Thursday, July 26, 2007

Tales from obstetrics OT

I'll only be on call this weekend.Somehow Hady arranged the roster in such a way that every month we will only do one weekend stretch call for the 4 of us. Fair i should say ; that I've spent my last 3 weekends doing various activities to my liking !

My day job for now is not very tiring ; in charge of the Obstetrics elective list AKA the CAESaR's List. We will only have from 1 - 5 caesareans per day ; and the time I go back will depend on who does the surgery. The other day , I went back at 6 pm.. and we only did like 4 patients !!! haks.. Not problematic list but maybe inexperience problematic surgeon ! I do pity though for the patients with virgin ( no abdominal operations done before ) abdomens - not being well done will ensure complications either to conceive or for the next caesarean..

80% of my caesareans will be done under regional anaesthesia ie either spinal or epidural. What is scary to my patients will be the thought of being awake during the operation. The technique performed will numb and paralyze one's body from one's midrib and below. Spontaneous breathing and consciousness maintained during the operation.Sedation is possible but for caesareans it is not encouraged before the baby is delivered ! Of course the surgical site is covered from the patients but one can still hear the buzzing and sounds of a surgeon cutting one's abdomen !!!! Thus ; the need to fully explain and counsel in such a manner that these patients of yours will be safe in your hands. And somehow , i enjoy this part !! :)

The technique is fairly straight forward and simple. One just has to have the knowledge of position , what can be poked and what should not be poked well as the complications that may arise with the technique. A local anaesthetic drug is injected into the sub arachnoid space - ie a small space where your brain fluid flows in one's spinal cord ; with the mode of action being blocking one's nerve root that supply the sensation and motor function from the abdomen downwards..

When your patient is not that fat takpe... but when her BMI is like 45 !! hakss... Imagine the difficulty of me unable to appreciate the space for injection while palpating !! hakss.. As you can see from the picture ( top to bottom )

First needle : Atrocan 26G with its special introducer...
( macam tak sampai jer... but hit a vessel.. so withdraw and change )

2ndneedle:Pencan 25G with green needle 18G as my introducer
( confirm tak sampai !!! )

3rd needle : Pencan 27G which is longer
( Hit the bone and the needle was bent as it was too flimsy )

4th needle : Pencan 25G which is as long as the above
( PRESTO !!! Success!! )

All that after lots and lots of manipulation of the needle...
And of course , my favourite laryngoscope ; McCOy...
but another story.. :)

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