r/anesthesiology

I could only visulize my needle tip 2/5 a lines that I did.

I ended up mixing up sliding the probe with fanning and got lost couple of tines.

What is the recommended approch specially for shallow vessels within 0.5 cm depth.

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Do you make the poke and slide your probe to see the tip or fan towards you ?

I’m in my CA-3 year and trying to understand

1. how many days I can take off per the ABA & ACGME before having to extend/make up residency

2. how being pregnant or potentially being on maternity leave in between graduating and starting an attending job would affect my prospects of getting a job

Ideally (and I know these things cannot be timed perfectly) I would either want to deliver right at the end of residency or after graduating so that I don’t have to necessarily make up days (I really want to be done with training lol). We get 4 weeks of vacation so I could stack my vacations in the last month of residency and then extend my “maternity leave” into post graduation such that I would basically start an attending job later than my non-pregnant colleagues and not get paid maternity leave from my attending job (which is fine for us financially).

So the question becomes, by delaying starting an attending job, will this limit my job opportunities? And am I being delusional about the whole thing? Maybe this is the wrong decision. Maybe there’s an entirely different option that I’m not considering.

To answer the question of why not wait until you become an attending so that job opportunities are not an issue and you possibly get paid maternity leave: we feel that we’ve already delayed this longer than we wanted to and we think having time in between residency and attending hood would be good for me in more ways than one (my program is a tad malignant and it’s been rough at times).

Unfortunately, no one in my program (residents or Attendings), family, or friends have been pregnant during residency so I don’t have guidance. I would prefer not to discuss this with my PD for fear of being treated differently or pressured into making a decision that isn’t right for me bc all they care about is money and staffing. I’d rather make a decision and tell them how it’s going to be.

This is a genuine question and not criticism. The U.S. consistently produces excellent anesthesiologists.

From my understanding, anesthesia training in the U.S. is typically 1 intern year (with no anesthesia exposure) followed by 3 years of dedicated anesthesia training.

For context, I’m training in a 5-year anesthesia residency program outside the U.S., and even with that length of training I still feel like there are areas where I have a lot to learn.

A few things I’ve always wondered about:

1)How do residents gain enough exposure to the full breadth of anesthesia within 3 clinical anesthesia years, especially when ICU and other non-OR rotations are included?

2)How do residents accumulate enough experience in OB, regional anesthesia, pediatrics, cardiac, thoracic, vascular, neurosurgery, and high-risk general surgery within that timeframe?

3)I’ve heard that some programs expose residents to complex subspecialties relatively early (for example, cardiac anesthesia during CA-1 or CA-2). How does that work, and do residents feel prepared for those rotations? I took my cardiac rotation during pgy-4 and read for 2 months in advance and still felt like i knew nothing….

4)I’ve also heard that in some programs residents are relieved in the afternoon (sometimes around 4 PM when not on call). If that’s true, how do programs still provide enough case volume and clinical exposure for residents to graduate feeling competent?

5)By graduation, do most residents feel comfortable practicing independently across the full scope of general anesthesiology, or is there an expectation that certain areas will be learned during fellowship or the first few years as an attending?

6)What do you think contributes most to the success of U.S. anesthesia training: case volume, autonomy, work hours, efficiency of training, fellowship opportunities, or something else?

I’d love to hear perspectives from both current residents and attendings.

On my first month of cardiac and am just looking for tips on what to do to to at least look competent. Fortunately I had ICU already so I have an algorithm for A lines and central lines but moreso it’s information overload and the setup.

I’m in a different hospital for my cardiac stuff that’s gone through a lot of turnover and the rooms are horribly stocked. Half the battle is getting there at 4 AM and there being no hotline, no A lines, 5/10 cc syringes missing, some crucial meds not in the cart. I chase down pharmacy and anesthesia techs to help me stock while scrambling to set up all the drips.

