Today I want to talk to you about some of the really (I mean REALLY) cool things that I have been doing recently in anaesthetics. Now to put this in some context, as a young (well, moderately young) wet behind the ears junior doctor (the ears are still slightly wet but fast drying out) I would break frequently into a sweat at the sight of a challenging cannula (-if you recall, these are the tubes we stick into your veins to give fluids etc.).
Today however, I have charged triumphantly past these earlier ‘sweat-inducing feat’, and was sticking rather large needles into patients’ spinal canals. This was to give them anaesthetic that would numb their lower limbs….in theory at least. Joking – they all were adequately anaesthetised!
So let me set the scene for you: I am standing there ‘scrubbed’ in mask, gown and gloves in front of my patient who are laying in the ‘left lateral position’ – that’s the foetal position to most of us…holding a very long needle (having already applied some local anaesthetic to the skin at the area of the spine that I will be anaesthetising). Yes my hand is slightly shaking. Bad for me and bad for the patient! So I take a breath and approach the spine with my needle. It pierces the skin…a drop of blood appears and the patient tenses up. “Stay nice a relaxed, Sir” I say in my most professional – I’m not at all nervous [cough] voice. I steady the needle now sticking out of his skin and after a sharp intake of breath I press my thumb and index into the end of the needle and advance the needle.
The patient grimaces.
As I keep advancing I am waiting for the ‘pop’ that tells me that I have pierces the thick ligamentum flavum and enters the needle into the subarachnoid space. This is the space that contains the cerebrospinal fluid (this is the fluid that bathes your brain and spinal cord).
I keep waiting.
I advance the needle further.
After an internal debate in my head of ‘should I’, ‘shouldn’t I’ advance the needle even further (and with a wry smile to myself at the thought of peering over the patient and seeing the needle poking out of his belly button!)…I decide to advance further…
Success! As I exhale with a blend of relief and triumph at the POP, withdraw a part of the needle that essentially leaves a hollow tube connecting the outside world to our inner bath of our brain and spinal cord. Now in theory a drop of cerebrospinal fluid should appear at the end of the tube to tell me that I am in the right spot.
I wait once again.
Willing the droplet to appear, I stare at it like a child staring at the chimney on Christmas eve with a carrot and milk in their tiny excited hands. Relief! It appears.
I nod at the drop, like it and I have met for the first time. It was a welcome sight indeed – mainly because the patient’s blood pressure was dropping. I insert the anaesthetic and 15 minutes later the patient’s lower body is numb.
Now this was indeed a victorious time for me – I stood over my patient deeply satisfied. I should however be honest and put this victory in context – today I attempted 8 spinal anaesthesia proceedures. I achieved 5 out 8 successfully. The other 3 required the seasoned head of the registrar anaesthetist (who later tells me that he must have done well over a thousand of these in his career!).
A good day indeed….
See you next week.