Saturday, April 6, 2013

The Myth About Anesthesia Sitting Around Time

Surgeons hate delays between operating room cases. They frequently attribute this to the anesthesiologist. They even have a term for this: Anesthesia Sitting Around Time, or ASAT. Some of the less charitable surgeons refer to this as AFAT. I'll let you figure out what the "F" stands for. But they only see half the picture. Let me tell you what really goes on after the surgeon finishes the last stitch and leaves the room.

Once the surgeon finally walks away from the OR table, the scrub tech can then put the dressing on the wound. By now I have already started waking the patient up. If I'm really good, I can extubate the patient almost immediately. However every patient is different, and every anesthesia is different so sometimes it can take a few minutes before the patient is awake enough to have his endotracheal tube removed. Once I have determined that the patient is safely alert and able to protect his airway we can then move him onto a gurney to be transported to the recovery room.

When we are in recovery, I have to give a report to the receiving nurse, including all the relevant patient history, pertinent events during the operation, and his fluid status. Vital signs also are done to ensure the patient is stable before I hand him off. Then I have to write a postop note to document the patient's well being. I then rush back to the operating room to set up my next case. But the janitorial crew hasn't finished cleaning the room yet. And I can't really complete my preparation until they are done. So I do as much as I can before I head over to preop to see my next patient.

If I'm lucky, the next case is on an ASA 1 patient with no complicated medical, surgical, or anesthetic history. The patient will already have an IV in or will have giant garden hose veins. Somebody will hopefully have already put all the important history into the EMR so that I can finish my preop assessment note in twenty seconds. That's the ideal. Often I'll have to prepare an IV bag, start the IV, interview and examine the patient, and write the note, all under five minutes if possible.

Once that is done I head back to the operating room. It is now cleaned and the scrub tech is opening up the surgical instruments. I attach a fresh anesthesia circuit on the machine and put in a clean suction cannister. I announce to the circulating nurse that I'm ready to bring the patient in. I have achieved my goal of getting the patient ready in less than thirty minutes. The nurse says she and the tech have not finished counting the instruments yet so they're not ready.

Okay, fine. I told her I'll meet her in preop when she's done. As I sit in preop waiting for her arrival, another nurse comes to interview the patient. I ask her what happened to the first nurse. Oh, she is giving her a lunch break. This new nurse then notices that the surgeon had not properly filled out the consent form and had not marked the operating site on the patient. Now we need to call the surgeon back to complete those essential prerequisites. In the meantime she needs to go back to the OR to count instruments because she wasn't there when the original nurse counted instruments the first time.

It is now going on forty five minutes since I left the operating room with the last patient. I can see that this is still going to take some time. Therefore I walk down the hallway to the operating room lounge and grab some water and answer nature's call. Suddenly my pager goes off. Preop is calling me. I head back to the room and the surgeon and the nurse are standing there waiting for me. The surgeon mutters something about typical anesthesia delay and stomps back to the OR. Sigh. Sometimes you just can't win for trying.

So you can see, ASAT is really a myth. There is hardly any sitting at all on my part between cases. For people who think anesthesiologist just sit around all day and collect easy paychecks, they obviously have never talked with one.


  1. Awesome post, Dr. Z. Great point.

  2. But... do you sit during the surgeries?

    I ask because I'm very interested in medicine but trying to see what specialty would be physically easiest for me. I've got a (very) bad knee. I'd probably be due for a knee replacement in the next 5 years but I'm very young so I can't be standing all day like a surgeon does, or I'll wear it out too quickly.