MedWorm Tags: anesthesia

Should You Consider Surgery To Improve A Scar?

Better Health — Sun, 14 Aug 2011 16:00:56 +0100

I have a wide scar on my leg that I got years ago. I have tried creams and stuff. When is surgery a good idea to improve a scar? Can a cream or a laser make it thinner? Scar improvement has several phases and the condition of your body and how the wound occurred have parts to play. Early on after wounding there is the question of whether or not to have surgery to repair the wound. If the edges are clean and close together, then surgery is not always beneficial. If they are apart or the wound is dirty a proper medical evaluation and/or surgery can make things better down the line. When in doubt, get that evaluation. Once the wound has started healing, (more…) *This blog post was originally published at Truth in Cosmetic Surgery* (Source: Better Health)

Really More Shadow Days

Nurse Anesthetist — Sun, 14 Aug 2011 04:34:31 +0100

The academic year is winding down and the senior SRNA’s are getting ready to graduate while the new incoming students will be arriving soon. Next week we have a welcoming party for all of the incoming and outgoing students along with their families at the Chief’s house. It will be a good time to meet the new ones and to congratulate the graduates. It is a little early to be talking about the Fall season but already the calls for Shadow days has picked up. Traditionally, the Fall is the time when most prospective candidates that are seeking positions in the nurse anesthesia programs are looking to hone their interview skills and catch that all important Shadow experience. I have written about this before but feel that the Shadow exposure is really invaluable for those wa...

Variations In Retrieving A Foreign Body From The Stomach

Better Health — Wed, 22 Jun 2011 14:00:52 +0100

I have observed extreme variation in how my colleagues manage GI foreign-body retrieval from the stomach. Some always use general anesthesia and endotracheal intubation; others (myself included) use conscious sedation. Some use an overtube to withdraw the object into if possible; others simply pull it up to the endoscope and use the endoscope to guide it through the esophagogastric junction and upper esophageal sphincter. The reasons for this variation are clearly related to the perceived risk of airway compromise or gastrointestinal wall injury during withdrawal of the object from the stomach. So my questions to you are: 1) When do you ask for endotracheal intubation during foreign-body retrieval? 2) Do you use an overtube when removing foreign bodies from the stomach...

iPhone App Can Substitute For Expensive Pulse Oximeter

Better Health — Fri, 27 May 2011 18:00:12 +0100

The Electrical and Computer Engineering in Medicine (ECEM) research group in collaboration with the Pediatric Anesthesia Research Team (PART) at the University of British Columbia have developed a mobile solution to measuring key vital signs — called the “Phone Oximeter”. The Phone Oximeter uses a traditional FDA approved pulse oximetry sensor, but researchers have modified it to interface with a phone, in this case, your iPhone. Currently the setup is being interfaced with an iPhone for trial studies, but is compatible with Android, and other mobile operating systems. What makes the Phone Oximeter special is its ability to capture SpO2 (blood oxygen saturation), heart rate, and respiratory rate — then dynamically comprehend the variables using the decision support software, giving...

Newspaper

i'm so sleepy — Wed, 18 May 2011 02:49:00 +0100

I was explaining the risks of anesthesia to a patient before cardiac surgery... the patient said "no problem, I'm not going any where". I said I just wanted to make sure we were on the same page. The patient said "As long as I'm not on the front page, nor on the back page (obituaries), we're in good shape" (Source: i'm so sleepy)

Placed A Laryngeal Mask Airway Today!

JeffreyMD.com — Tue, 03 May 2011 22:47:55 +0100

Today was my second day on Anesthesia. Unfortunately, none of the cases required an endotracheal tube placement. So I could not get that procedure signed off today. However, the attending did let me place a Laryngeal Mask Airway (aka LMA) on one of the older patients. And by older, I mean teen-aged. You can click the link above to see a description about what it is and what it does. But below is a picture of how an LMA might look. Silicon & PVC LMA I placed one that looks like the second, clear one. Once the patient is sedated with the anesthesia, you open their mouth and push that mask into their mouth and down into the pharynx. This figure illustrates where the LMA sits within the patient. Anyways… I was just excited about this. Not like it is a huge procedure or an...

True Story: An Anesthetist Attempts To Sabotage A Surgeon

Better Health — Tue, 12 Apr 2011 17:00:00 +0100

There is a sort of love/hate relationship between the surgeons and the anesthetists. Neither one can survive without the other. We supply them with work and they get the work to lie still while we cut and dice. Yet their job is to keep the patient alive while we challenge their ability to stay alive. At the moment of surgery they play good cop and we play bad cop. Of course after surgery the good cop is suddenly the surgeon through and through. But that is another story. I really appreciate a good anesthetist (I‘ve had bad ones) and to tell the truth these days I’m spoiled by the quality of the gas monkeys that I work with. However many years ago I remember a case where the anesthetist and I had a misunderstanding about time frame. I was doing a laparotomy in Kalafong. The gas ...

Surgeon Operating Without Anesthesia In Libyan Hospital

Inside Surgery — Fri, 25 Mar 2011 02:23:53 +0100

Conditions are reported to be so bad in the hospital in Misrata, Libya that surgeons are operating on patients injured in the fighting between government and rebel forces without anesthesia (Source: Inside Surgery)

I’m On Suboxone; Can I Have Surgery?

Suboxone Talk Zone — Wed, 23 Mar 2011 01:35:08 +0100

I recently resumed writing for the expert forum on addiction at MedHelp.Org. One result of writing for MedHelp is that I receive a number of e-mails from people with questions about specific issues related to buprenorphine. The most common questions are from people on buprenorphine undergoing surgery, asking about the safety of anesthesia and about postoperative pain control. There are very significant problems with medical coverage for patients on buprenorphine undergoing surgery. Patients on buprenorphine will occasionally need surgery, and in such cases there are often no doctors willing and/or competent to manage postoperative pain. Psychiatrists, frankly, have little knowledge or experience in this area. Before psychiatry residency, medical school graduates generally complete a medica...

Anesthesia Medications Automatically Delivered During Surgery

Better Health — Sun, 13 Mar 2011 16:00:28 +0100

A team of French anesthesiologists has developed an automatic delivery system of propofol and remifentanil, which they recently tested in a multi-center trial involving 196 surgical patients. The researchers reported in Anesthesia & Analgesia that the system, which uses a Bispectral Index (BIS) monitor as a guide, performed better than manual administration: We have developed a proportional-integral-derivative controller allowing the closed-loop coadministration of propofol and remifentanil, guided by a Bispectral Index (BIS) monitor, during induction and maintenance of general anesthesia. The controller was compared with manual target-controlled infusion. The controller allows the automated delivery of propofol and remifentanil and maintains BIS values in predetermined boundaries duri...

Tired Surgeons: How Long Was The Patient Asleep?

Better Health — Mon, 10 Jan 2011 20:00:40 +0100

In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate. The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules. As summarized in the WSJ’s Health Blog, the perspective piece argues for more regulation for tired surgeons: … self-regulation is not sufficient. Instead, “we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived,” they write. For exampl...

