u/peachblossomtears

​

PGY1 anesthesia resident here looking for opinions/learning points

Had a 34F with clear cell ovarian carcinoma posted for interval debulking surgery via laparotomy. We placed a T11–12 epidural and proceeded with routine GA + ETT.

Analgesia/antiemetics intraop:

- Epidural morphine 3 mg

- Fentanyl 150 mcg IV (including induction 100 mcg)

- Paracetamol (1 gram IV)+ diclofenac 75 mg iv

- Dexamethasone 8 mg + ondansetron 4mg prophylaxis

Intraop, hemodynamically stable with adequate urine output and acceptable fluid balance, bp was on the lower side (MAP 65-75) and heart rate 60-75 bpm with no tachycardia

Post-op: pain score around 2/10 even 24 hours postop, but multiple(almost 20 in the last 24 hours) vomiting episodes (in fact that pain was due to vomiting so much). did not give any epidural topups

Gyne team felt this was due to the epidural morphine and argued that under ERAS we should have avoided opioids altogether

My understanding was that ERAS is opioid-sparing rather than opioid-free, and that neuraxial opioids (including epidural/intrathecal morphine) can still be appropriate for major abdominal surgery when they reduce systemic opioid burden—especially if neuraxial LA options are limited.

Questions:

1. Was epidural morphine 3 mg a reasonable choice here?

2. Would you have approached analgesia differently in a hemodynamically tenuous gyn-onc laparotomy?

3. Do you view the postop vomiting here as “expected tradeoff,” avoidable, or a sign the plan was suboptimal?

We previously had a minimum account age requirement of 21 days for participation in this subreddit. Following recent events and after taking feedback from members, we have now increased the account age requirement and introduced a karma threshold.

We will not be disclosing the exact age or karma limits, as ban evaders and repeat offenders often wait it out or game the system once they know the thresholds.

For context: this is an ask subreddit. Many users come here seeking advice, help, or support, sometimes from throwaway or newer accounts. That is the reason we intentionally avoided stricter restrictions for a long time—we did not want to block genuine users who may not have an established Reddit account.

Unfortunately, repeated ban evasion, misogynistic trolling, and spam from bad-faith users have made stricter moderation necessary. These restrictions are not ideal, but they are being put in place to protect the community.

Now if you do have a genuine question and need help, and dont have enough karma or age, you can send your post to the mod mail and if its genuine enough we will manually approve it

We have also implemented additional ban-evasion detection measures(bot add chesam le) , and we hope this will help reduce repeat offenders cycling back into the subreddit.

Lastly, a request to the community: please report problematic posts/comments or send us a modmail. Moderators do not instantly see everything, especially in active periods.

During the recent incident, we received only 2 modmails and a handful of reports, mostly on later posts—by which point the situation had already escalated. Many users later asked why moderation did not happen sooner, but reporting genuinely helps us act faster. If something seems off, please report it instead of assuming someone else already has.

(modified by chatgpt)

Over the past few days, many of you have probably noticed an account called FerreroRocher96 repeatedly spamming this sub with hateful, misogynistic, and low-effort ragebait posts.

This is not a new issue. The same individual has previously operated under accounts such as FerreroRocher69, and after being banned, returned through multiple burner accounts (e.g., deepinside2b, 2c, etc.). They have been repeatedly banned from this community for over a year.

In response to this pattern, we had previously increased the age requirement for participation in the sub. Despite that, they continue to create new accounts to evade bans.

We were aware this was likely the same person this time around. We chose not to immediately ban the account because we wanted to better understand the pattern of ban evasion and explore whether there were stronger measures available through Reddit admins or other moderation avenues to limit repeated returns

The account has now been banned, and we are actively monitoring the sub

If similar accounts appear in the future, please avoid engaging with them. Report the posts/comments and move on. Accounts like these thrive on attention, outrage, and reaction. The fastest way to kill ragebait is to stop feeding it

(post modified by chatgpt)

we brought images back a few weeks ago so people could explain their questions better… and I think it's been helping

but some of you have taken this as a sign to post:

- random chat screenshots

- memes(idi malli oka question laga do you agree with this ani frame CHESI pettadam)

- and occasionally… your own faces😭

this is not a diary or journals sub okay😭 such posts are not relevant to the purpose of this sub

we are moderating actively, but if this keeps going off the rails, we’re gonna have to take images away again, so before it becomes an actual issue, just letting you guys know

so yeah. it's your call :)