By Lynette M Loomis
Anesthesiology is one of those words that is extremely hard to spell, sometimes hard to pronounce, and can make the difference between pain or no pain and life and death.
Physician Robert Young has been an anesthesiologist for more than 28 years. Practicing at Rochester General Hospital and Clifton Springs Hospital and Clinic, he has worked with dozens of COVID-19 patients in the last year and a half.
Q: What is the main difference between intubating (opening the airway) of a person with COVID-19 and a patient undergoing surgery?
A: Intubating any patient, whether COVID or not is usually a routine but invasive procedure. The majority of patients have adequate airways where intubation (placing the endotracheal tube into the trachea is routine.
In 10%-15% of patients, their specific anatomy makes intubation more difficult, sometimes requiring special equipment. These patients may have an “anterior airway,” leading to difficult visualization of the vocal cords.
COVID-19 patients are not necessarily more difficult, but are more precarious. Their oxygen reserve is diminished making oxygen desaturation a risk. We attempt to intubate these patients with minimal airway manipulation (avoid mask ventilation) to limit viral spread. In these instances, the anesthesiologist is standing only 12-14 inches from the patient’s airway, and airway manipulation placing the ETT causes a large viral release into the immediate vicinity. So, prior to the vaccine, intubation of COVID-19 patients was a very risky procedure to the anesthesiologist.
Endotracheal tubes ETT, are plastic tubes that are inserted into the trachea to allow artificial ventilation.
Q: How would you explain intubation to someone who has never had surgery?
A: Intubation is placing a tube down a patient’s throat so that air can gent in and out of the lungs in a consistent way. In other words, it helps a patient breathe and makes sure the person has enough air to avoid brain damage. It might also help slow down breathing.
Q: Why can’t patients eat or drink anything before surgery?
A: The concern with eating before surgery is that there is a small, but very serious, risk of aspirating that food material into your lungs after the induction of anesthesia. This can lead to a complication known as an aspiration pneumonia.
Aspiration pneumonia is often serious as food particles can obstruct airways and stomach acid destroys lung tissue. These patients may require a prolonged stay intubated in an ICU setting.
Therefore, it is especially important to be honest with your anesthesiologist regarding the consumption of food or liquids in the eight hours preceding surgery.
Q: What questions should you ask you anesthesiologist?
A: Nerve blocks are often utilized as part of the anesthetic plan. These blocks are performed either pre-op or intra-op to reduce or eliminate post-op pain and reduce narcotic use. Patients should always check with their anesthesiologist to see if their procedure is amenable to a block.
Patients should also ask about side effects so they will have a good understanding of what to expect post-op. Nausea is a potential side effect that can be treated with anti-emetic medications.
Q: What should you tell your anesthesiologist?
A: You may have eaten a little something or had a drink and decide not to tell your anesthesiologist. Think again. Make sure he or she knows everything that can help you and your surgeon achieve a successful outcome. For example:
Patients should always talk with their anesthesiologist about the type of anesthesia they will be receiving, including different options available.