Rapid Opioid Rip-Off

Suboxone Talk Zone — Mon, 10 Jan 2011 01:45:32 +0100

While I’m on the subject of rip-offs, I’ll mention an extreme form of ‘detox capitalism’; a process called rapid opioid withdrawal, rapid detox, or ‘the Waismann Method.’ The name of the process supposedly comes from a certain ‘Dr. Waismann’ who helped Israeli soldiers get off opioids after they were treated for various injuries. It sounds like a pretty exciting history, but to be honest there is nothing in the technique that takes a rocket scientist to figure out. The basic idea is to precipitate withdrawal using an opioid antagonist— something that is done many times over every day in emergency rooms across the U.S.—but to do it while the person is sedated with non-opioid medications. Put me out, Doc! I never expected to admit this back when it occurred, ...

New Study Summarizes Interesting Physiological Aspects of Being Red-headed

Inside Surgery — Sat, 11 Dec 2010 01:45:14 +0100

A new study just published in the British Medical Journal summarizes the different physiology that red heads have (they do truly require more anethesia) and how it impacts their healthcare. (Source: Inside Surgery)

Breast Implants Under Local Anesthesia?

Better Health — Fri, 10 Dec 2010 19:00:25 +0100

Reader question: A surgeon I’m thinking about seeing said on his website that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up, there are lots of differing opinions out there, but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D? I am not a fan of local anesthesia or twilight sleep for breast implant surgery except in rare cases (simple redos and such). The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles, and these muscles need to be relaxed for th...

Sultana-related Sentinel Event

Life in the Fast Lane — Wed, 29 Sep 2010 00:00:57 +0100

The LITFL team have heard through the grape vine that Professor Inglebert Struvite Staghorn, at the bequest of the Society for the Prevention of Surgery, has been investigating an unfortunate episode currantly referred to as the 'Sultana-related Sentinel Event'. (Source: Life in the Fast Lane)

Origin of the Word “Anesthesia”

Inside Surgery — Mon, 23 Aug 2010 08:34:17 +0100

The term “anesthesia” was coined in 1846 by physician and noted poet Oliver Wendall Holmes, Sr. in a letter to William G. Morton, the dentist who is credited with the first written description of the use of ether in a medical procedure to relieve pain. Immodestly predicting that his new term would be spoken by every civilization countless times, Holmes chose the prefix “an” meaning without and root “aesthesia” which roughly means feeling. Holmes is also credited with coining the term “Boston Brahmin,” of which he was one. (Source: Inside Surgery)

Does Anesthesia Contribute To The End Of The World?

Better Health — Thu, 22 Jul 2010 19:00:01 +0100

In a development that may have you undergo your next medical procedure the old-fashioned way, two researchers from the University of California-San Francisco and the University of Oslo are reporting that inhaled anesthetics significantly contribute to the destruction of the ozone layer and add to the overall global warming gas content in the atmosphere. Moreover, the study’s authors conclude with some valuable advice for your own practice: “From our calculations, avoiding N2O and unnecessarily high fresh gas flow rates can reduce the environmental impact of inhaled anesthetics.” We’d like to venture even further. Not only would we recommend closed-circuit, low-flow anesthesia even with sevoflurane (damn those kidneys!), we’d also suggest that patients arrive b...

What Does Your Hair Color Say About Your Health?

Breastfeeding 1-2-3 — Tue, 06 Jul 2010 17:49:48 +0100

photo: Thinkstock We all love our hair. (Or we hate it.) We preen over it for way too long in the morning, we spend months deciding on a new cut or color, and definitely think our luscious locks add to our feminine wiles. But apparently, our hair can even alert us to possible health risks. Check out what your natural hair color could say about your well being, courtesy of Women’s Health: Blondes You’re at risk for developing age-related macular degeneration (AMD), an eye condition that can lead to blindness. Eat food rich in lutein and zeaxanthin, like kale, spinach, and snow peas. Blondes are also at the highest risk for melanoma. Make sure you wear a full-spectrum SPF 30, and wear a hat in direct sunlight. Check out some of our favorite eco-friendly hats here. Brunettes Y...

Doc Goes To Jail In Pfizer Research Fraud Case

Pharmalot — Fri, 25 Jun 2010 12:45:58 +0100

Scott Reuben, who was accused of faking research for a dozen years in published studies that suggested after-surgery benefits from Vioxx and Celebrex, was sentenced to six months in jail plus three years supervised release after he pleaded guilty earlier this year to health care fraud, MassLive reports. The 51-year-old must also repay $361,932 in research grants, forfeit assets worth at least $50,000 and pay a $5,000 fine. The former chief of acute pain at Baystate Medical Center received grants from various drugmakers but never performed the studies, fabricated patient data and submitted info to anesthesiology journals that was unwittingly published. Later, an investigation found 21 papers published in journals between 1996 and 2008 in which Reuben made up some or all of the data (backgr...

Anesthesia for Tubal Reversal Procedures

Tubal Reversal Blog — Wed, 09 Jun 2010 11:19:53 +0100

Anesthesia for tubal ligation reversal is extremely safe at Chapel Hill Tubal Reversal Center. The anesthesia team consists of two board certified anesthesiologists - Dr. Timothy Harwood and Dr. Caryn Hertz. The ensure patient safety and comfort during and after tubal reversals performed by Dr. Gary Berger and Dr. Charles Monteith. (Source: Tubal Reversal Blog)

Pain-Free Dentistry: Nasal Anesthetic (Sniff, Sniff)

dental blog for dentists about dentistry — Fri, 14 May 2010 16:10:07 +0100

This is pretty darn cool. The lab of William Fray, Ph D and Leah Hanson, Ph D at Regions Hospital in St. Paul were pleased when their employee, Neil Johnson, discovered that lidocaine or xylocaine inhaled through the nose of laboratory rats ran down the trigeminal nerve to numb the teeth, jaws, and mouths. The results were 20 times stronger than when the same medications were administered to the brain or in the blood. In addition to using the new discovery for numbing dental patients during procedures, the technique may be used to treat dental phobia, severe facial pain, migraine headaches, and other problems. The research indicates that the sprayed lidocaine or xylocaine may be administered into the maxillary sinus for quick, precisely focused numbing. There is hope that the technique wil...

FDA Warns Teva Over Manufacturing Problems

Pharmalot — Tue, 27 Apr 2010 21:16:51 +0100

The agency sent a letter to the Israeli drugmaker, because its Parenteral Medicines unit failed to correct several manufacturing issues at its Irvine, California, facility, which resulted in contaminated batches of an injectable anesthetic called Propofol, which is widely used in operating rooms and intensive care units. Propofol was last in the news in a big way when it was discovered that Michael Jackson (you know, the former king of pop) died of an overdose of the med (see here). Teva recalled thousands of vials last year after elevated levels of toxins were discovered. At the time, the FDA said more than 40 patients suffered fever after operations, chills and flu-like symptoms. The December 2009 letter, which was posted today on the FDA site, noted that Teva responded six times to the ...

