In the operating room with Dr. Wilfredy Castaño Ruiz


I am still working on several posts – but in the meantime, I wanted to post some photos from my visit to the operating room with Dr. Wilfredy Castaño Ruiz, one of the thoracic surgeons at Hospital General de Medellin.

Readers may notice that some of the content of my observations of the operating room have changed.. In reality, the reports haven’t changed – I have just chosen to share more of the information that I usually reserve for the books since I probably won’t get time for a “Medellin book”.  So, if you are squeamish, or if you don’t want to know – quit reading right about now…

It was a surprise to meet Dr. Wilfredy Castaño Ruiz because it turns out we’ve already met.  He was one of the fellows I encountered during one of my early interviews in Bogota, with Dr. Juan Carlos Garzon Ramirez at Fundacion Cardioinfantil.

Since then (which was actually back in the early spring of 2011), Dr. Castaño has completed his fellowship and come to Medellin.

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin

Yesterday, I joined him in the operating room to observe a VATS decortication.  The case went beautifully.

Dra. Elaine Suarez Gomez, an anesthesiologist who specializes in cardiothoracic anesthesia managed the patient’s anesthesia during the case.  (This is important because anesthesia is more complicated in thoracic surgery because of such factors as double lumen intubation and selective uni-lung ventilation during surgery).

Anesthesia was well-managed during the case, with continuous hemodynamic monitoring.  There was no hypotension (low blood pressure) during the case, or hemodynamic instability.  Pulse oxymetry was maintained at 98% or above for the entire case.   Surgical Apgar: 8 (due to blood loss**)

Monitors at HGM are large and easily seen from all areas of the OR

Monitors at HGM are large and easily seen from all areas of the OR

Dr. Wilfredy Castaño Ruiz was assisted by Luz Marcela Echaverria Cifuentes, (RN, first assist*). The circulating nurse was a very nice fellow named Mauricio Lotero Lopez.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.

*”Registered nurse” is not terminology common to Colombia, but this is the equivalent position in Colombia, which requires about six years of training.)

** In this particular case, the surgical apgar of 8 is misleading.  The anesthesia was excellent, and the surgery proceeded very well.  However, due to the nature of surgical decortication (for a loculated pleural effusion/ empyema) there is always some bleeding as the thick, infected material is pulled from the lung’s surface.  This bleeding was not excessive for this type of surgery, nor was it life-threatening in nature.

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