Anesthesia

  Tomorrow is the BIG DAY.  I will be the "official" anesthetist on Dr. Small's (and our teams) first ovaro-hysterectomy (OVH).  Our patient will be a kitten from a local shelter.  First and best, I have complete confidence in Dr. Smalls (my fellow student and teammate).  Secondly, I am terrified of anesthesia. 
   Now here's the deal, anesthesia is scary to begin with.  You take an animal into a state of unconsciousness that inhibits not only their ability to move (obviously a goal) but to some degree their ability to do some basic things like thermoregulate, dictate appropriate ventilation or send blood around their bodies.  Hmmmm...that could be a problem.  You have approximately 4 tools to tell you if the animal is trying to die.  These are heart rate, respiratory rate, blood pressure and temperature.  There are some other tools we use like mucous membranes, reflexes and eye positioning as well.
   To top things off, my anesthesia will be conducted on a CAT.  Right.  So what's the saying?  "Its hard to kill a dog under general anesthesia and its hard to keep a cat alive."  Awesome.  Lets start by going through anesthesia.
   You start out with some drugs.  These are good drugs.  Things like opioids and tranquilizers.  The goals of these drugs is to chill the animal out and give them a nice buzz to make them more refractory to pain and get some actually analgesia on board.  These drugs will help me get an IV catheter into a tiny kitty vein.
   Once I've got that catheter in and my patient is purring away, its my job to take a really scary syringe full of something called an "induction agent" and get ready to induce (knock out) my patient.  In this situation I'll be using Ketamine and Diazepam (Valium).  So I'm going to inject this medication (in a very specific manner) and knock my cat out.  This is the scariest part of the whole show.  This is when cats stop breathing.  The only way for me to get the cat breathing is to get the endotracheal (ET) tube in the cat and start ventilating for it.  The clock is ticking.  As you may recall from driving through tunnels or swimming, you can only go without breathing for so long.  It may also be that when my cat is supposed to be knocked out and I'm about to put the ET tube in that it decides to wake up again.  Then I have to give it more of the induction agent and try again.
   Apparently cats like to close off the larynx (airway) when you try to intubate them, which makes things a little more difficult.  Still, once I've got that tube in and I hook the cat up to the gas anesthetic everything is peachy right?  Wrong.  In order to monitor our patients we use a doppler (blood pressure), esophageal stethoscope (allows me to hear the heart and breath at the same time) and an esophageal thermometer.  Using these 4 readings, I will attempt to keep this cat not only unconscious throughout surgery, but healthy, safe and ALIVE.
   Reports from yesterdays group of students are that almost (if not every) cat woke up during the surgery and they all became hypotensive (low blood pressure) and hypothermic (low temperature).  In other words, they were bouncing back and forth between two scary extremes.  This should make for a relaxing afternoon.
   So how do I feel?  You know, not bad actually.  I'm going to know what I can know and then what?  What possible expectations could they have of me?  I can simply do my best, know the information and use the minimal experience that I have.  There are going to be professional anesthesiologists roaming constantly helping us and they are some of the coolest customers you will ever meet.  Plus, it isn't as if everyone yesterday had a smooth and chill time and I'm going to be the one goof up.  No this is hard stuff.  Its tricky and specific and it takes time to learn it.
   Tomorrow afternoon the learning will make the jump to light-speed.