Page 18 - CASA Bulletin of Anesthesiology 2019 Issue 1

CASA Bulletin of Anesthesiology
the team members. During the discussion, I also explain to my team about backup plans, i.e. my plan B and plan C. So, if things do not work the way as planned, everyone knows what we need to do. Often times, they also bring up the things that I have missed.
In Chinese culture, we are used to be told what to do and are reluctant to talk to others.
We are usually afraid to be wrong or scared to be interpreted as aggressive. However, miscommunication can often lead to tragic events. Many things can be solved with a simple phone call or brief face to face discussion. In reality, most surgeons and anesthesiologists
are very approachable, and they will listen if your message is presented in the right way. So, learning to express a complex problem in simple language and communicate to others is critical.
3. Work as a team, trust each other
Although it is debatable who is the captain of the ship in the operating room, it is our common goal to provide the best care for the patient, and to get the surgery done with a good outcome. Also, cardiac anesthesia team is in charge of our CVICU. Surgeons have great reliance on the anesthesia team to archive early extubation, shorter ICU time and perform transesophageal echocardiogram when needed. They also manage Impella VAD, ECMO and numerous medical problems. I let them do all the small procedures such as tracheostomy, central lines, dialysis catheters, and ECMO lines unless surgical cut down is needed. So, when patients are doing well, everyone will get some professional satisfaction. Remember, little things can
go long way. We have our cardiac surgery governance council meetings as well which include Anesthesia team, perfusionist, physician assistant and nurse manager. Any unsolved issues can be discussed in the meeting.
4. Discuss our problem, moving forward
Even with good relationships, conflicts still exist. The appropriate approach would be private discussions to analyze and solve the problem first without an open confrontation, regardless
of whose responsibility it is. If that problem cannot be solved, the next step is to bring the concern to a higher level. In Chinese culture, both sides usually bear some responsibility. We all understand that the operating room is a stressful environment, and the issue is to improve the outcome, avoid the same problem in the future, and increase mutual understanding.
5. Know each other, help each other, and earn each other’s respect
It is helpful for a surgeon to know some anesthesia and vice versa. As a surgery resident,
I remember doing a very difficult lap chole in a 300-pound patient. The visual field was fine initially but got worse and worse over the time. Not knowing what changed, I was struggling with the exposure until a new anesthesiologist came. He just redosed the muscle relaxant. Suddenly my exposure got much better and the surgery was much easier. This anesthesiologist definitely earned my respect that day. I wish that the previous anesthesiologist would have paid more attention to the surgery or had known how to make my surgery easier. Nowadays, we do
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