I’m also trying to make sense of bypass and what’s happening in the surgery. Another issue is line organization, there are so many drips and I’m struggling to find a way to keep everything untangled…

Because I’m still slow, I’m getting there at 4 and we get relieved at 7 pm. Hopefully as I get faster, I will come in later but I would rather come in early and be prepared than rush. Does anyone have tips on how to succeed on this rotation?

trying to figure out this SIMSTAT PACU and I keep failing because I don’t talk to family about life support decisions. has anyone figured out how to contact family on this module? so frustrating.

Starting my peds fellowship in a little less than a month... excited but also pretty nervous. Jumping from a community residency program to an academic one, and the anxiety + reality of it is starting to ramp up a bit.

Anything I should be doing in the meantime to prep? Or should I just take this downtime to chill a bit haha

Hi everyone,

MS3 here, considering anesthesiology. Just wanted to get an idea of the day to day intellectual work.

How algorithmic is the day to day practice? Is there any deep problem solving or mostly protocol driven? Is the problem solving pattern matching, heuristics, and trial and error that become second nature, or is there any sort of genuine novelty (not just slight variations)? Do subspecialties solve this, or does it eventually become true for those too?

I hope the gist of what I am asking comes across. I like the idea of IM, but it feels too formulaic for my liking, among other bullshit. I understand what I am asking is rare in medicine in general, but I am just trying to get an idea of where anesthesia ranks among everything in terms of this.

How individual dependent are the outcomes in anesthesia? Meaning is there notable variation in outcomes between an “average” and a “great” anesthesiologist, or is it negligible?

Welcome opinions from everyone, but particularly experienced attendings.

I’m currently interviewing for a chief position. But the salary is vastly below the market for full-time locum salary. Somehow I just cannot get over this fact.

Still negotiating, but it’s hard to justify the extra work.

Just to add, I’m in Maryland. The market is still very much in favor of the staff. We have locum full-time employees. They are excellent. But they sometimes make double the salary of W2 staff.

Edit: thanks everyone. It sounds like I should go for locum job. Thanks to the Reddit hivemind for changing my career trajectory.

Edit 2: We might have convinced some people to become locums. Sorry to the chiefs.

Edit 3: Locum rate for anesthesiologist in Maryland is 350-450 dollars a hour. Not sure about the CRNAs.

Looking for some career advice from anyone who’s made a similar transition. I’m coming up on 2 years into my first attending job at a large academic center (chose to work here for geographic/personal reasons).

It’s time for me to leave the area and I will likely be transitioning to a full stack PP. For the past 2 years I have done zero OB, minimal neuraxial, and minimal regional (occasional opportunities at my per diem job).

Any recommendations from those who have made a similar practice transition after spending significant time away from blocks and/or OB? I am not too worried about working solo/fast as I have had the opportunity to do that with per diem/ambulatory site shifts. Just wondering if there is anything I can do in advance to smooth out my transition and reach speed/efficiency in the areas of regional/obstetric anesthesia

Thanks!

Incoming CA-2 here. I really enjoyed my OB rotation and could see myself doing OB anesthesia long-term

I’m wondering if doing CCM or cardiac primarily to bring these skills and apply them in OB is actually practical, or if it ends up being a waste of time unless you truly want to practice ICU or cardiac as a major part of your career.

Has anyone gone down this path or considered it?

Unfortunately, changing programs isn’t really an option for me, so I’m trying to make the most of what I have and I’m actively pursuing away rotations to fill gaps in my training.

My concern is that my residency is at a relatively small hospital. Most of our patients are ASA 1–2 and we don’t do a lot of high-acuity surgery. We’re not a trauma center and we don’t have major surgeries which is unfortunate

Case mix is mostly:

Lots of ortho
Lots of craniotomies (generally straightforward)
Bread-and-butter general surgery
Pediatrics
Urology
Plastics
Endoscopy, MRI, and IR

One thing I do appreciate is that our attendings give residents a lot of autonomy. By CA-2 we’re generally inducing and extubating patients independently (with supervision available, obviously), which has helped build confidence and decision-making skills.

