While admitting that I have not approached risk management, which would likely be ineffective anyway owing to their case-by-case approach to clinical questions, I’m wondering what sort of reasonable limits you all are seeing in your community hospital for pediatric anesthesia.

Background: I practiced in an urban facility with 100+MD anesthesiologists and we said all children <2 were to be cared for by peds anesthesiologists. But, in rural areas that might not be practicable without putting patients/families under travel duress.

I now live in said rural area with a small community hospital.

Recently we had an ENT surgeon try to book a 6.8 kg former 26 week preterm baby who was 8 months old on paper, but 4 months by conceptual age. They had spent first four months of life in NICU. The surgery was minor. The patient was not. I cancelled it and took a lot of heat. I don’t care about that: it’s why we get the big bucks. But where are your limits in your hospital? Being brave isn’t a clinical “skill.”

Here is a summary of the article:

• Court Decision: The U.S. Court of Appeals for the Sixth Circuit affirmed the dismissal of a lawsuit filed by the American Association of Nurse Anesthesiology (AANA).
• Core Issue: The AANA sued the U.S. Department of Health and Human Services (HHS) and its Secretary, arguing that the department failed to enforce Affordable Care Act (ACA) nondiscrimination provisions against private insurers who reimburse nurse anesthetists at lower rates than anesthesiologists for the same services.
• Standing and Causation: The court ruled that the AANA lacked legal standing because it could not demonstrate a direct injury or a causal link between government inaction and the private insurers' reimbursement policies.
• Redressability: The court noted that even if standing existed, the Secretary of HHS holds discretion over enforcement, meaning a court order might not necessarily change the insurers' practices or resolve the association's complaints.
• Broader Implications: The ruling highlights the significant legal hurdles healthcare provider organizations face when trying to hold federal agencies accountable for enforcing provider protection laws, potentially limiting future lawsuits of this nature.

Attending Anesthesiologist here:

So the vial says to "shake well before using." But my feelings are that aggressivelt drawing the entire vial up introduces sufficient turbulence to mix anything that would need mixing. But I figured I would ask around. I guess it might make sense if you were drawing just a small amount off a large vial.

Can someone help me better understand the thought process of running inotropes during bypass? I havent seen this often but a random time or two seen/heard of milrinone or epi running in the background.

Not MD...just a tech

I recently had a MOCA minute question regarding weight based dosing of cefazolin for SSI ppx. Particularly I am interested in if anyone has the study that show patients >120kgs no longer require a third gram of ancef. Does anyone have the studies on hand which show no increased risk of infections?

Like the title says. Starting a new PP job out of residency and want to be as good as I can, but don't need the board-prep stuff as much anymore.

For those of you who have been in practice for a while, do you find yourself regularly reaching for certain books or resources, or does most of your learning become more "on the fly" once you're out on your own?

If you could only recommend a handful of resources, what would they be?

What books, websites, journals, apps, or other references have actually been worth the money? Which ones do you still find yourself reaching for years into practice?

Im a very busy resident in a hospital that suffers from chronic chair shortages. I do a ton of standing and a lot of walking every day, and the rubber clogs I’ve been using for several years are looking worse for the wear.

I’ve been using WOCK brand OR clogs, and they are alright but seem to lack a bit of support.

I’ve tried calzuros and they really hurt me, the platform is too high and I turn my ankle.

Birkenstocks are ok but feel insecure when I’m out here running laps around the hospital.

I’m thinking of trying dr scholls but I’m wondering if they are worth the price.

Are there any amazon random brands worth trying?

Also I was wondering if anyone finds ways to sneak in some strength exercises in the OR? I do wall sits and some stretching, but I’m interested in any other ideas.

Thanks in advance for your thoughts :)

This article is from April, and the patient's husband has since sued JourneyLite, its staff, and the anesthesia group. I'm curious what everyone's thoughts are here. Mine: 1) What a long abdominoplasty case; even the slowest surgeon I've worked with schedules and finishes his abdominoplasties in 4, 4.5 hours. 2) This might be the first time I've heard of a surgeon suing staff over their patient's death. 3) What's the likelihood of a jury siding with the plaintiff when there is no autopsy to determine cause of death?

