Dr. Eric Freeman writes from China
Pictures from China by Dr. Eric Freeman
5/8/08 10:40pm
A Fiberoptic Intubation Show
It was another pleasant morning as I walked to the hospital. As usual, the streets were bustling with activity. Traffic is pretty bad here, just like NYC. The residents bike to work since they live pretty close to the hospital and having a car is quite costly. It is day 4 for me and I am getting into a routine by now here in China.
75 year old patient for gastrectomy. I enjoy using the fiberscope at any opportunity to improve my skills. I asked Dr. Cui if I could use it. He said "No problem, just be careful. I don't usually let the residents use it." I am used to having everything at my disposal but would now have to adapt. No TV screen, no viscous lidocaine, no fancy airway devices. I was working with a resident named Dr. Fenzhen. I told him that I had to lubricate the endotracheal tube somehow. He came back with a bottle filled with some oil. While ventilating the patient and waiting for the muscle relaxant to kick in, the OR started to get a little more crowded. Apparently, Dr. Cui told others about my impending fiberoptic intubation so the curiousity was heightened. I don't mind a crowd but I easily had 20 eyeballs focused on me. This was my first attempt without the aid of an airway device. I am used to just looking through the scope by now, so not having a TV was not an issue. I cracked the patients mouth open, adjusted the scope, and surely I immediately saw vocal cords. A few quick maneuvers, and then I slid the ETT rather easily over the fiberoptic. Connecting to the circuit, seeing the chest rise and end tidal CO2, I breathed a sigh of relief. Guess this can be done even without an airway device. Defintely got my confidence up. Dr. Cui gave me a pat on the back. Not one of the patients I have provided anesthesia to here has weighed more than 65kg. The Chinese are so little. I can only imagine what the exchange Dr. is experiencing back at my hospital where no patient weighs less than 65kg. The incidence of difficult airways must be very low here in China. I hope to see some during my time here. I asked 2 of the residents what their largest size patient was. One said 100kg, the other 120kg. They should experience a night of call on our labor and delivery floor! This patients starting HCT was 24%. We did end up transfusing 2 units of packed cells. No fancy hotline/fluid warmer.
Music is played in the OR. It is controlled from Dr. Cui's office. Most of the time it is some Chinese music which is quite soothing to the ears. I have heard some Sting and Madonna. Ha. I have been left in the OR by myself quite often. Of course I have no problem with that. It's just that should the patient have some major issue or the surgeons ask to do something like put the patient in trendelenberg, well then we might have as the famous Led Zepplin song is called a "Communication Breakdown." Dr. Cui introduces me to many of the surgeons before a case starts. One of them asked me if I knew Dr. House from television. Ha. That was funny.
I have been told that the ER doctors here do not routinely intubate patients, should it become necessary. Anesthesia is called. Dr. Cui said that they are just not skilled and have not bothered to improve their technique. Interesting. I will make a point to take a stroll down there just to check out the scene...