Diary of a Fourth-Year Vet Student: You Are Getting Very Sleepy

Anesthesiology is one of the more arcane aspects of human and animal medicine. When you do surgery, the animal is reduced to the square of tissue in your operating field. When you do anesthesia, the animal becomes patterns of breathing, heart rate, blood pressure, blood oxygenation…a bunch of numbers collected by machines and sensing devices, and sometimes the old fashioned way with your fingers on a big artery to count pulses or checking for eyelid reflexes or mucous membrane color (should be pink always!). By altering the amount of inhaled anesthetic gas, changing fluid rates, and starting and stopping drugs from the dozens we have available to us, we can affect all of these parameters. 

For me, being in charge of anesthesia for a procedure is super stressful—you are keeping the animal alive despite the terrible things being done to its body, and not just alive but keeping certain physical parameters within specific limits. Your attention cannot waiver. You have to keep one ear open to the chatter coming from the surgical team--they may initiate procedures that will have a dramatic effect on the status of the patient but they might forget to alert you in advance. You may have half a dozen different screens to monitor. And you are constantly recording things--physical parameters, when you give drugs and how much you give and where you give it...complicated but also very interesting from a physiological perspective.

I have been thinking pretty deeply about anesthesia for the past week as I completed the first week of my three-week anesthesia rotation. In one short week, I managed to rack up my "big four"--a cardio case (I ended up with two big ones), a cat, a horse, and giving an epidural injection to any species (I gave one to a dog).

Students are also responsible for placing IV catheters. I was pretty worried about that since I haven't had much success with small animals, but I have to say that I was rather successful this past week. I placed IV catheters in every one of my patients, and with the exception of one dog, I got the catheter placed correctly in a single needle stick (in that particular dog, I got it placed correctly with the second stick in the same leg). My tally includes a 12-year-old cat with chronic renal disease, a French bulldog, and an elderly long-haired doxie. Those particular dogs are difficult because they have short, deformed legs and veins with strange anatomical placements. Weird anatomy trivia: veins often vary from the ideal, arteries rarely do. The cat--well, it's a cat. You have a limited amount of time before any cat decides it is done with all of your nonsense. They have thin skin, fragile veins, and with renal disease they can also have low blood pressure. So my successes are a bit more meaningful because they include these difficult patients.

I also had to place a temporary venous catheter in a horse during a procedure so that we could give it some antibiotics. Horses are always trying to die so they nearly always require a dobutamine CRI (continuous rate infusion) added to their IV fluid line to keep their blood pressure up. All of that was going into the catheter placed in the horse's jugular vein so I had to use another location for the antibiotics (some drugs do not play well with others). The horse was in dorsal recumbancy (on his back) and the room lights were off since the procedure was laparoscopic and the surgeons needed to see their monitors. The anesthesiologist told me to palpate a particular vein on the bottom of the horse's jaw (which was fully exposed). I couldn't see the vein in the dark, and only vaguely recalled its position from first-year gross anatomy class, but I could feel it. And by golly, I put that catheter in the vein in one poke. In the dark. It was amazing and empowering to me for the anesthesiologist to act as if he was completely confident of my ability to do this, no matter what he may have been thinking.

I did not have the best experience with anesthesia during my junior small animal surgery lab although things got quite a bit better during my junior large animal surgery lab. And now I find that I am really enjoying a rotation that I was initially dreading.