Spinal Level Work

I started my residency in 1981. The first post I did was an incoming post meant for future anesthetists, for one month prior to regular residency, which I wanted to do because I knew I would get my Registrar’s post after one year of house job, and would not do any allied posts. I wanted to learn CPCR and spinal anesthesia. The Head department of anesthesiology was very kind. He gave me the post even after the last day for application had gone. I owe him. I learnt what I wanted to, and also a bag of tricks that anesthetists believe the surgeons know nothing about. There used to be a guy in anesthesia those days, who used to induce spontaneous GA, but the patient on inhalation agents ventilating self, and go and sit in the anesthetists room while the surgeon performed laparotomy. That was his laziness to give controlled GA, which was a lot of work. These days I find anesthetists who want to give spinal anesthesia for everything, so that they don’t have to give GA. Ventilating patients is a lot of work. They showed me as a reference a line in the footnote of a chapter on anesthesia for laparoscopy, that spinal anesthesia was a possible form of anesthesia for that. Now they give spinal anesthesia for all of our laparoscopies. Some patients scream with pain, because it does not block shoulder pain from irritation of the diaphragm. They ask us to instill local anesthetic into the peritoneal cavity for relieve that. If the patient still howls, they give GA. God help the patient if she develops a complication like a vascular injury or gas embolism under spinal anesthesia. They have a double standard. For laparoscopic sterilization they give general anesthesia, because they are scared of inquiry by a governmental agency if anything goes wrong. A remark in this connection made by a staff member is very amusing. “They give spinal anesthesia for everything except a craniotomy, cataract extraction and tonsillectomy.”