Truth from patients

i'm so sleepy — Tue, 27 Apr 2010 15:18:00 +0100

A patient said to me today - "There are two places you can't lie about your weight - when you're having anesthesia and when you're bungee jumping" (Source: i'm so sleepy)

MRI today

Turquoise Gates — Wed, 17 Mar 2010 17:03:00 +0100

At the ECHO homeschool demonstration night in February, telling our group about our unit study stemming from the Little House on the Prairie series. Amelia's disconjugate gaze is very apparent in this photo.Amelia has an MRI today at around 2 p.m. Please keep her in your prayers as this will be the second day with heavy duty anesthetic used for sedating her for procedures and tests. Please pray that she won't vomit while she is unconscious, and that she will wake up quickly and easily from the anesthesia. The MRI should take about 1 1/2 hours. I will try to post an update this evening. Thank you, friends & family! (Source: Turquoise Gates)

New Students in the OR

Nurse Anesthetist — Wed, 17 Mar 2010 01:45:32 +0100

It is a new year and a new group of first year SRNA’s are starting in the OR. Now the “Art and Science” begins. The end of January starts the clinical rotations for the Students in “The Program”. After the first four months of didactic theory its hands on time now. Its one thing to have a book understanding of concepts and basic science theory about anesthesia; it is another matter to deliver anesthesia care for a live breathing patient. I guess that is what makes what we do so much fun. The clinical rotations now are in addition to continued class room work. I want to discuss more about what its like to start clinical rotations but first. Here is a little digression. There are basically two types of Nurse Anesthesia programs out there. There are...

FDA Doesn’t Like Brochure on OraVerse by Novalar

dental blog for dentists about dentistry — Mon, 01 Mar 2010 20:40:45 +0100

Dentalblogs has covered OraVerse in previous posts. The drug is intended to reverse the effects of local anesthesia quickly so that patients promptly regain feeling in areas made numb during dental procedures. On February 26th, xconomy San Diego published an article that tells us the FDA is not pleased with a marketing brochure published by Novalar. The FDA instructed Novalar, maker of OraVerse, to amend the drug brochure. Read the letter here. The FDA claims that the brochure minimizes and omits risks and overstates benefits of OraVerse. Issues such as pain at the injection site, headache, and pain following a dental procedure are not mentioned in the brochure. In addition, the brochure states that OraVerse can be administered to children as young as four years old, while it is actually c...

When Antidepressants Fail to Work: Brain-Stimulating Techniques

World of Psychology — Sat, 05 Dec 2009 12:32:41 +0100

Let’s talk about the huge elephant in the living room of most homes of people who suffer from depression: the fear of treatment resistant depression. What if antidepressant medications fail to work? Are you totally screwed? Confined to a life flipping burgers, not that anything is wrong with that? U.S. News and World Report ran an intriguing article last month, “Chronically Depressed? What to Do When Antidepressants Don’t Work.” Reporter Sarah Baldauf discussed several brain stimulating techniques available to help people with treatment-resistant depression and mood disorders. She first presents the problem we face today: Some 27 million Americans were taking an antidepressant in 2005, more than twice the number almost 10 years earlier, thanks largely to the arrival...

Renova Caries Softens Decay = No Dental Drilling or Shots

dental blog for dentists about dentistry — Tue, 03 Nov 2009 14:44:41 +0100

A small article posted at www.livinginperu.com on October 31st, 2009 tells us about a new product, Renova Caries, that can soften tooth decay so that it can be removed without a drill, and thus, without administering anesthesia to the patient. The product is a gel created from the Papaya arequipena fruit, scientifically known as Carica pubescens. Renova Caries was presented at Catholic University of Santa Maria in Arequipa by the Interdisciplinary Center for Research and Innovation. Dr. Zaida Moya led the research team. Paypaya contains an enzyme that has bactericidal and anti-inflammatory influence, and this causes caries degradation. Up to 20 applications are possible with the product, which costs 36 nuevos in Peru. (Source: dental blog for dentists about dentistry)

Pediatric Dental Residents and Faculty

Bibby Library News and Tips — Fri, 14 Aug 2009 20:06:15 +0100

The American Academy of Pediatric Dentistry has updated the following policies and guidelines: Vending Machines in School Use of Dental Bleaching for Child and Adolescent Patients Infection Control Infant Oral Health Care Periodicity of Examination,Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Children Fluoride Therapy Use of Local Anesthesia for Pediatric Dental Patients Use of Nitrous Oxide for Pediatric Dental [...] (Source: Bibby Library News and Tips)

Diprivan (propofol) and Michael Jackson

Dr. Z's Medical Report — Thu, 09 Jul 2009 16:48:47 +0100

Although Diprivan is widely used every day in hospitals and surgery centers across the United States, very few people, outside of medical personnel, were familiar with it or had even heard of it prior to its being found in Michael Jackson’s home after his untimely death. And while we still don’t yet know if it was related in any way to his death, many people want to know more about Diprivan and what its potential effects might have been. I worked for ICI, now Astra Zeneca, the pharmaceutical company that originally developed Diprivan, in the mid-80s during the time it was being prepared for market launch. I was part of the team helping to train the sales people who would later be selling the product. But Diprivan was unlike any product previously sold by these representatives b...

Reducing Anesthesia Nausea

A Hearty Life — Wed, 24 Jun 2009 11:15:47 +0100

Undergoing surgery is difficult enough, between worrying about the actual procedure, worrying about what the surgeon may find or do, and of course, worrying about pain after the surgery. And, for many people (up to 80%), comes worry about being nauseous and vomiting after surgery. This nausea and vomiting doesn’t affect everyone, but it’s not an unusual complication after surgery and it’s due to the anesthetic. Acupressure, similar to acupuncture but using pressure points instead of needles, has been found to be successful in helping many people relieve pain and other discomforts, so researchers wanted to see if they (acupressure and acupuncture) could help relieve the nausea and vomiting. According to an article from Health Behavior News Service, Wrist Acupuncture or Acu...

Urgent Medicare Question from a Reader

Alzheimer's Reading Room, The — Tue, 16 Jun 2009 18:06:52 +0100

An 82 year old dementia patient who I assist with medical bills is going into the hospital (as opposed to Dentist's office) for oral surgery to extract multiple teeth. Because of her dementia, general anesthesia is required.However, Medicare apparently doesn't cover the cost for the hospital/anesthesia despite that the underlying condition.Dementia is the reason it is required for these extractions. The cost is over $10,000 for the hospital room and anesthesiologist at NYU MedicalCenter. The dentist's office manager has been trying to get them to reconsidercovering the cost but no success as yet.Anyone out there have a similiar situation, and if so, any suggestions / tacticsyou recommend?Thanks in advance for you help. (Source: Alzheimer's Reading Room, The)

Patients Overcome Control Issues, Dental Fear with The Dental Button

dental blog for dentists about dentistry — Mon, 15 Jun 2009 16:29:22 +0100

Comfort, trust, performance. That’s the tagline on www.TheDentalButton.com. The little hand-held device is similar to the buttons game show contestants hold to buzz in with an answer. But The Dental Button stops the drill. If statistics aren’t too stilted, about half of the population avoids dental visits because of fear. Of those, some unknown number experience fear because of control issues. As for the 50% who visit the dentist regularly, 85% suffer from anxiety in the dental chair. The Dental Button is intended to put control into the patients’ hands – literally. At the push of a button, a patient can stop your drill. In a yearlong trial, The Dental Button was shown to reduce patient anxiety by 50-80%. Also, during the trial, 90% of the patients who used The Dental Button told t...

weekend call

i'm so sleepy — Sat, 13 Jun 2009 16:37:00 +0100

Saturday cardiac call... doing an abdominal case for the cardiac service and an abdominal case for the thoracic service... weird. (Source: i'm so sleepy)

Gall bladder

i'm so sleepy — Sun, 10 May 2009 11:16:00 +0100

I was doing non-cardiac cases the other day... thought I might have a straight forward day for the first time in a while. Things seemed in order looking at the patient's history for a cholecystectomy (Gall bladder removal). I said hi to the patient asked a few questions and then moved along to see my other patient that morning.The resident came up to me a few minutes later and told me there was an "issue". The history has looked unremarkable and was wondering what I had missed.Apparently the patient wanted to take her gallbladder home with her as was getting visibly upset when the surgery resident told her that wasn't the usual procedure.Now I'm wondering why someone would want to take a nasty old gallbladder home...yuk.I think the gallbladder usually gets sent to pathology after these sur...

