Friday, May 1, 2015

Promoting Best Anesthetic Practices in Ho Chi Minh City: Part 2

Today concludes my second and final week in Vietnam (read about Part 1 of my adventure here!). 

Our Monday morning started off with a healthy patient having a significant facial reconstruction procedure for injuries sustained in a motorbike collision.  Using an arterial line and an experimental noninvasive cardiac output monitor from our home institution, we reviewed management of hypotensive anesthesia to control blood loss during procedures on highly vascular areas.  Minimizing blood loss during surgery is of particular concern at Rang Ham Mat hospital, since access to blood products for transfusion can take considerable time.  We were able to see some of our post-operative patients who were still in the hospital and discussed aspects of PACU care, focusing specifically on strategies to reduce airway swelling.

Later that week we were offered the opportunity to visit the Heart Institute in Ho Chi Minh City, hosted by the head of the anesthesia department B.S. Quy.  Roughly half of the surgical cases here are adults having mostly valve procedures, and the other half children undergoing repair of congenital heart lesions.  As a resident in anesthesia who is planning to do fellowship in pediatric cardiac surgery, I jumped at the chance to spend a day with the cardiac anesthesiologists.  The afternoon of our visit I had the fantastic opportunity to participate in the case of a one year-old child undergoing total repair of Tetralogy of Fallot.  In keeping with last week’s theme of the incredible efficiency of the Vietnamese surgical services, the entire case from incision to dressing was less than three hours, with a cardiopulmonary bypass time of only 65 minutes.  The child did extremely well and was extubated uneventfully by the next morning.  This efficiency is coupled with a remarkably low mortality rate: B.S. Quy explained that after reviewing their practices and making careful improvements, their mortality rate for total repair of Tetralogy of Fallot was now less than 1%.

Jamie placing a central line under careful supervision by B.S. Quy.

I concluded my week by giving a talk on one-lung ventilation in pediatric patients at the 2015 Asia Anesthesia Summit.  With an audience of around 300 anesthetists, it was the largest lecture I’ve given as an anesthesia resident.  I was fortunate enough to have the help of a Vietnamese translator, who translated my lecture in real time over hundreds of wireless headsets provided to the audience members.  I had also sent my lecture slides in advance to be translated as well—looking up at my slides and seeing them in Vietnamese with a little disorienting!  My attending Dr. Denman also gave an excellent talk on best practices in perioperative fluid management.  The conference hosts were extremely appreciative of our participation in the conference and delivered us back to the hotel with armloads of flowers and gifts.

Jamie presenting at the 2015 Asia Anesthesia Summit in Ho Chi Minh City.

These two weeks have raced by, and I have had an amazing trip.  I am so grateful to have had this incredible opportunity not just to do interesting cases, but to really participate in a different medical system.  I hope by working with Vietnamese anesthetists and residents that I have taught them as much as they have taught me.

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