26 September 2022 – Monday –

Everyone was up and eating breakfast at 6. Those of us who came from the east coast have a 2 hour advantage since Guatemala is on central standard time. We arrived at the hospital around 7 and quickly began to get ready for our cases. 

Anesthesia preparation begins with drawing up drugs and checking the anesthesia machine and suction. We get all our controlled substances from the hospital because it is apparently very difficult to travel with narcotics. We don’t need anything exotic so it’s fine. But the hospital has a great deal of paperwork required to account for narcotics. It’s a process. 

Once I was ready for my patient, an 11year old boy, I went to the patient holding area. Just as we were about to take him, the nurses stopped us for incomplete paperwork. Apparently I hadn’t signed some papers that I didn’t know existed. Oh well. I signed and away we went. 

Anesthesia induction went smoothly with an easy airway and intubation. As I finished taping the endotracheal tube, I put the patient on the machine ventilator. Hmmm it didn’t work. Apparently yesterday when the 2 nurse anesthetists were doing machine checks, the oxygen wasn’t turned on to allow for a circuit check. I had checked the breathing circuit this morning but didn’t check the ventilator because I thought it had been checked yesterday. No big deal. Back in the dark ages when I was a resident, there were cases where I wasn’t allowed to use a ventilator. I can hand ventilate until the patient’s paralysis wears off and they start to breathe spontaneously. Luckily the recovery room nurses were around and no case had finished so I had help with ventilation so that I could fill out the paperwork. Trish who has many years of OR, ICU and nursing was happy to help. 

A technician came to help troubleshoot the problem. There was a big leak that we couldn’t find in the ventilator circuit so they said they would change the machine before the next case. The case ended smoothly with a beautiful new ear for my patient.

The machine didn’t get changed. The problem was a cracked housing for the ventilator. That was replaced probably by taking it from a machine in a room that wasn’t being used. I doubt they have any regular visits from the anesthesia machine techs.

My second patient was a 27 year old woman who was having a second stage operation where the ear gets lifted up so that it is no longer stuck against the skull. A small piece of rib cartilage saved in the patient from the previous surgery gets used to lift the ear and a skin graft fills in the space behind the ear where it was lifted. I will have many photos in the coming days. It’s hard to take a picture when you are having problems with the anesthesia machine. I have my priorities.

The day ended early for me. It was a little after 4p. I stayed to give breaks in other rooms. Then I wandered back to the hotel by a long route through town. It took until about 6:30 before everyone else was ready for dinner. I chose a place but they accepted only cash. So we moved on. We sat upstairs in the Antigua brew house which Nancy chose. The sky was clear enough to view the city lights and it didn’t rain. The food was marginal. We ate and came home to bed. Another busy day ahead.