OraVerse Local Anesthesia Reversal Agent

dental blog for dentists about dentistry — Mon, 20 Apr 2009 14:02:54 +0100

DentalBlogs has covered OraVerse in the past, but now we bring you a visual explanation. We met Rick Orneals from Novalar Pharmaceuticals at Star of the South Meeting on April 18th. He’ll tell you just how amazing OraVerse is. Your patients will LOVE this product. < --> (Source: dental blog for dentists about dentistry)

Is My Suboxone Dose Too High to Have Surgery?

Suboxone Talk Zone — Mon, 13 Apr 2009 04:27:30 +0100

Thanks, all of you who wrote comments to my last post. I remind everyone once again to consider taking your comments here and after writing them, also taking them to SuboxForum.com. I am going to put up a new category to discuss topics that were initiated here; it would be great to get a spirited, respectful ‘give and take’ on some of these topics. As I have mentioned before, the only thing that I will block on that site would be debating whether people on Suboxone are ‘in Recovery’– just because there are plenty of other sites for that, and I want the forum to be for people who have made their decision– and don’t want to be harassed over it. I will be upgrading that site shortly and changing the hosting account; hopefully I will pull i...

Biolase Featured on The Doctors TV Show

dental blog for dentists about dentistry — Wed, 25 Mar 2009 14:29:16 +0100

The Doctors is a television show that features real doctors performing real procedures on real people. A panel of four “renowned” medical specialists discuss medicine in easy-to-understand and up-front discusccions. Today, in front of a live audience, cavity preparation on a very outgoing 9-year old pateint will be performed by Dr. Christina Do (Costa Mesa, CA) with a Waterlase. Want to see it? We don’t have a sneak preview, except for the promo on The Doctors website. Check the site for your local listing. For now, you may find this Biolase promo video humorous. Learn more about Biolase at www.biolase.com. SOURCE: Fox Business (Source: dental blog for dentists about dentistry)

Drug Testing, Prescribed Opiates, and Employment

Suboxone Talk Zone — Sun, 15 Feb 2009 01:11:10 +0100

Im in a methadone maintenance program and am currently at 130 and I have pre-employment drug screen coming up in about a month. I wanted to see how low I could get off the methandone and switch to suboxone. if it is not detectable in a drug screen. Also, I have a prescription for methadone can they not hire me because a Dr, prescribes methadone.? Any thoughts, ideas? My thoughts: There are laws that prevent a person from being fired because of certain illnesses or disabilities, but those laws are complicated. Drug addiction is a ‘protected disability’, so theoretically you cannot be fired for being a RECOVERING drug addict. On the other hand, you can be fired you for any other reason, or for no reason at all! So except for the occasional boss who is a total idiot who says ̵...

Busy morning

i'm so sleepy — Wed, 04 Feb 2009 23:45:00 +0100

It's a busy morning for me... I've got two cases to start... one of them is a Left Ventricular Assist Device (LVAD) in a really sick patient with bad heart failure.She's in the intensive care unit and will be a transport to the OR. I'm there a few minutes early (as I try to do, but don't always succeed) I meet my resident in the ICU and he tells me the case is on hold."Why?" I ask.Apparently there are two LVADs scheduled for that day, which is pretty rare. They do have two sets of surgical instruments, but there's a particular wrench which they use to tighten certain components of the device. They only have one of those wrenches. They don't want to start the case unless they make sure they have everything they need for the surgery. Of course the OTHER room has already started.I'm more than...

are you busy?

i'm so sleepy — Sat, 31 Jan 2009 12:45:00 +0100

I'm standing the preop area in the morning talking to some of the residents before cases get started for the day. One of the preop nurses comes over... "Are you busy?" Fateful last words "Are you covering the recovery room?"No cases have come out into recovery room yet, "I'm not covering, but you need help with something?""Can you come over and look at one of our perioperative techs? She's having some chest pain? We're going to hook her up to the monitors... could you look at her EKG?"They bring her over to a recovery slot, hook her up to monitors, everything looks okay, vital signs stable.... I take one of the residents over with me... we start getting some history.Family history of vascular disease... pain started this morning while she was moving things around in the OR... yes I've had ...

Opiates as the Other Man

Suboxone Talk Zone — Fri, 30 Jan 2009 03:15:02 +0100

This gentleman answered my post about the limits of will power. I feel for him– I moved his post up here because it describes what happens when one partner falls in love with narcotics. As I read the post, about his wife slowly checking out with opiates and then with benzos… addiction makes a person fade away, lost in hazy fog… I had this image of his wife cheating on him, telling him lies about it being over…but going back again to the other man without even having the decency to go to a motel. Will Power. I’m a person with strong will power, but my wife is not. My will has no power to get her help. Twenty years after 3 spinal fusions, she is now a daily methadone user (which I just found out 8 months ago?) for the past six years, to get off Oxycontin for ch...

Having Surgery: When to Stop Suboxone?

Suboxone Talk Zone — Sun, 25 Jan 2009 05:21:00 +0100

A question about Suboxone and Surgery: Hi-this is in reply to your message back to me. I am the girl who is soon to have surgery. You said that 3 days would be good to be off the suboxone, but you said the worst withdrawal takes about 3 days to hit, so it’s a bit of a compromise. But, won’t the withdrawal be halted once the pain medication gets into my body? Are you just saying that I will have to deal with some detox discomfort during the 3 day period? I, unlike many people, know quite a bit about suboxone (it is so surprising how many people are clueless), but the one thing I am not clear on is how long it would take to “feel” opiates after stopping suboxone (thank God I am ignorrant in this area!). On one of your blogs you said that opiates would work as short as...

iAnesthesia

The Palmdoc Chronicles — Fri, 23 Jan 2009 05:00:00 +0100

is an iPhone application which aids Anesthetists track their case logs. With iAnesthesia: Case Logs, you can use your iPhone or iPod Touch to: • Record a new anesthesia case log on the fly, even if you don’t have a wireless connection (your iPhone will sync data to the CaseLogs server once it regains connectivity). • Browse your Case Log History to quickly find a patient record and open the entry for easy editing (your anesthesia records are organized chronologically). • Review totals on your iPhone to identify how many Arterial Lines, Fiberoptic Intubations, Trauma case, etc. you have performed. • Work with a wide range of predefined data entry fields covering the most important information that anesthesia providers need to capture for every procedure. • Custom...

