular physiological parameters are monitored prior to induction. These parameters include heart rate, respiration, ECG, temperature, blood pressure, ETCO2 and pulse ox. If time permits, arterial lines are placed.  In patients with higher ASA (corresponding to a higher anesthetic risk) statuses, more parameters may be monitored.  For the most part, patients are induced with propofol, which offers the advantage of titrating to effect. When the patient is sufficiently induced. Intubation is via the largest endotracheal tube possible. After intubation, let the gases flow. The anesthetic gas we most commonly used was Isoflorane and secondary was Sevoflorane. Oxygen and the anesthetic gas of choice are delivered by the anesthesia machine, which will either host a rebreathing or non-rebreathing system.  If peri-operative antibiotics are indicated (we most often use Cefazolin IV), the first dose is given at induction and repeated every 90 hours for the duration of the procedure. At this time, local blocks are also performed, such as epidurals for ovariohysterectomies or testicular blocks for castrations.

And unless a patient has complicating factors, this process becomes fairly repetitive…contributing in a small way to anesthesia’s reputation. Viewed as the easiest rotation of 4th year, these are the particular “perks” that make this the vacation rotation.

[Vacation Perk #1] Chosing your procedure.
This provides the potential for case selection based on career interests…and while it can be a great avenue for learning, it can also be a curse in disguise depending on the students on rotation. I have yet to meet a student eager to take a 6-hour-long hemilaminectomy.

[Vacation Perk #2] No procedures, no problem.
Relax in the student lounge, run errands, go home, hang out in anesthesia, do as you wish with your time….pick any of the above if you have no procedures that day. We’ve got 6 anesthesia students on this rotation, and some days we’re looking pretty light with only 3 or 4 surgeries scheduled.

[Vacation Perk #3] Banker’s hours.
Unless you’re the student on call that night/day (on call 5PM-8AM), when the clock strikes 5:00 PM…you’re free. The student on call will come take over your anesthesia duty if you’re in the middle of surgery. Start time the next day? 7:45am.

[Vacation Perk #4] “Real” Weekends.
Like afterhours during the week, unless you’re on call, your weekends are exactly that- your weekends.

[Vacation Perk #5] Reasonable rounds.
Monday, Wednesday, Friday rounds are roughly an hour-long first thing in the morning. Relevant topics, rational duration, laid back and in the face of an extremely busy day- rounds may not happen at all. Compare these rounds to Ortho’s 3-6 hour rounds sessions that may take place starting at 4pm after a very busy day or equine surgery’s pop quizzes… anesthesia rounds are a dream come true.

[Vacation Perk #6]  Limited paperwork.
3 forms are filled out per patient. Sometimes, 4. And aside from the anesthesia monitoring log done during the procedure, the rest of the paperwork takes less than 20 minutes to fill out.

[Vacation Perk #7] No SOAP
Need I say more?

[Vacation Perk #8] Amazing, supportive staff
Helpful, knowledgable, friendly, encouraging, hard-working, efficient….I couldn’t design a better team. Anesthesia’s technicians and clinicians win the award for best rotation support staff. No complaints here, not one.

[Vacation Perk #9] Extended stay.
Most rotations are of a two-week duration…but we get four wonderful weeks on anesthesia.

[Vacation Perk #10] All inclusive pharmacy.
Maybe its just our vet school, but our pharmacy wait lines are such that you could easily read the Iliad three times through before receiving a medication like Rimadyl. Anesthesia would not be able to function if it held these standards. That, and owing to the nature of anesthesia, immediate and convenient access to medications is essential.

All in all, a promising rotation with abundant clinical opportunities for learning. Previously, I had limited epidural administration experience. Art catheters were not something I was well-practiced in and intubation of small animals was something I had only done once. Already a couple of days in, and I’ve had a fair amount of practice at all of the above.