I'm not having anything done under local anaesthetic!

Hello.!

I have finished my month in respiratory medicine and now am stuck in cardio for three weeks. I think it's a bit crap that this three weeks is all I have in cardiology for the whole of my clinical training. Seems like too little experience for such common illness. This is made worse by one of my consultants wanting me to attend a pacing clinic three times a week. I went this week and watched a patient have an implantable defib fitted under local (more about that later) than I watched another patient having an implantable defib fitted. Then I watched another patient having an implantable device....OK you get the picture.

I'm a bit annoyed at having to stand in theatre three times this week watching patient after patient having the same thing done. I learn very little from this - watching one so that I am aware of what happens is great, but having to watch it again and again isn't. I feel like my time would be so much better spend on the wards, trying to work out how to look after barn door heart failure, arrhythmias etc. It's hard though because if I dig my heels in and go to the wards rather than theatre, I might well end up in a situation where the consultant refuses to sign my end of module forms (Details of attendance, performance etc)

What has also scared me is that having one of these devices fitted is a bit nasty. They take around 2 hours and the patient has it all done under a local anaesthetic. They lie there and seem to be in agony when the local is being given. Things get better then apart from one patient who seemed to feel the whole thing and was squirming throughout. I was starting to feel a bit light headed to be honest - it's not nice watching someone in pain during an operation.

It seems that the risks of G.A make it much safer to do this under local. Also, they are not often able to give the patient midazolam (Sedative) because it makes the blood pressure drop which they tell me isn't good in the middle of heart procedures.

I hope I never have to have anything done under a local - on my last block an old chap was having his carpel tunnel done under an axillary block and told the surgeon he could feel her cutting his hand. Hells bells.