Wrapping it up at Aim Shans

 One major difference between Egypt and the West Bank is the number of women in medicine in Egypt. Yasmina, who is looking to see if her IV will run, is a senior resident in the anesthesia department at Aim Shans. She is far and away the handiest registrar anesthetist I met and was a pleasure to work with. I've been to Palestine four times and haven't seen any women in the anesthesia or surgical departments.

 Another cute baby!! This little girl has a unilateral cleft that will make intubation difficult. If you put the laryngoscope blade in in the midline, you'll be able to see the larynx but it will be hard to pass the endotracheal tube because the premaxilla, the part of her lip that sticks out in front, will hang down in your way. What you need to do is put the blade in from way over on the left and expose the vocal cords. That way you'll have plenty of room to intubate, passing the tube beneath the gap in the baby's upper lip.

 Young Kim, CRNA from Columbia-Presbyterian, is a great teacher and a skillful anesthetist. Here she's working with one of the female anesthesia residents. She was very well prepared and well-stocked, with a supply of endotracheal tubes and IV accessories that made me green with envy.

The anesthesia equipment at Aim Shans was pretty good. One of the three machines we used didn't have a CO2 absorber so an open system, where the fresh gas comes to the patient close to the mask and the pressure release and rebreathing bag are at the far end of a length of corrugated tubing. The problem was that we didn't have a real pressure relief valve. One way around this is to cut a small hole in the end of the rebreathing bag. This works fine so long as you have the dexterity to control the pressure in the system by partially or completely closing off that hole. I've never been good at that, so I used something I saw in Gaza last spring. I made a slit in the barrel of a 3 ml syringe and then stretched the opening in the bag around the business end of the syringe. With this I could vary the release pressure by moving the plunger. It made it easier for me to concentrate on managing the airway, and gave me a chance to show off my Leatherman!