Our drive to the hospital was scenic this morning. It’s not easy to get good shots of the local housing slums from the moving bus but there is an occasional opportunity to see a good distance back into town.
Since all or most of you reading this are not anesthesiologists, I will give a very simple explanation of our latest anesthesia issue. We determined that the anesthesia machine in one of rooms was extremely old (45 years old) and probably not functioning correctly. It turns out that the OR we were using was used only for cases where local anesthesia was given when we weren’t present. The anesthesia gas system had most likely not been calibrated for many years. So…we had had some problems that made us realize that we should not and could not give general anesthesia in that OR. Nancy’s husband in CA queried chat GPT to find out that we were correct in our assessment of the problem.
For those of you who sail offshore, think about being in the middle of nowhere in the middle of the night and you have an equipment problem. You just have to figure out what’s wrong because you can’t reach any help and you need to problem solve on your own. I suppose Starlink will offer a chat GPT service but not right now on every boat!
We are doing 2nd stage cases today where patients who had their first surgery with a cartilage ear framework placed under the scalp in ear position now were having their first surgery ear framework elevated with a banked piece of cartilage and a small skin graft to give the ear dimension. Many patients can tolerate this being done under local anesthesia with a bit of sedation. Our plan was to do local with sedation with one of the surgeons who is very comfortable doing just that. In addition she is fluent in Spanish and can talk with the patient to explain what’s happening.
Unfortunately things didn’t go as planned. We sedated an extremely anxious 18 year old boy. His reaction to sedation made him disoriented and agitated. We added more drugs which made matters worse. The surgeon had not explained the procedure under local and we had a wild patient. Luckily it is possible to reverse some of the drugs or wait a short while for them to dissipate. We proceeded with very little sedation and lots of encouragement in Spanish along with music. He was very pleased when his surgery ended.
The rest of the day went smoothly. We had our usual midafternoon thunderstorm. Then our small anesthesia group planned a dinner at a very high end restaurant in Quito. I was the last person to leave the hospital. I feared that my taxi ride through horrible traffic would make me much too late but the rest of the group got to the restaurant only about 20 minutes before me. We had tasting menus with wine pairings. It was delicious and not a huge amount of food. It’s a late night but very much fun and worth it to be with a small and very dedicated group who have worked well together. Tasting menu was $95. A very good deal.
Early bus tomorrow. Time for bed.
The Adventures of Anne 