Thursday, October 08, 2009
Looking for an airway?
It was a challenging ENT list today. I had fun in terror but it was definitely a good experience. What happened today showed how the important communication between ENT surgeon and anaesthetist is needed to ensure the success of the op planned. It was not easy but having a common interest( shared airway) prompted the 2 disciplines to collaborate!
We had a patient who had almost 100% obstruction above her trachytube; subglottic stenosis which was caused by ETT high cuff pressure during her ICU admission which caused necrosis and fibrosis. We did a Shian Lee which in the beginning i had no idea about! till our thorough discussion with the surgeon. It was interesting as I had to insert the J tube first before the start the Op! the stoma wassmall and i struggled initially to push it in! That was the easy part; the tricy part was when they hadto pull the Jtube out and go through and through with the Shian Lee stent.. hehehe suspen gak but it was m first time doing this and it was cool...:)
Then, i had a go at jet ventilation for another man with a similar problem but this time they were looking at trying once more to laser the stenosis to enlarge it. It was just not the airway but he had a bad heart; with a 35% ejection fraction!! hahahaha so imagine me & Alvin( the lecturer) threading very gently not to cause overshoot on either side. The jet part was a bit unsmooth in the beginning and i managed to get hold of the rhythm as we went by.. At this stage i have to be competent at this not only for my exams but for my future role as a specialist..kenalah pandai buat!!!
Thank you Mr ENT for the good coordination. Plan is certainly important and the execution was excellent i thought! A is always for airway right? :)