Monday, November 1, 2010

A glance of OT experience

Patient’s History
Name: Tasneem
Age: 4 Years Old
Diagnose: Chronic Tonsillitis (Bilateral)
Operation: Tonsillectomy (perform by Dr.Ahmad)
Time: 12.30-1.45 pm, 30 Oct 2010

Patient’s been given general anesthesia. Usually there’re 4 technique performed, but the commonly used is dissection. The other 3 are Guillotine, Laser Dissection or cryptolysis and Cryosurgery.

Only three main things were done by Dr Ahmad and of course, the operation shouldn‘t take much time. But due to his generosity, we (3rd Group)stand for almost one and half our observing and questioning this and that, what and why, bla3… After the patient was fully unconscious (in supine position), the mouth was maintained open by Davis-Boyle mouth gag (seriously guys, this gag is scary! with rusty look, we do think it’s one of the instrument use in SAW movie~) Then the incision of the pillar which involve mucosa only and lastly, dissect the tonsils and ligate the blood vessels. This was when we saw Dr Ahmad was kind of struggling since the child’s mouth space was so narrow and the tonsils were quite deep. But he managed to do them well, though the MO-in-charged of anesthetic that day was pushing him to hurry and the Senior MO also kept telling that he was wasting time doing a small operation. Pressure!

What’s the most important were the complications that need to be handled after the surgery. Still remember the 6 things? Anesthesia, haemorrhage, trauma, infection, pulmonary and miscellaneous. But what’s the most important was hemostasis, stop the bleeding once the operation was finished. 3 types of haemorrhage might occur: primary, reactionary and secondary. Primary might occur during operation, due to any blood vessel injury but still can be managed by ligating it. The reactionary happened within 24hours, caused by the sudden elevation of the BP after recovery from anesthesia. And the secondary was the dangerous one. Why? Because it usually happened within week post-op, due to wound infection and the patient might need to be re-operated and other complication need to be monitored also.

The other one thing that made us felt a bit awkward was when the anesthetic tried to make the child woke up after the surgery. One of us do ask why the doctor was like using violence to the child? (she got ‘beaten’ at the chest, pinched on face and also the tonsil part where the surgery’s been made!) He answered that it’s a way of making painful stimulation so the patient woke up naturally, and the team can monitor her BP (which can cause reactionary haemorrhage), O2 saturation, or any cardiac manifestations that may persist post-op. And all of us then…OOoooooo~

Seriously, it’s fun playing in the OT! It really feels differ, when you read word by word in the book, compared to the situation when you get real experience from the doctor in the lecture or OT. When we were given chances that were not given before, why don’t we grab this chance, instead of let others go and watch all by themselves? Everybody deserve the same knowledge, be competitive, and share our experience together here!

*some of our colleague make advanced move,go to O&G, and experienced to see a normal and caeserian delivery. Care to share?=)

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