Where do I begin... let's just say that oxygen is essential to life both in and outside of the OR. In almost every case of any duration thus far, we have had oxygen pipeline failures. The oxygen concentrator for the hospital has been "fried", so they are forced to buy oxygen in large cylinders. These inevitably run out, as medical air is not available and all patients are ventilated on 100% O2. Instead of having someone replace the cylinder when empty, they wait until the supply fails, someone gets called, and up to 30 minutes later the flow is restored. There are no backup cylinders on the anesthetic machine, either. Most of the time, we have to bring in an old-school ventilator from the 1950s with its own oxygen concentrator (and no end-tidal CO2), hook it up to the circuit (under the drapes, during a craniotomy) until oxygen returns to the original system.
This is sub-optimal.
We went for a tour of the technical services for the hospital in the hopes of addressing this problem. Halfway across the hospital compound, there are banks of cylinders ready to be filled (once the part arrives to fix the oxygen concentrator), which explains the delay in changing these tanks. Perhaps I will construct a small cart that I will pull behind myself, loaded with an oxygen tank, so at least my patient will get tidal volumes and maybe an anesthetic, partway through their neurosurgery.