Not at all like Baby Bunnies

  She's all grown up now...

I learned several good lessons today:  infant anatomy is nothing like a rabbit's, and babies don't don't do well with no oxygen.  You might be reading this going "duh," but until you're in the position of trying to intubate a 4 month old baby, thinking you're ready, and suddenly hearing the pulse ox (monitor of O2 saturation) drop lower and lower, you don't realize just what a delicate and precarious position you're in no matter how prepared you think you are.

Let me go over a few things.  A pulse oximeter is a monitor of the O2 (oxygen) saturation in your blood.  Just like in school, you want to be in the "A" percentage range, high "B" maybe. (92 - 100%).  You might have been to a doctor who puts the little red light on a finger and measures your oxygen saturation.  That's the pulse ox.  In the OR, it's connected to a bigger unit that also measures heart activity and breathing rate. 

Most anesthesiologists that I've met are trained to listen to the sounds the machine makes.  At 100%, the machine beeps at a certain frequency with every heartbeat.  If the O2 sat drops, the machine starts beeping in lower and lower tones.  That way, if the anesthesiologist is intubating or writing notes, they can tell something is happening because of the tone.  During surgery, you get real used to listening to the monitor, and I would even look up every once in a while during a case if I heard it suddenly going down.

When you go to place a breathing tube in a normal adult, you "pre-oxygenate" by giving them several breaths with the mask;  almost like when you are about to dive into a pool and you take a number of deep breaths before holding your breath.  Adults can go for a short while before their O2 sats start to drop.  Babies don't have the same kind of reserve. 

In the time it took me to tilt the head, find the vocal cords and try to put the tube in, their O2 sat had already droppedto 79%.  Bad for baby, and bad for everyone else's blood pressure including my own.  The anesthesiologist had me step back, he gave the baby a few more breaths with the mask and oxygen and the baby's O2 sats came back up.  He then placed the breathing tube. 

Once everything was settled, he gave me some words of advice and told me that infant intubations are very difficult because you're used to working with adults and have the time, not so with the wee ones.  He assured me I would get more practice in, and that I would get it in eventually.  A lot of people have asked me why as Emergency Medicine doctors we do an anesthesiology rotation, and it's for this very reason.  You need to "practice" in a controlled environment so that when that infant comes rolling in the ED doors at 3 in the morning, you know exactly what to do and have that sense of urgency that comes with experience.

It was a slow day in the OR for me today, and that was my only intubation attempt.  This was o.k. with me since by that time my cold pill (the six hour kind) was starting to wear off, and I really could use a nap.  Hopefully, tomorrow will be a better day as I spend my last day with the pedis.

Tags: infant intubation, pulse ox, O2 saturation