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Saturday, March 6, 2010

Little things

Kids, rugrats, sprogs. All different names for the same entity. And for most of us, cause for the smallest of flutters. You see, kids aren't simply small adults. They have unique physiology and they have given me more grey hairs as an anaesthesiologist than any other patient group.

Having said this, however, I consider myself to be reasonably confident in dealing with anaesthesia for small people. This is born of a large amount of experience - we have a very busy paediatric surgical department and, in addition, perform a (relatively) large number of surgeries for congenital cardiac conditions. So, when I was called upon as a registrar, late one night, to dope a 3 year old boy for a repair of a nail-bed injury, I didn't worry too much. As they say, pride comes before a fall....

As anaesthetists, we dislike poking children with sharp sticks while they are awake, so when we anaesthetise children we generally induce anaesthesia with gas. We explain to the parent that we are going to get the kid to breathe in our gas, and they will drift off to sleep. We also tell them that this is not a painful process and that the child will probably have no recollection of the induction. This explanation falls into the category of "if I say it often enough, someone will probably believe it."

To be honest, every once in a while I can pop a kid off to sleep without it really noticing, but these are few and far between. The fact is, the gas smells funny, and children don't like having things thrust in their faces, especially in an unfamiliar environment like an operating theatre. As a result I usually try to sneak the kid off slowly and surreptitiously (ninja style) but if they start crying or fighting we go full blast, hold them tightly and get it over with as soon as possible.

Unfortunately, this is the situation I find myself in on this particular night. Despite all my cajoling and ninja techniques, this poor child is fighting and kicking. So we switch to the infamous "gorilla style" induction. Hold him tight (anyone who as had to confine a strong 3 yr old will know that this can take 3 people) and go full blast with the Sevoflurane (anaesthetic gas). Sevoflurane typically works in 2-3 minutes especially if the child is taking deep breaths, which they typically are when they are crying. So you can imagine my surprise when after a good 3 minutes of fighting the kid is still wide awake.

"Don't worry," I tell the mom, "he'll sleep soon.." We carry on for another 2 minutes or so - no change. Now I am starting to think about why he isn't going to sleep. I turn around and see, to my horror, that the breathing circuit is not connected to the anaesthetic machine anymore. Our patient must have kicked it off very early in the process. I have spent 4 minutes trying to put the child to sleep with room air. Any parent will tell you that this approach is generally suboptimal.

So I have a dilemma. Do I tell the mom the truth i.e. that I am an idiot, or do I surreptitiously plug it in and carry on? I'm embarrassed to admit, all these years later, that I simply plugged it in. Once the child was actually getting the gas, he went to sleep in about 60 seconds flat. I wonder if the mother noticed. If she did, she never said anything....

6 comments:

tracytodd said...

I love the fact that you are so unashamedly honest in your writings. It takes courage to speak the truth but more importantly it makes you so real.

Thank you for sharing such a personal mistake.

Jabulani said...

My daughter broke her arm at 28 months and had to have 2 surgeries, so I've seen how fast those masks work. I confess, there've been times since then that I've remembered that mask with longing ... ;)
Btw, the mom probably didn't even notice. Ok, she did, but just pretend she didn't.

VIVA TIVA said...

Oh man!! It's like when you religiously pre-oxygenate with 100% oxygen for a few minutes then induce, only to find that you never opened up the oxygen!! I believe that there are angels on our shoulders during those mid-night cases...

Doc-ZZZ said...

@VIVATIVA - That has NEVER happened to me :)

VIVA TIVA said...

Lucky you!! It's happened to me once only, but I'll never forget it!!!

Bongi said...

the mother noticed all right.

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