This is going to be a hot take.
The circulator’s role during induction of anesthesia is to be standing at the side of the OR table, ready to assist anesthesia.
End of story.
Yes, cases can be routine. Patient in the room, patient on the table, patient intubated, surgery, patient extubated, patient put on gurney, patient taken to recovery.
Being blind to anything but routine is where mistakes happen.
Where the circulator should not be:
- charting at the computer.
- discussing weekend plans with the surgeon and scrub tech.
- looking at hotels for their next getaway.
The circulator should be at the side of the patient, offering comfort to the patient.
Who is probably scared out of their wits. Many are.
This should be an expected role of the circulator.
To offer a hand to the patient as they go under anesthesia.
And to offer a hand to the anesthesia team as they intubate.
Because sometimes there is difficulty in securing the airway.
The endotracheal tube goes into the esophagus.
The patient has a very short jaw and the anesthetist is unable to see anything. And they do not intubate blind. Well, they shouldn’t.
And if the circulator is across the room, attention on anywhere but the field, this can lead to disaster. By the time the inattentive circulator realizes that there is a problem the O2 sat has dropped and this can have outside-of-surgery complications.
During the very beginning of the pandemic, circulators were forbidden from being directly at the side of the bed. Because covid was known to be respiratory and the team wasn’t supposed to be more exposed than necessary.
Some circulators adopted this habit of not being at the OR table during induction. Worse, some are teaching this bad behavior to new people.
Don’t do it.
Stay at the bedside during induction.
Your patient’s life may depend on it.