The Challenges of Anesthesia in the OR We have three wonderful anesthesia providers on the trip. Melinda Seering is an anesthesiologist from the University of Iowa, Cynthia Haas is a nurse anesthetist from the University of Iowa and Rose Silveira from Madison, Wisconsin. Rose has been on many trips with SRW and has been a great resource.
“I was initially worried about doing a medical mission in Honduras. I had never done anything like this before and was unsure what to expect.
When I arrived in Siguatepeque, however, I was pleasantly surprised. The facility is clean, and the operating rooms are spacious. While the OR machines are old, we have seen them before, and they are in working order. Supplies are abundant. anesthesiologist from the University of Iowa, Cynthia Haas is a nurse anesthetist from the University of Iowa and Rose Silveira from Madison, Wisconsin. Rose has been on many trips with SRW and has been a great resource. On our first day, we set up the ORs and met the children who were scheduled to have surgery. Many of their families had traveled far to see us. Meeting these families is heartwarming and rewarding. Although there is a language barrier, we feel genuine gratitude from the families for the work we are doing.
Being here has renewed my love of anesthesia. This is an opportunity to problem-solve in ways that are unnecessary in the United States. For example, at one point, I was unable to place an IV. At home, I would usually use an ultrasound to solve the problem, but there is no ultrasound here. We improvised by using a cell phone flashlight to transilluminate through the hand and function as a vein-finder.
We also had to set up the scavenger system on the anesthesia machines. A machine technician typically performs this task at home. Instead, our team opened the machine manual and solved the problem quickly.
The friendliness of the staff and patients here has made this a wonderful experience so far. I am looking forward to the rest of the week and planning to come back next year!!”
One challenging case of the day involved a 3-year-old boy with an impending malunion of the humeral lateral condyle. The injury was 4 months old. Pre-operative elbow flexion was limited to 90 degrees. Despite not having fluoroscopy in the OR, we elected to proceed with open reduction and fragment fixation. This required a more extensile approach in order to visualize across the anterior aspect of the joint and reduce the lateral condyle. A tension band construct was created with K-wires and Ethibond suture. The child was sent for post-operative x-rays in a nearby town once he had awoken from anesthesia.
Despite not having fluoroscopy, the elbow flexion improved to 130 degrees and we were happy with the outcome.
Additional cases included a pediatric patient with a split thumb deformity, revision of syndactyly with groin graft, realignment of a both bone forearm fracture malunion, multiple finger soft tissue release and rearrangement for contracture and and a 19-year-old with a Wassel-Flatt V split thumb deformity which had never been treated. We were able to perform a removal of the extra digit with osteotomy to correct alignment of the ulnar thumb.
Tonight the team was invited to a local the home of a local orthopaedic surgeon, Dr. Silvio Gonzalez, for dinner. It was a wonderful meal and great company. It was a challenging but rewarding day.
Quote of the Day
“The best way to find yourself is to lose yourself in the service of others.”
-- Mahatma Ghandi