Nearly..

spinal.. 

Obstetrics analgesia is very unpredictable. One has to be ready to deal with any possible complication. Damn.. things always happen when you least expect it to happen. You just have to be on your toes.. day in ..day out.. I am glad that the Consultant in charge ; Dr Satber is very helpful and ever willing to teach. SHe;d always be around when you call her for help !! HAd my first call on Tuesday night ; it was cold however.

Its true what my seniors told me about this posting. It maybe routine but you just cannot be too sure of everything. I've been doing like an average of 10 epidurals per day. haks.. giller banyak.. I was slow initially , but by the end of the day.. you sort of just poke and walah.. tak ler susah sangat.. hehehehe.. Hmmm.. can't wait to insert epidurals in private.. RM1000 woo per service..

Anyway , something happened today when i did a breech in labour case. A chinese lady , in her mid 30's , 3rd child with i previous LSCS scar . She was about 75 kg and a height of 170cm. Fairly tall for asian ; she had a large frame anyway. Did my spinal , it was easy ; no blood aspirated , inserted it slowly and the amount of drugs used was the normal routine dose. She was fairly happy when she was unable to move her legs.. and i was passing over to my afternoon shift colleague.

This lady suddenly snored.. but it sounded more like a stridor. I thought she was sleeping but we were not able to wake her up. Its like when one hass been given Midazolam - totally knocked off. We managed to wake her up..but she was confused. I was unable to communicate with her ; compared to before she was under.

Damn ..i said.. she became more restless. Funnily , her saturation was good 95- 100 at that time , and the bP NEVER dropped. However she was acting awkwardly , nobody was able to understand what she was saying. During this commotion , i called boss to ask for her opinion. She was a bit on the obese side with a FAT and SHORT neck. haks.. then , suddenly her saturation DROPPED. She was refusing the mask.. haks.. Apa laga.. intubaTE SAJALAH... My colleague gave the necessary IV drugs.. and i managed to intubate her.. syukur alhamdulillah it was not that difficult...

Her saturation picked up - the LSCS went on and the baby was delivered with a good ApGAr Score.. Boss came in later ; she was actually on her way back home but returned after receiving my call. Thanx boss !!! We manage to extubate her in the end..Alhamdulillah she was alright.

In retrospective , Dr Satber said most likely what happened wasa manifestation of a high block from the spinal anaesthesia. Although she agreed with me of the atypical presentation , the most likely reaosn would be that. She was worried of Amniotic embolism , but she picked up and was ok intra-Operatively. hakss.. Gila high spinal macam tu.. I was soCUAK you know !! But it was a good experience , coz i have a rough idea how bad it can be when you least expect it. She was tall !! But i did not consider her tummy was "tall" as well and this might have caused some compression ; hence the high block !!!

Anywya , i'm glad that the patient is ok. but my god.. my adrenaline was sky high !! sakit jantung ahh.. Can;t imagine when i';m realy alone in the middle of the night. SHit..it's tomorrow... haks...

Preferred characteristics of anaesthetists BMJ 2004

A good doctor—the characteristics of a good doctor as outlined by the General Medical Council are found in good anaesthetists
Calm under pressure—anaesthesia can be 99% boredom and 1% terror. You must act clearly and decisively under testing conditions
Dexterity—nimble fingers are not only the territory of neurosurgeons—ask a paediatric anaesthetist!
A good team worker—often the anaesthetist is team leader in theatre
Academic—sound understanding of physiology, pathology, and pharmacology is essential
Communicative—surprising as most patients are asleep! But good communicative skills are necessary through the pre- and postoperative periods
Methodical—anaesthesia is procedural and repetitive, so attention to detail is paramount