working with surgeons as a critical care anesthesiologist (i.e. preop, OR, PACU, ICU, M&M)

I got a comment on a prior video asking about how surgeons and anesthesiologists work together so this is my interpretation of the request.

At the end of the video, I talk about some of the surgical culture I’ve witnessed and how I’ve dealt with it.

Where do critical care anesthesiologists work with surgeons?
1. In the operating room - the most obvious time that surgeons and anesthesiologists interface and the most vital time for a patient. In fact, there’s a JAMA surgery study that demonstrated that familiarity between surgeon and anesthesiologist led to improved postoperative outcomes for the surgery types studied. This makes sense because the surgeon anesthesiologist relationship requires communication - when there is an unexpected complication or challenge in the surgical field, the best surgeons I’ve worked with communicate with us so our anesthetic can adjust to it
2. Preoperatively - I direct our preoperative assessment service at my hospital and this is another timepoint. Some patients have underlying medical conditions that require closer attention and coordination in order to prepare them for surgery. One major example is in the setting of a recent cardiac stent. When patients get a stent in the heart, they need to be on anti platelet medication which typically needs to be held for surgery.
3. PACU - sometimes complications occur immediately postoperatively in the PACU. This is a vital time where we would call our surgical colleagues to assess - while I can identify life threatening bleeding (most common complication we see) and support it with blood and medications, I cannot go back to the OR to control it. Only a surgeon can.
4. In the ICU - certain types of procedures are extremely morbid and there is a plan to go to the ICU even before the case has started (e.g. open heart surgeries, certain transplants, big abdominal surgeries, etc). Or certain types of cases require very close monitoring after they’re done to identify potential complications early. Some patients are so sick that they would benefit from ICU level care after surgery. These are times when I’m very closely in communication with my surgical colleagues to discuss care plans and concerns.
5. Educational sessions - M&M and other discussions like high risk medications for the preoperative period

A Comment on Surgical culture

Any medical trainee that has had a surgical rotation has experienced the “toxic” surgical culture. Bullying. Criticism. Yelling. Narcissism. God complexes.

It’s not consistent and it’s getting better but the echos of this culture still remain and come through at times.

It can also be very site and specialty dependent.

I remember as a medical student on a rotation being told to sit against the wall instead of at the table because only the senior residents were allowed to sit at the table.

I remember the yelling at surgical M&M.

How do I put up with it now?

One thing is that often the yelling and frustration isn’t directed at the anesthesia team. There are times when our team may “disappoint” a surgeon and the yelling is directed at us. But ultimately this is the environment that I signed up for. There is no other environment like the operating room. There is no other experience like managing an anesthetic. So we pick our price when we pursue certain fields.

The culture is getting better.

Familiarity with surgeons also makes the experience better.

Would love to hear your questions/thoughts in the comments!

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