Facing anesthesia during surgery in a romantic way

Wang Jianyu, Anesthesiology Center, Beijing Anzhen Hospital

When I first got started, I thought that general anesthesia was nothing more than three types of drugs and different combinations of five or six drug names. Performing an operation is more like a one-night stand, giving your best, leaving no regrets, and making yourself satisfied. Apart from these, it seems that there is nothing special that I need to pay attention to.

Today, looking back on my 10-year work experience, I feel that in fact, every operation is more like a love affair with the patient. We are similar to the male partner in the relationship, while the patient plays a role similar to the female partner. Of course, if everything goes well, we will feel very happy and full of a sense of accomplishment; if there are twists and turns, we may need to discover them early and make adjustments and corrections ourselves in order to return to the smooth path in time; there is also a more tragic ending, that is, failing to discover the crux of the problem, resulting in irreparable mistakes in the process, and finally ending in failure.

An operation is the same as a real love experience. It requires an introducer or a go-between, and this person is often the chief resident in the anesthesiology department. The chief resident assigns the patient to the doctor who is going to perform anesthesia on the patient the next day. This is equivalent to the introducer bringing the man and woman together. It is necessary to consider the woman's surgical requirements and evaluate the man's basic strength. Let the anesthesiologist know the patient's medical history, surgical history, drug allergy history, and the demands and purpose of this operation, just like understanding the woman's past emotional experience and the basic goal of this mate selection. Of course, before that, we must first evaluate whether the anesthesiologist's professional ability is competent for this operation, which is equivalent to understanding the man's basic information and personal strength.

The rest is for the anesthesiologist to understand the patient's current basic condition through the hospitalization medical records, auxiliary examinations, and test reports, similar to the man tentatively inquiring about the woman's family background, personal preferences, educational experience, etc. After everything is initially understood, most anesthesiologists will choose to go directly to the ward for a preoperative visit to specifically understand and verify the patient's general physical condition, and intuitively assess the patient's current condition, which will help to formulate a specific anesthesia plan. Similar to the first meeting between a man and a woman, they usually meet in a relatively quiet place such as a cafe or a Western restaurant, sit down and have a preliminary chat to see if the information they learned before is true, and whether they need to deepen their understanding of some new information. Often after this meeting, they will psychologically accept the beginning of a relationship and begin to work on the next step of their relationship plan.

The real establishment of a romantic relationship often occurs after a series of specific understandings. Through pre-operative communication and education, vital sign monitoring in the operating room, etc., the anesthesiologist and the patient will have a new rational to emotional understanding of the patient, which will formally confirm the "romantic relationship" between the two parties and begin the specific preparation stage for anesthesia. According to my country's current national conditions and established customs, when a man and a woman fall in love, the man usually takes the initiative to give a small gift to the woman from the beginning. The small gifts that anesthesiologists give to patients are often 16G or 18G trocars, which are conducive to rapid fluid replacement during surgery; there is also invasive blood pressure monitoring after local anesthesia, in order to better observe the changes in the patient's vital signs in real time; some will choose to place a central venous catheter in the patient according to the specific condition of the disease so that medication can be quickly administered.

As the relationship deepens and the emotional integration of both parties strengthens, it is inevitable that some small conflicts and even small frictions will occur between the man and the woman. The woman will sometimes be a little bit temperamental and lose her temper. Usually, the more sensitive man will take the initiative to correct such small emotional conflicts and get the emotions of both parties back on track in time. The carefree man will often ignore the small details and changes in the beginning. If the woman knows how to restrain herself, she may be able to return to normal. If the woman goes further and further in the state of the man ignoring emotions, there will definitely be a big conflict. If the man still does not find it or is too tired to manage it, in Beijing dialect, it is called "more acting", and the woman will really move away from the state you want, and the ending can be imagined.

This process description is very similar to anesthesia induction, which is the process in which the anesthesiologist uses drugs to make the patient enter the state of general anesthesia from the natural physiological state. Even the most skilled anesthesiologists can hardly guarantee that every patient's vital signs, hemodynamics, body internal environment and other data will be stable during the induction period. In other words, some fluctuations are normal or inevitable. Then, experienced anesthesiologists will often prepare in advance and intervene through drugs and other methods to maintain the stability of the patient's vital signs and internal environment as much as possible, and there will be no large fluctuations in hemodynamics. This is the truth in love, similar to the woman being petty and the man having to know how to coax her in time.

If the anesthesiologist ignores the fluctuating state, or tries to let the patient correct the fluctuating vital signs by himself, then a small number of young patients in good general condition may really be able to compensate for their physical condition to a relatively stable state through self-regulation. This state is similar to a man and a woman in love. When a conflict arises, the woman is well-educated and tolerant, and the relationship recovers entirely because of the woman's tolerance and the boy's good luck.

Half an hour after the induction period is usually the time when the anesthesiologist fully understands the patient. This is also the time when the anesthesiologist is most present and the busiest during an operation. During this stage, we need to fully understand the patient's general condition after anesthesia, the body's internal environment, the state of heart function, the degree of fluid demand, and the sensitivity and adaptability to different vasoactive drugs. Similar to a relationship, the man must understand the woman's bottom line. The purpose of understanding is to stay away from the bottom line, not to touch it. If the man is really "acting" and frequently touches the woman's bottom line, the woman will definitely interpret the classic Internet phrase for you - no zuo no die.

If we don't touch the bottom line of both parties, make everyone feel comfortable communicating, and carefully maintain each other's feelings, most men and women in love will definitely get married. This is just like anesthesiologists work hard to monitor their patients, cooperate with surgeons to complete the operation, and let patients smoothly go through the recovery period and perioperative period, and finally achieve a satisfactory result.

Suddenly I want to write down something that I have wanted to say for a long time: Anesthesia that is not aimed at surgical safety and patient comfort is hooliganism.

I would like to use this article to commemorate my inner feelings after working in the Anesthesia Center of Beijing Anzhen Hospital for ten years, and to express my gratitude to the teachers and friends who have guided, helped and encouraged me during these ten years!

Written at home on May 21, 2022

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