Archive for September, 2005
Anesthesia for Aortic Aneurysm Repair
Posted by: | CommentsThis is the last week of my Cardiac Surgery rotation at the County Hospital. The anesthesia techniques that I have learned this past month have been very interesting. Today I was able to put it all together for a sort of cap-stone experience in a big case.
Aortic dissection repair is not a surgical case that is approached lightly. This condition may result from chronic hypertension and possibly congenital weakness of the intima of the aorta leading to aneurysm formation and dissection. Unchecked an aortic dissection often proves to be fatal. Remember John Ritter from Three’s Company – he fell victim to a ruptured aortic dissection. Death is usually extremely quick and mercifully without drawn out pain.
This vascular case required not only sternotomy but a thoracotomy as well. These are big surgeries. Initially, the plan was for circulatory arrest and profound hypothermia with lumbar drain for cerebral protection. The surgical team decided on the double incision providing a greater exposure and was able to perform the surgery without the circulatory arrest. This was a good thing for everyone. Rewarming after a complete circulatory arrest with profound hypothermia takes several hours. As it was the surgery was long.
Preparation and setup for anesthesia was nevertheless extensive with two arterial line placements both a right radial and right femoral, double lumen introducer central line placement in the internal right jugular and floating a pulmonary artery catheter. Additionally because of the thoracotomy and the extensive dissection into the left chest that was required we used a double lumen endotracheal tube which allowed us to deflate the left lung improving the surgical exposure on the left side. At the end of the case the double lumen tube was replaced with a single lumen endotracheal tube. This was a great experience and wonderful case for me to participate in. You can see the entire Slide Show of the case at flickr. I must warn you that some of the pictures are very graphic and not for the squeamish.
These cases require cardio-pulmonary by-pass. For this case it was a partial bypass that was used when the surgeons isolated the aortic arch. Never the less this resulted in full heparinization and use of the “heart lung machine”. You can see Julia here with her bight smile behind the mask. The presence of the perfusion team in the cardiac room is always a pleasure.
Enjoy the pictures at flickr. If you can recall your anatomy you will notice the aortic arch repair and marvel at the gortex graft creation by the sugical team.
Xiao Hui’s Birthday
Posted by: | CommentsXiao Hui’s birthday is today. Well not today but yesturday because she is in China. She is across the date line you see and their today is our tomorrow or something like that. Anyway today or yesturday was is her birthday and she is enjoying the celebration with Qian Qian and her husband Henry.
Happy birthday Xiao Hui and hope that you enjoy your day. We miss you.
Cupid’s Hotddogs
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Today was the day that we relived the past and drove into the San Fernando Valley to visit Cupid’s Hotdog stand in Northridge. Seth Gary and I all met at the appointed spot and dug into several of these famous “dogs”. There was a fairly long line for a Sunday afternoon which supprised me a little.
Seth’s visit this weekend has been really great. Today we plan on doing some crazy things like visit Cupids Hot Dogs in Northridge California. This was one of his favorite spots growing up and you know how those memories make the hot dogs just taste better. Seeing the huge Cupid Hot Dog sign and munching down on a couple of those dogs was great. They have to be the best hot dogs in the world. For a review of Cupid’s Hot Dogs you can visit the HotDogSpot.com for full details. The dogs we ate today were not as good as I remember but then what is.
For a look at Seth and Gary munching down the dogs follow the link Read More→
Rich Dad Poor Dad
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Today I was able to see Seth during his birthday week. He was here in the United States and Los Angeles briefly and we were able to get together before going to see the Dodgers and the Pirates game at Dodger Stadium. Seth is now an adult and as you might imagine I am very pround of him.
Seth has told me that his plans are to remain in the United States untill Monday and then leave for Barcelona Spain where he plans on continuing to work for the next several months. I am hoping that he will be able to come back to Los Angeles and stay a while. Baring that Jennifer and I may be able to visit him in Spain after I finish school. That would really be nice.
During Seth’s visit this weekend we plan on doing some crazy things like visit Cupids Hot Dogs in Northridge California. This was one of his favorite spots growing up and you know how those memories make the hot dogs just taste better. Believe it or not I am looking forward to seeing the Cupid Hot Dog sign and munching down on a couple of those dogs. They have to be the best hot dogs in the world. For a review of Cupid’s Hot Dogs you can visit the HotDogSpot.com for full details.
Seth and I had a great talk about life and what it means to he successful. He told me about a book, Rich Dad Poor Dad that he has been reading. You know which one I am. A review of the book by Howard Rothman follows:
Personal-finance author and lecturer Robert Kiyosaki developed his unique economic perspective through exposure to a pair of disparate influences: his own highly educated but fiscally unstable father, and the multimillionaire eighth-grade dropout father of his closest friend. The lifelong monetary problems experienced by his “poor dad” (whose weekly paychecks, while respectable, were never quite sufficient to meet family needs) pounded home the counterpoint communicated by his “rich dad” (that “the poor and the middle class work for money,” but “the rich have money work for them”). Taking that message to heart, Kiyosaki was able to retire at 47. Rich Dad, Poor Dad, written with consultant and CPA Sharon L. Lechter, lays out his the philosophy behind his relationship with money. Although Kiyosaki can take a frustratingly long time to make his points, his book nonetheless compellingly advocates for the type of “financial literacy” that’s never taught in schools. Based on the principle that income-generating assets always provide healthier bottom-line results than even the best of traditional jobs, it explains how those assets might be acquired so that the jobs can eventually be shed.
More Chinese Sayings
Posted by: | CommentsRebecca is my dear sweet niece from China that is visiting for summer vacation. She says she is very “Cool” and she wears jeans with holes in them so I guess she is cool indeed. Anyway here is a little story about her.
When she first came to Los Angeles she kept talking about how ‘America was coming’ down but by the end of her trip here she was commenting on how educated the average man from California seemed to be. Besides, it was fun it was to here which is the best of all.
Rebecca says, “The lips live with teeth”. This is a famous Chinese saying meaning what? Rebecca says, “If you let your neighbor country be attacked without helping and the country falls to its enemies then you will be next to be attacked. So the moral is that when your neighbor meets difficulty you must help.” This is her explanation for why China helped Korea during the war with the US. Now I am really confused.
We will be hearing more from Rebecca Cui in the future. She is such a bright and shinning star that the media is clamoring for more from her pithy wit.
Patric O'Brian
Radical Brewing
