Yesterday, like most days, my patients came in all different shapes, sizes, and situations.
Patient #1 was petite and frail, in her early 60’s, and only 5′ tall. She had the body habitus that we who work in the OR always love to see. Light as a feather, and easily lifted and re-positioned. Which we needed to do several times during her operation for lung cancer. It was quite easy for the surgeon to get access to her anatomy, and it was practically effortless for the anesthesia team to find the blood vessels we needed for anesthesia care, and for putting in her special breathing tube.
In stark contrast to patient #1 was . . . patient #2. He weighed over 400 pounds, and with a height of under 5’9″, his BMI was estimated to be around 60. He was so big (and wide) that he would not fit on our standard OR table. All of his excessive tissue caused him many, many problems, one of which brought him to our OR yesterday. He had one of the worst cases of obstructive sleep apnea I have ever seen. He had to be intubated on arrival to the hospital, and he came to our OR to receive a tracheostomy, in order to save his life. But his redundant skin and tissue everywhere, especially below his chin, made it nearly impossible for his surgeons to find their proper way. This was really a scary patient to take care of – his airway could have easily been lost.
After surviving the near-storm of patient #2, my 3rd patient presented with a mouth full of loose teeth. While this may seem like a dentist’s dream (kidding), it’s an anesthetist’s nightmare. And the proposed surgery was not even to remove these teeth – surgery was on the patient’s belly. This patient, too, needed to be intubated, so now things get really tricky. Inserting a breathing tube into someone’s mouth is an art that is honed in anesthesia school and through career experience. There is always an inherent risk of doing dental damage during oral intubation because instruments have to be inserted into someone’s mouth. When we anesthesia providers are presented with loose teeth, the risk of dislodging something now increases precipitously. There are several ways to get around this, fortunately, and yesterday, the styletted lightwand came to our rescue. The tube went in seamlessly, all teeth (loose and otherwise) intact, and we were then free to deal with the rest of the patient’s problems!
Giving anesthesia involves a lot of problem solving, and also careful planning to prevent problems.