Making history can be painful

The anesthesia students have been very excited this week.  That is because today, we scheduled the very first surgery under general endotracheal anesthesia at Kibuye hospital.  There has been an anesthesia machine in the OR since I arrived, but it had not been set up or used until today.  This week, Jason and I worked on getting it ready to go, connecting an oxygen tank to one port, an air compressor to another and filling it with expired halothane and expired CO2 absorbent.  So what could go wrong?

After discussing the plan with the students, drawing up the medications and preparing the intubation equipment, I handed my ipad to one of the students and asked him if he would take a couple pictures of the intubation to memorialize this historic event.  So, we injected the induction drugs, and this patient turned out to be one of the most difficult intubations I have ever encountered.  The reason for the surgery was to remove a tumor on his neck.  This tumor was apparently distorting his airway, making visualization of his vocal cords almost impossible.  So, what should have been a 15 second induction of anesthesia turned into a 45 minute scene of chaos and mayhem.  At one point I could not ventilate the patient and so his oxygen level dropped to undectable  levels.  The medical student with my ipad continued to take pictures this whole time, 133 photos to be exact.  And I remember thinking at one point that I REALLY wished I had not asked someone to take photos of this historic event.

Alas, by the grace of God, the endotracheal tube finally found its home, the man had his surgery, woke up and appears to be doing fine, and hopefully our next general anesthetic will go a little smoother than this one.  

A few of the less incriminating photos .....

This is the air compressor which is driving the anesthesia machine.