Recently joined the mod team on medical salaries and got permission from Offcall to use some of their data/infographs that talk about different salary trends across the profession. This one highlights the four specialties where salary progression is basically non-existent throughout an MD's career.
How many people here use IV lidocaine to smoothen their emergence? I had a friend recently tell me that he's started trying it after seeing an attending use it and it has significantly decreased his bucking on emergence? I haven't tried it yet outside of deep extubations so was curious if anyone here has any more experience than me.
Do you worry about total local anesthetic toxic dose if surgeons are using local? Would you avoid it in shorter cases (say induction was less than an hour ago and you gave 1mg/kg for intubation)?
Junior SRNA doing a HIPEC today, and I’ve historically struggled to keep the patient cool despite following department protocol to the letter. Today’s patient is quite small, which I’ve found makes it harder to cool as they seem to heat up faster. I plan to cool to 35°C prior, run the forced air at room temp, place ice packs at groins and axillae, and ice down a couple bottles of 5% albumin and LR to run in as needed. Any other tips?
Guys, does anyone know of any literature supportong precedex iv push dosing rather than the usual 10 minute infusion? most textbooks only discuss continuous infusions. is this mostly based on clinical practice/experience? I’m aware of the theoretical risk of bradycardia or hypotension, but I haven’t found any textbook or paper clearly explaining why the drug is recommended to be given over 10 minutes or where that recommendation originally came from. I’d appreciate any references.
About to start CA2 and starting to figure out what’s important to me in my future position. Any insight is appreciated!
Now, I’m just sitting here in an airport ruminating on all the stupid/obvious stuff I said or missed/needed direction on. Honestly, will be surprised if I passed and it’s eating me up.
Just posting this for anyone else out there feeling the same— this is horrific. Such a let down.
I'm an anesthesia resident but I'm frustrated with still not being able to confidently place a CVC. The problem is almost always I lose my intravenous placement when I go for the guidewire so that I realise a resistance when I push it through. I usually try to go at a 45° angle through the skin and try to flatten it once I aspirate with the hope of avoiding a posterior wall puncture.
Hence I would really appreciate tips on this issue, I have seen so many videos and all so far and I really feel incompetent with this matter. Does it at some point get better with repetitive execution or should i just change my field :/
If you’re not familiar, Louis Rossman is an attorney with a youtube page that does amazing work protecting digital freedoms, and exposing companies and organizations that infringe on them. I let him know about the ASRA coags app situation which you can read about here.. https://www.reddit.com/r/anesthesiology/comments/1tdbxkm/asra\_sending\_out\_cease\_and\_desists\_for\_3rd\_party/
He did a pretty extensive write up and will likely make a video. Can you all look at the article and check for errors. He would greatly appreciate it.
Scientists recently recorded neural activity in the hippocampus of seven patients under general anesthesia and found something strange: the brain was not just passively hearing sounds. It was still learning patterns. In one experiment, hippocampal neurons became better at detecting unusual tones among repeated sounds over just a few minutes.
In another experiment, patients under anesthesia listened to speech. Their hippocampal neurons responded to word frequency, parts of speech, and semantic categories, and even carried information about what kind of word might come next in a sentence.
Clearly, nobody is learning a new language while knocked out, but the takeaway is clear: even when consciousness is completely switched off, the brain keeps mapping out the outside world.
As stated above. Entire OR then just thinks I’m completely incompetent I guess 🥲
Some days I just can’t.
Wallowing in my own embarrassment now
UK based and TIVA enthusiast.
What's your favourite combination for short cases? I'm talking about day case hysteroscopies, I+D abscesses, ERPC. I find two pumps with remifentanil and propofol aren't always conducive for quick wake ups and list turnover.
I think propofol TCI with manual fentanyl boluses + multimodal analgesia and BIS monitoring good but just wondering if that increases risk of patients being too light/less good analgesia on board.
Thanks!