Nitrous Oxide Plus Relaxation Coaching

dental blog for dentists about dentistry — Fri, 09 Jan 2009 18:32:08 +0100

An InnovationsReport post says that one study shows patients under nitrous oxide may experience enhanced effects if hypnosis or relaxation coaching is performed. This is good news for dental phobic patients who do not want oral sedation or IV sedation. Thirty people were administered nitrous oxide and given a series of imagination tests. THe tests showed that oxide improved imagination by about 10%. Because imagination is closely related to hypnotic suggestibility, the study could lead to more research on the topic. Many dentists overseas and some in the US currently employ a relaxation coach or hypnotherapist for patients, upon request. Read the full article here. (Source: dental blog for dentists about dentistry)

Surgery Preparations for a Suboxone Patient

Suboxone Talk Zone — Mon, 05 Jan 2009 05:36:44 +0100

The questions: I am having surgery and my doc was unaware of some things and I thought that you could confirm them for him? Could you advise him to take me off the Suboxone 10-14 days prior to surgery? I have been researching this religously and I have come to the conclusion that it would take 2 weeks to get the Bupenepherine 100% out of my system so that there is no blockage, unless you think otherwise? Also could you tell him about the oxycodone to keep me out of withdrawal and to help me cope with the pain? Note: I had also received a note from the doctor, saying that he was going to change the patient from Suboxone to Subutex before the surgery, and then back again at a later point. This is fine, but not enough– the naloxone isn’t the problem– the buprenorphi...

A picture worth a thousand words… V

AEQUANIMITAS — Tue, 30 Dec 2008 07:02:31 +0100

Hopefully none of us will need to use this technique anytime soon!… Fig. 13-12. AN IMPROVISED LARYNGOSCOPE (kindly contributed by Peter Bewes) from King M, et al (1986). Primary Anaesthesia. Oxford Medical Publications. If the light on the laryngoscope fails, clean the contact between the blade and the handle, and check that the bulb is screwed in place securely. If this fails, use your spare laryngoscope, which you should have instantly available. Or, transilluminate his pharynx by shining an electric light through his neck as in Fig 13-12. If you don’t have a laryngoscope you can use a bent spoon. - from King M, et al (1986). Primary Anaesthesia. Oxford Medical Publications. (Source: AEQUANIMITAS)

consent

i'm so sleepy — Sat, 20 Dec 2008 13:42:00 +0100

All surgical procedures must have a consent form signed by the patient before we go back to the OR. Most of the time this is done in clinic before surgery. The doctors describe the risks of the procedure, and weigh them against the benefits. (Sometimes glossing over the risks, in my opinion, but that's a different discussion) With some surgical services this is done the morning of the procedure before they go to the OR. (Usually with the more straight-forward procedures). To assure that we don't miss this there are brightly colored signs at the patient bedside that scream "NO CONSENT"I walk up to the patient and there are these NO CONSENT signs everywhere, so I start flipping through the paperwork after I introduce myself. I see a signed consent form..,I'm surprised a bit, because the surg...

New Study For Schering-Plough Anesthesia Drug

Pharmalot — Wed, 03 Dec 2008 11:58:18 +0100

This likely does not come as a surprise, given that FDA staff reviewers raised concerns about allergic reactions last spring (back story) and the agency subsequently issued a ‘not approvable’ letter this past summer (back story). Additional trials were expected and this has now been confirmed. In a posting on its web site late yesterday, Schering-Plough wrote that “in order to address issues which primarily related to hypersensitivity/allergic reactions, the company plans to conduct an allergy sensitivity trial in healthy volunteers that will include repeat exposure to sugammadex. The study protocol is being developed, and the company anticipates conducting the trial in 2009.” There was no info, though, on exactly when the trial should be completed and, if successfu...

Fentanyl patch for post-op pain, on Suboxone?

Suboxone Talk Zone — Wed, 03 Dec 2008 05:16:03 +0100

I’m in a bad mood tonight– squabbling with my 13-y-o daughter will do that to me– so I’m going to cheat and copy an e-mail that I recently sent to a reader. She takes Suboxone and will be having surgery; she did everything correctly, tapering her dose and then stopping the Suboxone for a few days before surgery. Ideally her addiction doc or her surgeon would prescribe her a large dose of oxycodone to treat the post-op pain, but instead she was told that she is already treated for pain from being on the Suboxone, so she doesn’t need anything more. After her appropriate objection, he told her that he would recommend that the surgeon prescribe– of all things– fentanyl patches. Never mind that fentanyl patches have a ‘Black Box Warning&...

Pain Control After Surgery for Patients On Suboxone

Suboxone Talk Zone — Fri, 28 Nov 2008 19:22:16 +0100

The topic of post-op pain control on buprenorphine is important enough to get top billing Many thanks to Dr. J Walsh in Seattle for the following post: I am a physician in Seattle. In two c-section cases we have found that high affinity opiates (fentanyl or hydromorphone) delivered by PCA can provide adequate anesthesia even while sublingual buprenorphine is continued. To clarify, patients taking Suboxone, Subutex, or any other form of buprenorphine face a problem when they need pain control, particularly if the need is acute– after injury or surgery. Buprenorphine is a ‘partial agonist’ at the mu opiate receptor; it has a ‘ceiling’ to its effects, so that increases in dose of buprenorphine will not provide increased analgesia. This is great for addic...

Thanksgiving and Suboxone… Is My Surgeon A Turkey?

Suboxone Talk Zone — Tue, 25 Nov 2008 00:10:34 +0100

Thanks to Mike for this question: I’m having surgery the day before Thanksgiving.I take 24-32mg a day for the past year,and I’m a little worried about surgery.I told my surgeon I take suboxone and I’m a recovering addict,and I don’t take pain medication. But he told me he will treat me as a normal patient,and with that percribed me 60 percocets. I went to my pharmacist and talked to her about it,she called the doctor and he called me back to his ofice, I told him I was concerned about the 60 percocets he gave me,his reponse was again “I’m going to treat you as a normal patient” what ever that means? Anyway I did’nt fill original perscription,so he gave me a new one, 40 percocets,hmmmm. Anyway NO one in my family know’s I take suboxone,and they also don’t think I have a ...

platelet shortage

i'm so sleepy — Mon, 24 Nov 2008 20:19:00 +0100

Interesting email this week:This is a reminder that Thanksgiving is next week. We anticipate severe platelet shortages for the first week of December. Platelet availability will be VERY tight December 1-4. Monday and Tuesday will be the worst days since there will be virtually no blood donations Thursday-Sunday. If you have elective surgeries with high anticipated platelet needs, I would recommend rescheduling for the following week. I guess I never thought of that, but it makes sense.Platelet availability is dependent on recent (last 4-5 day) platelet donations. The week immediately after Thanksgiving and the Christmas-New Year holidays are always characterized by platelet shortages due to low whole blood donations in the preceding week. (Source: i'm so sleepy)

Dental Anesthesia Reversal Drug

dental blog for dentists about dentistry — Fri, 14 Nov 2008 15:28:19 +0100

This February at the Chicago Dental Society Midwinter Meeting, Novalar will introduce a drug that reverses the effects of dental anesthesia injections. OraVerse will come in prepackaged inserts for syringes, and it will cost about $12.50 per injection. Patients who dislike the lingering numbness caused by anesthesia will enjoy prompt reversal of the sensation, up to 80 minutes faster than without OraVerse. While the medication was approved by the FDA in May 2008, packaging concerns prevented Novalar from introducing OraVerse at the San Antonio ADA conference in October 2008. How will OraVerse do in the market? Surveys show a strong interest in the drug, and about 30% of responding dentists say they’ll offer OraVerse. Novalar doesn’t expect insurance to cover the medication, bu...

