Page 19 - CASA Bulletin of Anesthesiology 2019 Issue 1

a lot of mini thoracotomy valve surgeries, it is not uncommon that single lung ventilation is not working. Some anesthesiologists become very defensive when the problem occurs. Instead of arguing, I just break scrub and reposition the double lumen tube myself. I also come up with a plan to do these surgeries in case the single lung ventilation cannot be performed.
6. Know each other’s limitation
If an anesthesiologist understands that one's role is to provide the best operating conditions so that the surgeon can perform at their best, then the patient wins. To accomplish this, an anesthesiologist must be intimately involved in understanding what the surgeon needs and when, and the surgeon needs to understand the needs and limitations of what the anesthesiologist can provide. In the end, understanding and respect of each other’s circumstances is key.
I will say that most anesthesiologists fail this idea when they decide to be passively aggressive, pursue the path of silent violence with the surgeon, or choose not to pay attention to the surgery such that they predict or know the surgeon’s needs.
Most surgeons fail this idea when their expectations of an anesthesiologist’s ability to control patients parameters (Blood pressure, Lung isolation, etc) are inflated, blaming poor performance on the technical ability of the anesthesiologists instead of patient factors. Choosing aggressive demeaning behavior only further puts a barrier to effective communication.
After these general principles, ( 大道理讲完了 ) here are some things we can do to improve the relationship between surgeons and anesthesiologists:
1. Case starting time and turnover time
First case starting time is usually tracked by the time patient get into the operating room and surgeons are usually to blame for most of the delays, which is usually less than 10 minutes. However, surgeons are more concerned about the actual skin incision time which can vary between 30 minutes to 90 minutes in my experience. Most surgeons usually do not complain about a slow anesthesiologist as long as he/she does a good job. Though, fast anesthesiologists usually help make things run more smoothly and make the staff happier. Turnover time can be multi-factorial, from staff shortage to system problems in which efficient turnover may mean more workload ahead.
2. Attending availability during critical times
It is common practice to use CRNAs or residents to do most of the cases, including open heart surgery. If the anesthesia attendings are not available in critical times, bad things can happen. It is important to make sure that attendings are available when we need them.
Vol.6, No.1,2019
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