This topic recently came up. What have you done in the past for pregnant woman undergoing minor procedures such as cystos. Spinal, general, mac? Any literature or findings as well. I am a nurse anesthetist. Thanks.
I'm an anesthesiology resident based in Europe and I actually love my job very much but people make it unbearable sometimes. It seems like whatever you do, you are always doing something wrong and somebody always comes to criticize you. I'm not talking about medical things, the medical challenges are surely stressful but it's what I signed up for.
What I didn't consider was how lacking of manners and logic people would be. Do not get me wrong I can also handle respectful critique in my opinion and I have to be criticized obviously at this stage of my career so that I can develop my skills. The critique is mostly about organization and extreme time pressure which leads to no net benefit and is from time to time leading to poor medical practice in my opinion. Hence when I do things the safe way I get complaints. One would think, the other person would be able to see this doesn't happen everyday so they should be able to come to the conclusion something extraordinary happened. And when it's commented it's with terrible and respectless words, very very rude with cursing from time to time. Does anybody really think this would lead to enhanced performance and efficiency ? Why do we keep giving psycopaths roles in management?
One feels like a robot and the natural swings of a human performance is not calculated into daily life at all. I really don't know how much longer I can survive in this system, as much as I love what I do it breaks my heart to say this. I'm sick and tired of being scolded like a child, although I think I am on my way to become a fairly good anesthesiologist who advocates for their patients.
Rant over.
I’m in the dregs of prepping for advanced. Finished the ITE TrueLearn and am about 50% through the advanced. I have religiously used TrueLearn, anki and some Hall for ITE in years past and have been consistently above 75%ile. Is there anything else I should do for advanced besides the old exams?
Thanks!
(ST3 resident here, in UK)
A situation I encounter fairly frequently in obstetrics and never got a straight answer for.
Doing a spinal, as you feel the spinal needle pass through dura and you get a loss of resistance feeling, the patient reports a fleeting paraesthesia down one leg. You remove the stylet and you see clear CSF flowing freely.
What should you do in this situation? Withdraw and reinsert/withdraw and redirect the spinal needle, aiming away from the side you got paraesthesia on? Or, seeing clear CSF flowing freely, assume you’re safely intrathecal, and inject your spinal dose? Why/why not?
Does the calculus change if it was a difficult spinal that required a few attempts?
Does paraesthesia always indicate you’re off midline?
Was reading an overview of a closed-claim case and one of the arguments prosecution made was that since the patients preoperative SBP was greater than 180 the case should’ve been canceled. This was an elective surgery in a hospital setting. While the actual event was not related to hemodynamics, the anesthesiologist was ultimately found partially liable anyway.
The somewhat arbitrary cutoff (asymptomatic SBP>180, DBP>110) for cancelling elective case that I was taught in residency is almost never practiced in my experience. I work in a very busy community hospital, conservatively we’d be canceling 15+ cases per day if this was followed.
My question to the community: For patients undergoing elective surgery in a hospital setting, who took their home antihypertensive as directed, presenting with asymptomatic hypertension by the definition above… how are you proceeding? And (potentially more importantly) what is the culture at your institution, how do your colleagues and surgeons act in this case?
- do you cancel outright?
- do you pretreat and proceed, or pretreat and wait for response?
- does the actual case make a difference in your decision ie: TCAR, TSR in beach chair, MAC case? Or is everyone getting treated the same?
- does the fact that they had a recent clinic visit where they had a normal blood pressure make you more wary? What if their preop visit had them at 170/100?
Nobody at my institution feels like the asymptomatic hypertensive patient is a hill we’re all gonna start dying on, but I wonder if this is maybe the wrong take?
Yes, he is crazy. But his patients love him! (besides the 10% that hate him)
I have my first job interview for a private practice in a couple days. I’ll be interviewing for a peds job. It’s physician only at a large hospital center. What should I be looking for/asking about?
I’m only a couple here out of residency and my thumb joints are giving out. I tried to switch to my non dominant hand as much as possible and now that’s giving out to. I’m in disbelief. what do I do?