morning surprise

i'm so sleepy — Mon, 10 Nov 2008 15:18:00 +0100

You think you're going to have a relatively quiet day... 2 thoracic rooms, only 2 casesone room is a late start, so no having to try to start two rooms at the same time.Come in... pull up the computer to double check the patient's histories...Hmmm... double lung transplant.*sigh* it's a living (Source: i'm so sleepy)

Anesthesia and Suboxone, revisited…

Suboxone Talk Zone — Thu, 30 Oct 2008 04:27:25 +0100

Important enough to move to the front page: HELP!!!!! I’m so confused. I am having surgery on Friday and have been told to stop suboxone(8mg twice a day) 24hrs prior. I’ve taken it for a little over 2 years and it has really changed my life-for the good. Now I’m scared after reading everything. I do not want it to interfere with anesthesia. Post op I had planned to go back on suboxone. The surgeon is implanting a pump that delivers xylocaine directly to the site of the surgery so I feel certain that will be a tremendous help I just don’t want to “wake up”while under general anesthesia(I’ve heard horror stories about that happening). Someone please reply ASAP now I can’t sleep! Thanks so much for reading this Carrie Reply: Carrie, don’t worry. I am a Board Certified An...

STA™ Anesthesia Delivery System for Dentists

dental blog for dentists about dentistry — Thu, 25 Sep 2008 14:28:09 +0100

Computer controlled local anesthetic delivery has been around for a while now. The CompuDent STA™ System, which stands for Single-Tooth Anesthesia, by Milestone Scientific, is supposed to increase patient comfort, precise injections, and an overall better local anesthesia delivery process for doctor and patient. STA uses a tiny needle to make one tooth numb, so patients don’t have to deal with a numb nose, cheeks, lips, or tongue. Anesthesia is delivered consistently by a regulated pressure system. STA is good for children’s dentistry, endodontics, cosmetic work, and general dentistry applications. Visit www.stais4u.com to download a diagram, watch videos, read testimonials, and learn more about the STA System and Milestone Scientific. STA has also been featured on CBS, and ...

Heart Monitor Required for Dentistry in Maine

dental blog for dentists about dentistry — Mon, 08 Sep 2008 13:25:12 +0100

The Maine State Board of Dental Examiners has proposed legislation that will require dentists to use a heart monitor on any patient undergoing “moderate sedation.” This would include nitrous oxide, IV sedation, and anxiolysis. The new law comes at the same time as other changes recommended by the ADA. However, it is not part of ADA recommendations. The Maine Academy of General Dentistry does not back the law. Required heart monitoring will cause dental costs to rise, and it may also discourage fearful patients from visiting the dentist. Furthermore, there is talk that the regulation will discourage dentists from catering to fearful patients. The Maine Dental Board is open to hearing public opinion on the matter. A vote will take place Friday, September 12th. SOURCE: http://www....

Fall Lecture Series

Nurse Anesthetist — Sun, 07 Sep 2008 03:29:52 +0100

The Fall is here and a new class start their didactic schedule. This season is a break for the clinical faculty here at the USC program of anesthesia. The senior students are for the most part off doing advanced rotations such as cardiac or neuro surgery with Staff Anesthesiology in attendance for teaching and patient supervision. The CRNA faculty is concentrating on lectures and rest from a long 8 months of OR teaching. Of course we get to now do our own anesthesia cases which is really SWEET! This year I have been really privileged to participate in the recent graduation of our 2008 class here at USC. The slide show that was put on by JR included many of the pictures that I took over the past two years of this SRNA group. They were great to work with and I am sorry that they ...

ACCUPAL® for Comfortable Injections

dental blog for dentists about dentistry — Thu, 14 Aug 2008 13:02:48 +0100

The patent-pending ACCUPAL® Comfortable Palatal Injection System is now FDA registered and ready to ship anywhere in the United States. Specifically, ACCUPAL is a cordless, compact, handheld device invented by a practicing dentist that effectively pre-conditions the oral tissue to receive virtually pain-free palatal or other intraoral dental injections that were previously unobtainable via manual injections or through the use of other devices. This hand-held anesthesia delivery technology was invented by a “main street” dentist and is about the size of a power toothbrush. It costs less than $500. Some great demo and testimonial videos on www.accupal.com. SOURCE: ACCUPAL Full Text Press Release (Source: dental blog for dentists about dentistry)

Gah!

i'm so sleepy — Sun, 10 Aug 2008 19:19:00 +0100

Don't want to talk about the exact incident.When I supervise residents or CRNAs I am responsible for their actions......regardless of whether or not I am aware of them.The case was managed correctly.I didn't know about significant blood loss until I was informed by another anesthesia provider.Wouldn't have done anything different, would have liked to know about it. (Source: i'm so sleepy)

Anesthesia Delivery in Liposomes is Less Painful, Longer Lasting

dental blog for dentists about dentistry — Wed, 06 Aug 2008 13:01:52 +0100

Liposomes are little spheres made from the same material as cell membranes. The medical field uses liposomes to administer medication and drugs. At the International Association for Dental Research Meeting in July, a report was released from the Institute of Biology at State University of Campinas in Brazil that says anesthesia delivered in liposomes is less painful and lasts longer than traditional means of administration. It also has a better acceptance into the body’s circulation, less toxicity, and an increased half-life, according to Dr. Giovana Tofoli. The study showed that when encapsulated mepivacaine (an anesthesia) was injected into rats, oral mucosa did not become as inflamed as it did with another traditionally administered drug that is similar to mepivacaine. Why aren&#...

Highmark/Blue Shield Criticism

Waking Up Costs — Sat, 02 Aug 2008 14:55:48 +0100

Heard in our household this morning: "They [Highmark Blue Shield] send there bills out in two seconds and their payments in two years." It makes me wonder if all their clerical errors which delay payments to providers are a strategy rather than a mistake... (Source: Waking Up Costs)

O.R. Nurse

Tubal Reversal Blog — Fri, 27 Jun 2008 10:36:24 +0100

Sally Muncy, RN is an Operating Room Nurse at Chapel Hill Tubal Reversal Center who assists patients throughout their tubal reversal procedures. She explains the responsibilities and functions of the Operating Room Nurse in this blog topic. (Source: Tubal Reversal Blog)

Time Out Day

i'm so sleepy — Wed, 18 Jun 2008 12:15:00 +0100

Image taken without permission from Benches.comApparently it's National Time Out Day...No we don't have a bunch of rowdy 6-year-olds in the hospital (though it seems that way sometimes)It's a partnership of the Council on Surgical and Perioperative Saftey and the Joint Commision, and other organizations such as the American Society of Anesthesiologists and the Association of periOperative Registered Nurses, among other groups to improve safety in the operating rooms and prevent wrong site and wrong side surgery. (There have been several tragic cases of the wrong limb being amputated... etc. gah!)For some reason National Time Out Day was June 25th in 2004, June 22 in 2005, June 21 in 2006 and June 20 in 2007. Really it's National Time Out Day-somewhere-in-middle-to-end-of-June. Guess you co...

Anesthesia for Your Tubal Reversal Procedure

Tubal Reversal Blog — Tue, 17 Jun 2008 11:17:34 +0100

At Chapel Hill Tubal Reversal Center, we use general anesthesia for our tubal reversal surgeries. You will be completely asleep thorough your operation. When under general anesthesia you will be totally unconscious and will not be able to feel any pain. In addition to the general anesthetic, your tubal reversal surgeon will place local anesthetic into the skin and deeper structures that are operated upon to help you be as comfortable as possible when you wake up. (Source: Tubal Reversal Blog)

Do You Have The Fire In The Belly?

