Day 4: Sugeries
Note: we are rejoining the blog after technical difficulties (see our Facebook page for write-ups about screening day and the first day of surgeries).
This morning I observed my first surgery–que milagro! The team operates two OR rooms and six-month old Maria Guadalupe was scheduled for the cleft lip surgery in OR #1 first thing this morning. She had not been allowed to nurse for 8 hours ahead of surgery and so she was not a happy camper! Her mom and dad did their best to console her but she was not having it–but the anesthesiologist Dr. Martin Mueller felt good that she has a strong set of lungs and was getting plenty of oxygen. After talking with mom and dad to explain the procedure and reassure the, it was time to take Maria to the OR.
Once in the OR, the anesthesia team got to work. While the set-up may not all be exactly like home, the care and concern for the safety of the patient is. The team needed a little extra time to ensure that Maria Guadalupe was OK for anesthesia and surgery, and she fell asleep sitting up during the brief wait. Anesthesiologist Dr. Dave Swanson was also on hand to assist as needed.
Next, Dr. Mueller and his team gave the baby general anesthetic and closely monitored her through the the process. Anna Reissen, a 4th year anesthesia resident, and medical student Mark Ramirez, as well as circulating nurses Brandi Seitz and Amanda Fisher completed the team.
Once Maria Guadalupe was safely under anesthetic, Dr. John Canady began the surgery assisted by medical student Kristen Seligmann, scrub nurse Paula Sauceda, and circulating nurse Diane Miller. Also on hand was Elvira Zuninga who is the volunteer translator with the team. Pat Wehrle, the head nurse, checked in frequently to make sure nothing was needed.
The surgery itself lasted about one hour or a little more. Surgery begins with the injection of local anesthetic, much the same as is used when you get a tooth filling, the purpose of which is to constrict the blood vessels so there is very little blood. Everything went smoothly and Dr. Canady made it seem so easy–though operating on a small child like Maria Guadalupe is no small feat.
The main goal of the surgery is to get as much vertical height so when the lip repair heals, the scar does not cause notching in the lip. After stitching the cleft lip, Dr. Canady made a small incision in Maria’s right nostril in hopes the little bit of scarring inside the nostril would help reshape the nostril a little. Next was the application of Durmabond which is sort of like a thin layer of medical superglue; this lasts about a week and protects the stitches and also helps keep the area clean and free from infection. The stitches themselves will dissolve on their own.
The work of the anesthesia team is perhaps most critical after surgery is complete and the extubation occurs. The team is vigilant to ensure good airflow and a smooth transition to consciousness. Maria Guadalupe woke up peacefully and everything went exceptionally smoothly. Once the team moved her to PACU (Post Anesthesia Care Unit), she really woke up and realized how hungry and exhausted she was. Mom came in to nurse her baby and PACU nurses Erin Steffen and Haley Fernandez monitoring baby’s breathing and heart rate. Head nurse Pat Wehrle also assisted since baby Maria was very fussy. Pat’s singing and rocking seemed to help soothe her a little.
Maria Guadalupe does not have a cleft palate or any other related conditions so the hope is that this may be her only trip to the Hospital Especialdades during the annual Iowa MOST mission–at least for any medical reasons! She is just one story of hundreds over the dozen years of this mission and seeing her healthy and happy after her operation is why the team is so passionate about this work.
Muchas gracias a todos que han contrubuido al exito del proyecto!