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Anesthesia in Hangzhou, Year 4.March 7th, 2015
This marks the fourth year of the exchange rotation between UCLA and the Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU). I was very glad to have this opportunity to participate in anesthesia care in a foreign system and immerse myself in a different culture.
SAHZU, established in 1885, became affiliated with the Zhejiang Medical College in 1952, is a tertiary medical center in downtown Hangzhou and houses a total of 3200 inpatient beds combining the main campus and the newly opened Bingjiang campus. There are a total of 60 ORs, and the highest number of cases per day is about 210, making it quite busy at times. Most of the attendings and residents speak English, but I also speak Mandarin fluently so I was able to learn the system quickly.
I first started with activities outside of the OR:
- Induction room: Anesthesia residents place awake arterial lines and central venous access catheters in patients who are non-first-start OR cases or anyone requiring central access from the inpatient units. I practiced how to place an A line without using Seldinger's technique and refine my hand-eye coordination on ultrasound guided A line placement.
- Acute Pain Service, a team following up inpatients that have a PCA or PCEA.
I spent the following two weeks in the OR and was able to choose which types of cases I wanted to participate in. There were many interesting cases, including resection for primary liver tumor with metastasis to the IVC and RA, burn patients, awake craniotomy for tumor near the central gyrus, prophylactic balloon occlusion of iliac artery placed by the anesthesia team for total lower extremity amputation due to Ewing's sarcoma, TAVIs under sedation and general anesthesia, and liver and heart transplants. OR days started with a 7:30 morning conference, 8:30 first case start time, and usually ended around 5-6pm for me.
Most of the patients are admitted days prior for pre-op workup instead of having most of the workup done in an outpatient setting due to insurance reimbursement. Most patients would remain intubated and then be extubated in the PACU for faster turnover. There is a full-time TEG machine run by anesthesia residents, who are also responsible for doing intraoperative EEG, SSEP, and MEP monitoring.
I shadowed in the ER ICU for two days; this ER ICU acts as a mixed MICU and SICU. I also spent a day in the pain clinic, and then I spent the rest of the week doing various nerve blocks (upper and lower extremities nerve blocks, TAP and rectus abdominus blocks) under ultrasound guidance. There was also a Saturday nerve block workshop for residents.
Living in Hangzhou:
The international office provided a spacious apartment that was less than five minute walking distance from the hospital. There are various sight-seeing opportunities in Hangzhou. The famous Westlake is 20 minute walking distance from the hospital, and public transportation is convenient. I also spent one weekend in Shanghai, which is only one hour away from Hangzhou via the high-speed rail.
This rotation provided me the opportunity to experience how the Chinese healthcare system operates and how to think outside our routines and utilize other tools to maintain high quality anesthesia care. I also enjoyed the beautiful Westlake, great food in Hangzhou, and the most memorable hospitality and friendship that I will forever treasure.
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