Newer anesthesia resident looking for insight from you seasoned vets. I feel like a walking punching bag for any nurse/resident/surgeon who wants to take a shot.

It’s 2am and the surgeon is moving the patient without telling anyone, the nurse is disconnecting your monitors while moving things constantly, surgeon is worried about getting the table up immediately while the patient is unstable, etc. It’s clear that anesthesia is the only one worried about how the patient is doing clinically, yet we get the worlds biggest eye roll when we ask for a few seconds to ensure our monitors are working correctly etc.

I feel like a huge as$ after every call shift cause im constantly having to ask the team to avoid certain things in order to ensure the patient is being appropriately monitored / safe.

Is this a normal thing I just need to grow thicker skin for?
How do you deal with these situations where you need time / the team to stop whatever they are doing?

Interesting discussion today. Keen to hear the thoughts of learned colleagues.

When to start CPR intra-op with profound hypotension - despite ongoing evidence of cardiac output (eg A line, SpO2 trace, good etCO2 or POCUS).

It seems to be an emerging evidence zone, with resuscitation experts questioning the usefulness or perhaps harm of unsynchronised compressions, maybe over the LV maybe not, in pseudo-PEA.

Meanwhile international expert consensus in Anaesthesia, particularly in UK & Australia, seems to recommend starting compressions if SBP is < 50.

Thoughts?

Newer CRNA here with a question about preops with pacemakers in place. I work in a midsized hospital in the southern USA.

Today I was in endoscopy about to put someone to sleep for a colonoscopy. Somehow it had slid through the cracks that patient has a pacemaker. We have no in house data on this pacemaker since 2016 and patient is not a reliable historian. What would you do in this scenario?

I paused the room, grab the interrogation device from down the hall, and did a quick scan to get a report on the pacemaker settings and events. Took about 5-7 minutes. Proceduralist got annoyed, complained that no one else stops workflow for this. It’s my understanding that you need a report from within 6 months for an anesthetic to proceed, but several members of my group are saying they don’t think it was necessary/wouldn’t have stopped the lineup for a pacemaker report.

Looking back, I could’ve sent the patient back to preop and had the nursing staff do the interrogation, but I didn’t think about it at the time.

Looking to structure a position different from what we currently have going on here, thought I would get the group input.
Midwest regional hospital currently running a shareholder/buy in model, looking to establish an employed position.

700k w/100k sign on
10 weeks PTO
weekend call q5 weeks
weekday first call q14 days
guaranteed post-call off
most days done between 2-4 unless call (1,2,3)
Full 401k + compliment of benefits

Would you take this job? What would you change about it?

I'm joining the club and switching back to general from pain. For those who've been out for a while, what resources do you recommend for high yield knowledge refreshers that I can peruse over the next few weeks while I get my feet wet again?

I’ll start.

Asked for table up, but didn’t say when. Then got upset when I overshot by 1 inch.

Told me the patient was “waking up” because the thumb twitched in response to the TOF.

Showed up 30 mins past the case start time to consent the patient thereby delaying the case then proceeds to blame everyone else for the delay.

I am looking for the best/comfortable scrub cap brands. I had been looking for a good one, but can’t find it. A lot of them are just cloth with no interior liner and do not feel comfortable at all.

Any help is appreciated!

hello everyone, I'm new at anesthesia and I graduated recently.

I have a question

intraoperatively the patient became tachycardia and there was an abnormality in the capnograpgh

I searched for it recently it was (Curare cleft),

the anesthesiologist said the patient about to wake up (I guess he meant like the patient about to react to surgical stimulus or something like that),

so he said give more muscle relaxant

so we gave atracurium (same muscle relaxant that we initially used after propofol,)

my question is.. the sign of Curare cleft + tachycardia are enough to indicate the muscle relaxant is about to wear off?