Nurse Anesthetist — Thu, 22 May 2008 03:51:36 +0100

Today I will submit two letters that I have received in this last month. The subject of “desire” has come up frequently in those that have written and has caught fire as it were. The idea that a candidate must have a certain, “Fire in the belly” as coined by Wyne Wagaman, really seems to have ignited a response in those that have written to me recently. Here is a good example: Dear David, As I was eagerly reading your blog I could feel my pulse furiously pounding in my neck…. right before I read the part that said “If you just take a self-check now and measure your pulse you will know.” ….and then I knew I wasn’t crazy, I just have a burning desire for the field.I will begin my BSN studies at Goldfarb School of Nursing at Barnes-Jewish...

Do You Have The "Fire In The Belly?"

Nurse Anesthetist — Thu, 22 May 2008 03:51:36 +0100

Dental Anesthesia Reversal Drug

dental blog for dentists about dentistry — Mon, 12 May 2008 13:18:57 +0100

The FDA approved OraVerse, a dental anesthesia reversal drug created by Novalar in San Diego. OraVerse reduces numbing time by 85 fewer minutes in trials, and about 40% regained sensation in about an hour after receiving the drug. Not only can patients return to work and daily activities with a little more self-confidence, but dentists can perform procedures on both sides of a mouth in one visit. If you’re interested in placing an order, you’ll have to wait until the October ADA Conference in San Diego. SOURCE: SignOnSandiego.com (Source: dental blog for dentists about dentistry)

Easy Recovery After Tubal Reversal Surgery

Tubal Reversal Blog — Mon, 05 May 2008 23:10:40 +0100

There is no better place for women to have tubal reversal surgery than at Chapel Hill Tubal Reversal Center. Our anesthesia staff goes to extra lengths to ensure the patient’s safety, comfort, and sense of well-being during and after the tubal reversal procedure. (Source: Tubal Reversal Blog)

Epidural testing

i'm so sleepy — Sat, 03 May 2008 10:06:00 +0100

I put in a thoracic epidural with a resident yesterday. Epidurals are small catheters that go into the space right outside the spinal cord. We give local anesthetic solution through them and it numbs up portions of the body. They are useful for controlling surgical and labor pain. We test them to make sure they are working well. One way is to use a piece of ice and see if the patient can feel the coolness. The other is to use a "sophisticated testing device" called a toothpick to see if they can feel pain sensation.We finished putting in the epidural and I asked the resident to test the patient. She was testing areas and the patient was amazed that she could not feel the toothpick at all..."Give me that..." she grabbed the toothpick and started jabbing herself in the side. "Wow" Somehow sh...

Meet Dr. Caryn Hertz

Tubal Reversal Blog — Tue, 22 Apr 2008 22:47:24 +0100

At Chapel Hill Tubal Reversal Center, the close coordination between the surgical and anesthesia teams makes tubal reversal surgery the safest and most comfortable surgery that is possible. Performing 4 tubal reversal operations together every day, 5 days a week, is unique in the medical field and is one of the factors that makes the tubal reversal experience at Chapel Hill truly exceptional. Dr. Caryn Hertz, Director of Anesthesia says, “I am dedicated to making each patient’s surgery comfortable and safe. Working regularly with Dr. Berger has enabled me to truly optimize and continually improve the Tubal Ligation Reversal experience for our patients.” (Source: Tubal Reversal Blog)

Student Nurses Visit the OR

Nurse Anesthetist — Sun, 06 Apr 2008 23:38:06 +0100

Last Friday we were privileged to have several student nurses visit us from the California State University at Long Beach. Friday’s is our conference day with a late start in the operating rooms. This week’s presentation featured a couple of Residents presenting poster boards in preparation for their showing in a couple of weeks before a state assembly. Following the morning conference it was back to the Operating Rooms for the days cases. The student nurses followed a couple of the CRNA’s until noon and were able to get a glimpse into what we do on a daily basis. For the students it was a good exposure to Nurse Anesthesia practice. This morning I received a note from two of them that I would like to pass along. I have slightly modified the letter to correct a couple of s...

Anesthesia For Outpatient Tubal Reversal Surgery

Tubal Reversal Blog — Fri, 28 Mar 2008 23:02:43 +0100

There have been many milestones in outpatient anesthesia since its inception. Imagine what the first patient was thinking when told he or she would be going home the same day after the administration of a general anesthetic! These milestones include vast improvements in patient monitoring, shorter acting anesthetics, and improved surgical techniques. Anesthesia at Chapel Hill [...] (Source: Tubal Reversal Blog)

Helicopter

i'm so sleepy — Wed, 05 Mar 2008 16:20:00 +0100

I hear helicopters in the background. Not so long ago, as a child, I often looked up in excitement at the incredible speed, power and agility of such magnificent machines. Now more often than not (even when I'm not at work) I hear that engine noise and I think... work (Source: i'm so sleepy)

soaked to the skin II

i'm so sleepy — Mon, 18 Feb 2008 22:54:00 +0100

anyway, sorry for the delay.. where was I...So they're doing CPR on the patient. I went up to the anesthesiologist and asked what was going on. Apparently they were doing an ablation in the ventricle and they had starting getting low blood pressure during the case, then a cardiac arrest.Now you see some people have irregular rhythms in their hearts. Usually these are cause for little areas of abnormal tissue in the heart, they can burn these areas and usually the irregular rhythms will go away. This is called an ablation. Sometimes they burn through too much and they can get into trouble. It's known to happen, but usually rare.The problem they have here is now they have a hole in the heart and it starts to bleed. That in and of itself isn't great, but the main problem is that the heart sit...

soaked the skin

i'm so sleepy — Thu, 07 Feb 2008 23:41:00 +0100

As an anesthesiologist you shouldn't need to go to your office and change your scrubs in the middle of a case.No I didn't soil myself because the case scared the heck out of me because it did, but I was covered in blood from moving the patient on to the bed.I'm on call today and I was headed down to the Electropysiology (EP) lab to relieve the anesthesiologist down there so he could go home. I'm poking around looking to find out which room he's in. I pop my head in one room, I see a CRNA... have you seen Dr. X? Oh he was just here but he's probably next door... they're having trouble.Hmm... that's not a good sign. I go into the room and usually the room is dark and quiet, the patient is on the bed under light sedation... they're usually pretty sick, but generally unexciting. Anyway... I go...

Stat!

i'm so sleepy — Tue, 29 Jan 2008 15:40:00 +0100

"Staff Stat to OR Z"Hmm.... not good. usually.This is an alarm system we have so if there's anesthesia emergency and the staff is not in the room, the resident or a nurse can call overhead on the speakers and everyone available can come to the room to help whomever is in there.Sometimes it's only a false alarm, the patient's oxygen level is reading a little low and the resident gets a little worried.Sometimes it's much worse."Staff stat to OR Z"I shuffle quickly over there.I walk in, they are doing chest compressions. Apparently the patient "crashed" about 10 minutes after the start of the case.... low blood pressure of uncertain origin, didn't improve with treatment at all so they started CPR (Cardio Pulmonary Rescusitation). Emergency drugs were given.... epinephrine, atropine, all the g...

