Most surgical procedures at the BMC are done under either spinal anesthesia or with the use of ketamine (a dissociative anesthetic which blocks the connection between one’s consciousness and the pain). Rarely is a patient put under general anesthesia.
Giving a patient spinal anesthesia is the same basic process as doing a lumbar puncture (aka spinal tap). Instead of taking out a sample of spinal fluid, a local anesthetic such as lidocaine or marcaine is injected into the canal. In the states, I have seen several residents and doctors do lumbar punctures, but I had only tried it once before. The spinal cord basically ends several inches higher than the location for the tap, so there is a very low risk of injuring the spinal cord during the procedure. I have now done a handful of lumbar punctures and given several surgical patients spinal anesthesia. I’m building up my repertoire of procedural skills which will be very useful once I start residency.
The Ghanaian anesthesiologist approaches the lumbar puncture differently than I was taught in the States. Even he will admit that he does not follow what the books say. Instead of asking the patient to round his back as in a fetal position, he has the patient sit straight up. He has found that he is able to access the spinal canal easiest this way. Since he has been teaching me how to give the spinal anesthesia, this is the way I have been doing them, and have had good success. When I go back home, I may need to alter my approach once again, but as the old adage goes: “when in Rome…”