An anesthesia tech job is at my local hospital. I'm taking some time off from my undergrad in biology. While I was there I worked for 3 ish years in research labs doing histology work, genetic sequencing, and other neuro related jobs. This is the listing for the job:

"EDUCATION: Knowledge of aseptic techniques and the anesthesia process. Ability to read and write, understand and follow oral and written directions, perform basic arithmetic as acquired through high school graduation or the equivalent.  
 

LICENSURE, REGISTRATION, CERTIFICATION: BLS certification must be obtained within the orientation period, and certification must be kept current while in this position.

EXPERIENCE: Experience and knowledge of hospital and departmental policies and procedures, hospital locations and body mechanics."

Could I apply and get the certification during training? Or do i need the certification beforehand?

Haven't felt this horrible after an exam in a while :)) how do you think you guys did?

I am an anaesthesia doctor based in the UK, therefore, I don’t know a great deal about the structure of anaesthesia in the US; however, I’ve been doing a bit of reading.

From my understanding, there are just over 65,000 practicing CRNAs in the US, compared to roughly 50,000 Anaesthesiologists.

In many videos I’ve watched on YouTube, Twitter, Instagram etc, most (if not all) CRNAs being interviewed claim equivalence to anaesthesiologists and seem to do fairly similar cases and dabble in almost every single subspecialty in anaesthesia. I’ve just watched a video of an obviously very competent CRNA saying they do the exact same job, the only difference is the path they take to get to said job. This may very well be true, and I’m sure she’s absolutely brilliant at what she does.

A lot of videos I’ve watched of anaesthesiologists being interviewed seem to disagree with the above, but at the same time, seem to advocate for the current model.

Given that there are more CRNAs (and other non-doctor anaesthesia providers) in the US than there are physicians, do you guys ever worry that anaesthesia, although a fairly young speciality, is perhaps a slowly dying one for doctors?

From the outside looking in, I’ve always been curious about this and the future of the speciality in the US and what you guys think about it, since it seems non-physician practitioners can be trained to perform the exact same job.

This post isn’t to belittle any anaesthesia provider in the US; I’m sure you’re all grand, but I am genuinely curious as to what the general consensus is.

TIA

The guidelines surrounding SGLT2i and minimizing the risk of euglycemic DKA are continuing to evolve.

I have a question about your practice and rationale for your practice surrounding SGLT2is in the setting of endoscopy.

Specifically, I have had patients show up for their colonoscopy, having done a prep and fasted appropriately without having held their SGLT2i.

Initially, I followed the official policy that SGLT2i must be held for 72hr prior to surgery/anesthesia or the case gets canceled.

However after more consideration, it seems that in the setting of endoscopy specifically, the majority of the risk is from the prolonged fast, not the stress of anesthetic or the procedure. And thus the risk has already been undertaken. With that in mind, I started proceeding with these cases.

Am I completely off base? Am I putting these patients in harms way?

Note that this is outpatient endo. There is no capacity for lab work. These patients are discharged home on their own recognizance whether we proceed with the case or cancel it.

ETA: this is an example of more recent recs that have relaxed the “cancel everyone” guidelines.

https://www.apsf.org/article/euglycemic-ketoacidosis-concerns-in-perioperative-use-of-sglt2-inhibitors-re-examining-current-recommendations/

Hi Im currently at a new program and my co-residents and I are not sure where to find past key words from previous basic exams. Can anyone help us out and send us the previous 5 years or point us in the right direction? Thank you!

I work with a surgeon who recently started wanting to combine mastopexy with rhytidectomy. The first combined case was performed on an otherwise healthy 50 yo. She received 10 decadron and 3L of fluid for the 8 hour case. Upon completion of the face lift (final procedure), her airway was too edematous to safely remove the tube. She was a grade 1 on induction, video scope was a grade 3 after some effort. She required transfer to local hospital. I'm a little gun shy now after this given no comorbidities and the resulting events. I'm curious if anyone else is doing this combination.

Thanks!