Anesthesia

I got a paper copy of my medical record from Mass General a few years back. A section of interest to me was the Anesthesia report from my first THR operation in 2004. I then showed the report to a friend of mine who is a retired anesthesiologist. He explained everything and helped me understand some of the symptoms I reported before. Here are the pertinent parts of the report:

Aesthesia

I hope you are viewing this on a device with a large screen. You might have to do some scrolling otherwise.

The top line is time. The next line indicates they were giving me oxygen, I guess, although I didn’t remember that. The next nine lines are the various drugs and chemicals they injected into my body. I’ll describe each of them later on. The next nine lines are various vitals recorded. Some of these are graphed at the bottom of the report. Between the table and the graph is  listing of events. Here are the events as reported with my comments in [square brackets]. I have also interspersed comments about the drugs administered.

1  15:02  1210 Allergies:: nkda

2  15:02  1401 Anesthesia machine and monitors checked

3  15:03  Start of Anesthesia Care

4  15:03  L180L IV: 18 ga inserted, left hand  [I thought they had done this outside the OR.]

[1000 mg of cefazolin was administered. This is an antibiotic.]

5  15:15  A804 Spont. breathing. O2 by face mask (l/m):: 6 l/m  [I’m glad I was breathing. I don’t believe I ever had a face mask on.]

6  15:15  1403 Routine mtrs: ECG, NIBP, SpO2, exhaled CO2  [The ECG rhythm (–) line shows many PVSs. Bigeminy in my case means a PVC was occurring every other beat.]

7  15:38  ***** B TIME (Anesthesia Induction) *****

8  15:38  6103 Spinal: patient placed in left lat decubitus position

9  15:38  6106 Spinal: steril prep and drape; LA @ L3-L4

10  15:38  6113 Spinal: 24 ga Sprotte

11  15:38  6121 Spinal: no paresthesias, clear CSF, LA injected  [No paresthesias means they didn’t hit a nerve (although they did). LA means local anesthesia, I guess.]

[4.5 ml of bupivacaine 0.5% was administered. This is the anesthesia agent.]

12  15:38  2210 Warming: Bair Hugger blanket on patient  [Bair Hugger? Hee hee.]

[50 mcg of fentanyl was administered. This is a potent painkiller. One side effect is to lower blood pressure, which it did. One symptom of low blood pressure is nausea, which I had.]

[4 mg of ondansetron was administered. It combats nausia.]

[20 mcg/minute of Phenyleph Inf was administered for about 15 minutes. This combats low blood pressure.]

13  16:09  Start of Surgery

[They note PVCs (premature ventricular contractions).]

[5 mg of ephedrine was administered. This combats low blood pressure.]

[They note I have passed 200 ml of urine. They note urine volume and estimate blood loss and try and replace more than that volume of liquid. They hooked up a 1 liter bag of Ringers Lactate to my IV.]

14  16:38  0000 Comment:: pt has chronic frequent PVCs. he alternates between sinus brady and then bigeminy. comes on with low heart rates and breaks spontaneously.  [The surgeon didn’t like these PVCs. I’ll have to make sure I mention them before the upcoming surgery.]

[Another 5 mg of ephedrine was administered. This combats low blood pressure.]

[Two separate 0.1 mg doses of glycopyrrolate were administered. This slows stomach and intestine activity and reduces production of saliva and phlem. It is often used with anesthesia.]

15  15:45  Scheduled Case End  [??]

[They note PVCs through the end of surgery.]

16  17:06  1411 Fluid warmer in line

17  17:38  C110 Medical Direction of anesthesia care by Visit

18  17:38  C120 Pt ID, chart & anesthesia consent evaluated by Visit. PO status & site/laterality verified. Pt reassessed immediately pre-induction.  [I don’t know who Visit is but I guess he/she wants to make sure it’s me and they are working on the correct hip.]

19  17:38  C201 Visit at start: Visit present at induction, periodically, at all critical times, and always immediately available until care transferred to:

20  17:39  C401 Visit at end: Following transfer of care, Visit present at emergence, periodically, at all critical times, and always immediately available

[ They estimated 500 ml of blood loss and noted an additional 110 ml of urine. They put another 1 liter bag of Ringers Lactate on my IV.]

[1 mg of hydromorphone was administered. This is morphine. It is a potent pain killer and can make you tired. It made me tired.]

21  19:02  End of Surgery

[Another 40 ml of urine output was noted for a total of 350 ml. The total estimated blood loss was 500 ml. So total liquid loss was 850 ml. They added another 200ml bag of Ringers Lactate to my IV for a total of 2200 ml input.

22  19:08  ***** C TIME (Patient Leaves OR) *****

23  19:22  4312 Pt accompanied to PACU with supplemental oxygen and appropriate monitoring. Report given to nurse.

Temp:  HR:  BP:  RR:  SpO2:

24  19:22  End of Anesthesia Care

I hope you have enjoyed this little trip through my 2004 THR surgery from the standpoint of the anesthesiologist.

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