When I first started learning about anaesthesia I was worried about if the patient would wake up or even survive the surgery. I was thinking about this today and realised that my thinking about anaesthesia has evolved since then. It used to be that I was grateful no one died when I was doing anaesthesia as that would be bad, I would have failed, and it would have taken a life because of my failure.
Today however I realised that it is not just enough that my patient survives any longer; it is how they survive that is more important. It is the quality of the anaesthesia, the maintenance of the depth of anaesthesia and the quality of the recovery from anaesthesia. All of these can be managed with an understanding of physiology, the effects of drugs, and with the correct monitoring. There are specialists in anaesthesia and whilst previously they mainly resided within universities there are many that are moving to private practices and referral hospitals. This means that the quality of anaesthesia is increasing – and in some places is done by specialists that only do anaesthesia which allows a higher standard to be provided.
Something that has always been a big problem here in Slovakia is maintaining temperature as the heating in the hospital is not great, the weather regularly drops below freezing in winter and we do not have warming blankets or systems apart from microwave heat pads which tend to go cold on a long surgery. In addition our monitor does not include an esophageal thermometer so we do not have any continuous monitoring of the body temperature once the patient is under drapes.
Once surgery finished instead of the recovery being as fast as it should the decreased body temperature and hypothermia increased the time that patients took to wake up. This was not so great for the patient however in terms for learning it was something that increased my experience and understanding of the physiology of the body system. It gave me experience in how quickly the temperature of an animal can change and the importance of body surface to volume ratio. Hopefully in the new surgical hospital now it will hopefully be less of a problem with new heating systems.
This is not the only factor that is important when it comes to anaesthesia, one of the things that I find important and I do not like to be without is a cannula which is an injection port into a vein. Normally I would also include fluids here at a low maintenance rate so that if I get problems I can then increase the fluid within the vascular system quickly in response.
It seems that things always come in bunches and so last week we had a few patients that had unwanted heart rhythms during their surgeries. Emergencies can and do occur and in this case from seeing the rhythm on the monitor it took just a minute to prepare the medications needed and get them into the patients because there was an IV cannula in place giving us access.
Thinking forwards I see anaesthesia becoming more about the big picture of pain management to ensure a smoother anaesthesia and recovery without the patient experiencing pain. And that is the entire point of anaesthesia – to allow operations without pain.
Well today was my birthday, if it wasn’t for facebook I would have got away with skipping it. Not only am I 26, however in Slovakia (and in fact a lot of Eastern Europe) you lose eligibility to student discounts when you turn 26. This means that the trams have just doubled in price for me from 25 cents up to 50 cents, along with losing discounted entry to various attractions. This evening I had a quite meal out in town which was pretty awesome (my favourite Italian restaurant) with quite a few people from my class! Especially when the weather is like this and all the restaurants here have tables in the street…
Before this however today felt long, it started at 8am this morning with a look at bumblebee’s and how the different types of bee’s are used. We then looked at the different treatment options for diseases in bee’s along with the application of treatment to bee’s. Surprisingly it (at least in theory) is easier to administer antibiotics to bee’s than it is to cats which is pretty cool. There are different options from setting a drug saturated strip on fire within the hive to placing strips where the bee’s will come into contact with them.
We then had fish where it was about parasitic infections which is one of the common problems with fish. We then had physiology with a rescheduled Animal Nutrition practical after it so after starting at 8am we finished around 6pm this evening…
For those that don’t know what embryology is; it is the growth of an animal after fertilisation of an egg (ovum) by sperm (or in the case of some species self-fertilisation). The sperm and egg fuse together with the haploid DNA contained in each combining to form diploid DNA within the nucleus. This single cell the goes on to rapidly divide multiple times with the number of cells doubling with each division (2-4-8-16 etc). Talking simply, this then folds in on itself (invaginates) to form a tube through the middle which will later become the digestive system. At this stage 3 different layers are formed; the ectoderm which is the outer later, the mesoderm which is the middle layer and the internal layer which is the endoderm. The cells in each of these layers are then differentiated to form different organs and structures related to that part of the body – for example the ectoderm forms the majority of the skin.
After embryology we then had the histology lecture that we had missed previously on the senses and today looked at the eye and ear. Personally I think the eye is amazing as the cells here are some of the fastest replicating cells within the body – most injuries to the surface layer heal within hours! The retina is the part of the back of the eye that is responsible for processing images into nerve pulses for the brain to understand and under the microscope looks like this…
Looking at it quickly the layer at the top which is thick forms the fibres that holds the eye together known as the choroid and is attached to the sclera. Under this we then have a layer of pigment before the layer of rods and cones with the associated ganglionic nerve structures.
We finished this afternoon with our Physiology lecture which was looking at the brain, this is something so complex that by the end of the lecture most of use had our head aches. As vets we need to understand how different signals are processed, and the areas of the brain that deal with different functions of the body. In fact if we wanted we could actually progress to become Veterinary Neurosurgeons…. Is that cool or what?!?!