Assuming everything goes as expected, these are roughly the numbers I’ll be graduating with:

— Well over 200 spinals/epidurals (not worried about neuraxial experience)

-Good OB load, mostly healthy

— 200 pediatric cases, mostly routine cases, plus 1 month at a dedicated pediatric hospital during CA-3

— 80–100 single-shot regional blocks

— 40 craniotomies, straightforward cases

— 30–60 cardiac cases during a 2–3 month rotation at a tertiary cardiac center

— Only about 5–10 double-lumen tubes because thoracic surgery volume is low

— Probably no major vascular cases (AAA, aortobifemoral bypass, etc.)

— No meaningful trauma exposure
— Lots of endoscopy, MRI, and IR anesthesia

— About 40–50 central lines by graduation

For those of you already in practice or nearing graduation:

Would you feel comfortable graduating from a program with this experience?

What are the biggest weaknesses you
see in this training?

If you were in my position with one year left, what would you prioritize during away rotations?

Are trauma and major vascular exposure things that can realistically be learned during fellowship/early attending years, or are they gaps that should ideally be addressed during residency?

Honestly i’m not interested in pursuing a fellowship….

I’d appreciate honest opinions. I’m not looking for reassurance i genuinely want to know where the deficiencies are and what I should focus on during my final year.

EDIT: guys i cant do trauma. We dont have traumas where i live

I can do one month of transplant but idk if that would be useful for me. It’s really competitive to apply for a rotation and the attendings there are not friendly they usually dont get you involved… so they’ll do all of the lines and most of the management

Would you consider this training bad?? Genuinely, am i cooked?

Recent grad with minimal pre experience. Practice does mostly elective healthy peds and some burns. For those that do peds frequently, during an emergent/urgent peds case, are you placing a preop IV or still masking. Had a 3y/o that wasn’t NPO with FB (kid stuck something up nose that was now far down in nasopharynx after another doc tried retrieving) that ENT deemed emergent due to risk of aspiration. Was a struggle placing preop IV because patient in addition to being 3, kid was developmentally delayed.

Would love to hear how others would approach the case.

Hi all,

So I'm a UK trainee studying towards the first of the big anaesthetic exams (the FRCA primary for any uk members). I'm reading up on pharmacology and have started reading about pharmacological models. The rub is that I stopped maths in school at gcse and we didn't cover differential calculus at all. Like, not even slightly. I only barely know what it is in the broadest possible terms - I get that it's a way of determining the slope of a graph at a point, but I have absolutely no idea at all how you go about actually doing that, and I'm not familiar with the mathematical notation.

As a result, I'm really struggling to understand a lot of the equations that I'm being presented with. I wonder if anyone could advise me as to whether it is worth me trying to give myself a grounding in calculus for this purpose. My study time is obviously limited and I don't want to go wandering off into the weeds if it's not actually going to be useful.

Does anyone have any advice here? Beyond cramming facts into my head for an exam, how useful is understanding this on a basic mathematical level for being an anaesthetist?

Newish attending, will be 2 years out when I plan to start my new job (Fall 2027). Changing jobs to be closer to family and in a location where we plan to stay long term.

Goal is to move only once from current location to our new house (ideally) but housing market where we plan to move to is extremely, extremely competitive. Current rental and work contract ends around August 2027.

When would you seriously start looking for a new job and interviewing, as well as applying for a mortgage to look for housing?

My fear is having a job lined up next Fall but with no where to live.

Any other tips or input is appreciated, thanks.

I had an interesting case present itself the other day. A patient had a steroid injection in the cervical area for arm pain and had PDPH symptoms within the day, went to the ED and we were consulted for an EBP. Given the location, I wasn’t comfortable doing the procedure at that level, and I had doubts doing it at lumbar region would reach high enough to treat it. I referred them to the doc that did the injection to do the patch and recommended conservative management in the meantime.

What would you have done? Anyone done a blood patch in the cervical area? How was it, what volume blood did you use and did the patient have any issues like the crampy/spasm-like pain that can sometimes happen after an EBP?

Edit: Thanks for the CME everyone, always glad to see perspectives from colleagues. At my practice we try to help when we can, but it’s a community hospital so we avoid doing things with minimal-to-no evidence in the literature.