Debra Morrison, MD, anesthesiologist at UCI gave a talk on anesthesia and robotic prostatectomy. While many of the points she reviewed have been covered elsewhere, there were a couple of suggestions that she had that I had not heard of before. She mentioned that with the extreme Trendelenburg position not only is the diaphragm pushed up into the chest but the trachea can be displaced towards the head. This can result in the ET tube migrating into the right mainstem bronchus and an abrupt increase in difficulty ventilating the patient. She is a pediatric anesthesiologist so perhaps she has seen this in that age group but I have not seen or heard of it happening in an adult. Still, it is worth keeping in mind in case you ever experience a sudden deterioration in the patient’s status. The problem may be corrected by simply withdrawing the tube a cm or two until ventilation is returned to normal. At least try that before aborting the procedure and breaking everything down.
Aggravated DocSurg posts his thoughts about the effect of an 80 hour work week on general surgery residents:
>>Tuesday, December 27, 2005
80 hour week Redux
This month’s American Journal of Surgery contains an interesting article from the Dept. of Surgery at Baylor in Houston entitled Impact of the 80-hour work week on resident emergency operative experience. As I have written previously, I am not convinced the 80 hour work restrictions will deal an even hand to surgeons in training, or their future patients. <<
Although the intention of the 80 hour work week for residents is probably good, it certainly has its downfalls.
I was fortunate to finish my residency at Indiana University in 2003. This was the same year that the 80 hour work week was instituted.
I have noticed after several recent cases that my eyes feel dry and itchy. I think it is due to a reduced blink reflex, a well reconized problem for those working with computer monitors and sometimes called Computer Vision Syndrome.
“Research has shown that the blink rate of VDT workers dropped very significantly during work at a VDT compared to before and after work. Possible explanations for the decreased blink rate include concentration on the task or a relatively limited range of eye movements.”