An eventful and memorable first day of surgery

Our first case was a lady in her 30's (I’ll call her Carole).  Carole is a mother.  She has a history of rheumatic fever and has increasing shortness of breath and chest pain.  Several years ago, she had a stroke, likely related to a clot that formed in her enlarged left atrium. Her ECHO exam confirmed a diagnosis of severe mitral stenosis.  

I arrived in the OR at 7am to prime the pump, set up the cellsaver, and make the cardioplegia solution.  After all of the equipment was prepared , discussions about anesthesia technique, monitoring, cannulae, and perfusion lines ensued; and then the patient was brought to the room a little before 10am. After lines were placed and the patient was prepped, Agnetta, the chief surgical resident, led in prayer, thanking God for Carole and asked Him to be present in the operating room, to watch over her, and to bring comfort to her and restore her health.  Agnetta also asked God to help all of us to do our best as we worked together to replace her mitral valve.    

Russ White assisted by Agnetta and surgical technician,
taken just after Agnetta led us in prayer

Next, the Kenyan anesthetist did the pre-op briefing, “This is Carole; she has mitral stenosis; we are going to replace her mitral valve. Is the blood in the room?  The antibiotic has been given… we are ready for incision.”  Everything proceeded according to plan, except for three brief power outages and a brief alarm from the oxygen delivery system.  I was so grateful to Bill Griffiths from Sorin, who previously helped me to trouble-shoot a problem with the un-interrupted power circuitry on the S-3 pumps here at Tenwek.  Last October, the local 50 cycle current fried a power supply board, which took out the uninterrupted power supply (UPS).  Via email, Bill helped me locate wide frequency boards that could handle the current here.  The pump seamlessly transitioned to battery power during the brief outages.  Thank you, Bill Griffiths!

OR Oxygen Monitoring System

I have learned from others that you always keep a full bottle of 100% oxygen within arm’s reach, behind the pump.  Tenwek does not have a liquid oxygen supply system. Instead, they have an oxygen concentrator system that concentrates ambient oxygen.  These systems are not as reliable as liquid supply systems. It is not uncommon to see the fraction of oxygen at 80-85% (it should be 100%).  One must pay particular attention to this, since we are at 7,500 feet above sea level and the partial pressure of oxygen is somewhat lower at this altitude. 

ISTAT Monitor

Supplies and equipment can also be challenging. For example, Tenwek has a portable blood gas analyzer, ISTAT, that measures blood gases and chemistry with just one drop of blood.  These devices require disposable cartridges to do the blood tests.  I contacted Abbott Laboratories and received a donation of these cartridges, which Holly and I carried in our checked luggage.  On Monday, when I checked the analyzer, I got an error message, stating that the software (CLEW) expired on June 18^th , causing the analyzer to lock down.  I consulted with  the central lab at Tenwek and learned that they had discontinued the use of ISTAT, and they did not have the interface to upload the new CLEW.  We decided to try tricking the analyzer by  resetting the clock on the analyzer to May 30, 2013, and Eureka, the device was no longer disabled since it assumes the clew hasn't expired.  This maneuver has given us two more weeks’ use of the device to complete the planned surgeries.  We will bring the analyzer to the States for a CLEW update at the end of our visit.  Sometimes it just takes a time machine to overcome seemingly insurmountable problems. 

This morning, we had a surprise visit from a large brown and white owl, that flew into the surgery building and made its way down the corridor near the operating rooms.  Two of the surgical technicians cornered our “guest” and fashioned a tether from gauze strips, and then escorted him (or her) out of the building.

So how did it go to today? 

It went splendidly!  Eighty-nine minutes on the pump, cross clamp time:  67 minutes.  The post-bypass Transesophageal ECHO exam revealed that the placement of the valve was excellent and that the new mechanical valve was functioning well, with no evidence of obstruction.  It appears that Agnetta’s prayer was heard and answered. 

See my next blog to find out how "Carole" is doing.  I’ll try to include a photo of our fine feathered friend.