Friday, October 12, 2007

Neck mobility

I was in preop anesthesia clinic yesterday. I saw a patient that had been in a car accident and had his neck fused c2-c5 (I believe) and he had very little neck movement at all.

In anesthesia there are markers to predict or at least suggest it may be difficult to place a breathing tube in someone. These include mouth opening, dentition, mallampatti score, which assesses the favorablity of the anatomy of the oral cavity (i.e. mouth), hyoid to mentum distance (essentially chin size), neck thickness/anatomy, neck extension and flexion. No one predictor predicts a difficult intubation, but together they form a picture of how easy or difficult you think it might be.

Someone with very limited neck movement would be very difficult to visualize the vocal cords generally, so I was worried a bit in this case. Apparently he had had two surgeries in the past six months with no problems and the anesthesiologists had not told him anything about his airway. So just to be sure I requested the anesthesia record from the other hospital.

It was your standard anesthesia record, with lots of checkboxes for standard things that you do in the operating room.

  • Easy mask ventilation - checkmark -- reassuring because that means you can still mask ventilate if you happen to have trouble intubating.
  • Iv induction - checkmark.
  • Easy intubation - checkmark
  • Mac 3 - checkmark
  • 2nd attempt - checkmark
  • Blind intubation - checkmark
    whoa.... wait a minute. it was an easy intubation, but he/she wasn't able to visualize the vocal cords?

    So now I flip through the rest of the records... no note about the airway at all, or being difficult or anything. I have to now doubt the accuracy of this whole chart now.... How can I trust that he was a easy mask ventition if she/he was willing to describe the blind intubation is easy.

    Enough to drive you crazy.
  • Thursday, October 11, 2007

    Perioperative Guidelines

    Got sent the new ACC/AHA revised perioperative cardiovascular guidelines for non-cardiac surgery. It was a PDF attached to my email, and I figured I should know what's in them since I work in the preop anesthesia clinic, so I printed them out...what could it be... ten pages maybe...


    I went to the printer and it was still printing and it was neverending.

    82 pages!

    Yikes... I know it's a complex topic, and I need to know them.

    6 pages down... 76 more to read... i think some of them are references though... maybe only 70 pages...

    Wednesday, October 03, 2007

    Hand Sanitizer

    Image used without permission from

    Just got a message on my pager.

    I accidentally contaminated the sterile field with [brand deleted hand sanitizer] ( that went out of control) --[resident name deleted]

    Our hospital has gone to having alcohol based hand sanitizer everywhere, to decrease the spread of infection... there's one on the side of the anesthesia cart. Apparently, the spout had gotten clogged a bit and when she went to pump some on her hands it squirted sideways and hit two people scrubbed-in and the corner of the instrument table... and we're doing a descending thoracic aneurysm repair and they're often super-paranoid (rightfully) so that the artificial graft material doesn't get infected.

    Didn't seem the surgeon had flipped out though... probably due to the fact that it's 62% alcohol and probably made the surgical field cleaner.

    You can't make this stuff up.