Diagnostic Laparoscopy Before Tubal Reversal: A Recap

Tubal Reversal Blog — Sun, 13 Jan 2008 00:35:22 +0100

Why Some Patients Choose To Have Screening Laparoscopy Tubal ligation procedures vary in the severity of injury occurring to the fallopian tubes. Although most tubal ligations are reversible, there are some cases where tubal reversal is not possible. If the operative report from your tubal ligation indicates there may be a problem in repairing the [...] (Source: Tubal Reversal Blog)

Sick

i'm so sleepy — Mon, 10 Dec 2007 03:27:00 +0100

It's that time of year again. Time for flu, colds, etc.I was in charge of making sure rooms in our building were assigned to residents and faculty the other day. This includes assigning where add on cases go and making sure people get breaks and lunches and relieved at the end of the day.One of the residents came up to me and told me he might need extra breaks because he's been having some "GI (gastrointestinal) problems" and been running to the bathroom. He said he was probably going to the emergency room after work because it had been going on for five days or so.Yikes! A few minutes later his faculty came up to me and said his resident looked terrible and diaphoretic (sweaty) and should be sent home. I agreed and called over to the main building to see if there was someone extra to send...

Anesthesia at Chapel Hill Tubal Reversal Center

Tubal Reversal Blog — Wed, 05 Dec 2007 22:55:52 +0100

Chapel Hill Tubal Reversal Center Anesthesia Team The Anesthesia Team at Chapel Hill Tubal Reversal Center ensures your comfort before, during, and after your tubal reversal procedure. We are Caryn Hertz, MD, Pamella Mills, CRNA, and Ann Pflugrath, MD. Our team consists of two board certified anesthesiologists and a registered nurse anesthetist specializing in outpatient anesthesia. [...] (Source: Tubal Reversal Blog)

Shock of your life

i'm so sleepy — Fri, 23 Nov 2007 15:45:00 +0100

Image used without permission from freepatentsonline.comI'm staffing a case down in the Electophysiology (EP) lab. Here is where the cardiologists look at the heart from the inside and do various procedures to help fix conduction abnormalities in the heart. They implant defibrillators and pacemakers in the EP labs. There was a young man on the table, we were getting ready to sedate him for a procedure for an irregular heartbeat. Our anesthesia monitors were being put on and I was looking at the chart. All of a sudden I saw the patient jump up... I thought he was trying to crawl off the bed. Then someone started apologizing....Apparently she was testing the external defibrillator. This is the device used to put a shock through a patient's chest to put it his/her heart back into a regular rh...

Neck mobility

i'm so sleepy — Fri, 12 Oct 2007 13:50:00 +0100

I was in preop anesthesia clinic yesterday. I saw a patient that had been in a car accident and had his neck fused c2-c5 (I believe) and he had very little neck movement at all.In anesthesia there are markers to predict or at least suggest it may be difficult to place a breathing tube in someone. These include mouth opening, dentition, mallampatti score, which assesses the favorablity of the anatomy of the oral cavity (i.e. mouth), hyoid to mentum distance (essentially chin size), neck thickness/anatomy, neck extension and flexion. No one predictor predicts a difficult intubation, but together they form a picture of how easy or difficult you think it might be.Someone with very limited neck movement would be very difficult to visualize the vocal cords generally, so I was worried a bit in th...

Perioperative Guidelines

i'm so sleepy — Thu, 11 Oct 2007 13:42:00 +0100

Got sent the new ACC/AHA revised perioperative cardiovascular guidelines for non-cardiac surgery. It was a PDF attached to my email, and I figured I should know what's in them since I work in the preop anesthesia clinic, so I printed them out...what could it be... ten pages maybe...nope.I went to the printer and it was still printing and it was neverending.82 pages!Yikes... I know it's a complex topic, and I need to know them. 6 pages down... 76 more to read... i think some of them are references though... maybe only 70 pages... (Source: i'm so sleepy)

Chili Peppers as an Anesthetic?

PharmaGazette — Thu, 04 Oct 2007 17:05:37 +0100

Researchers have found that adding capsaicin to a lidocaine derivative called QX-314 it had the ability to enter nerve cells but only the pain-sensing nocieptors.So what is capsaicin? Simple, it's the potent ingredient in chili peppers. Seems QX-134 doesn't have the ability to get through the nerve cells and that's where the chili pepper come in. Pain sensing neurons have the TRPV1 receptor which only opens when stimulated by excessive heat or a spicy compound.So far this combination has only been tested on lab rats so more work has to be done to establish if it will work on humans. If so then a "cocktail" of anesthetic and capsaicin will have to be developed to mitigate the painful effects of the capsaicin."Eventually this method could completely trans...

Hand Sanitizer

i'm so sleepy — Wed, 03 Oct 2007 13:28:00 +0100

Image used without permission from childrenshospital.orgJust got a message on my pager.I accidentally contaminated the sterile field with [brand deleted hand sanitizer] ( that went out of control) --[resident name deleted] Our hospital has gone to having alcohol based hand sanitizer everywhere, to decrease the spread of infection... there's one on the side of the anesthesia cart. Apparently, the spout had gotten clogged a bit and when she went to pump some on her hands it squirted sideways and hit two people scrubbed-in and the corner of the instrument table... and we're doing a descending thoracic aneurysm repair and they're often super-paranoid (rightfully) so that the artificial graft material doesn't get infected.Didn't seem the surgeon had flipped out though... probably due to the fac...

Locked out

i'm so sleepy — Fri, 28 Sep 2007 09:46:00 +0100

I was on call yesterday and there was a fire drill going on so the fire alarms were going off... i was headed to the ORs to wake up a patient with one of the residents and I swiped my ID at the OR doors... Nothing... no click, just blinking lights on the pad. I swiped my ID again. Same. So I pulled on the door. still locked no way to open it. Luckily someone was exiting the locker room and I got in there and cut into the ORs. This happened on one other occasion with a different door soon after the opening of our new addition, which I chalked up to being in a new building. I don't know if this is the case with any other doors, but I'm guessing it is.This is a serious problem. Luckily I was going to a routine wake-up with a good resident and I wasn't really needed. But we need to get into t...

The Latest In Controlling OR Heat Loss

Waking Up Costs — Tue, 25 Sep 2007 00:01:57 +0100

Keeping patients warm in the operating room can be a challenge. On call two weekends ago I had an 'Aha' moment--give them knit caps! Below is the protype--a scullcap made from 6 inch stockinette. [note: this photo was taken with an iPhone!] (Source: Waking Up Costs)

Fat

i'm so sleepy — Mon, 24 Sep 2007 19:39:00 +0100

Wow. One of my rare days now where I'm not doing cardiac or thoracic cases.The patient had a Body Mass Index (BMI= weight in kg/ [height in meters]squared) of 78! Overweight is above 25, obese above 30. It's a little conservative in my opinion, but this is ridiculous. He was 5 foot 6 or so, and above 220kg. (~500 lbs) fortunately he was here for gastric bypass surgery.When they're this big, you worry if you're able to get IV access, establish the airway, and whether the surgeons will have difficulty with the procedure.Luckily no problems.I did have salad for lunch... I need to work on my own BMI. (Source: i'm so sleepy)

Tool of the Trade: Lidocaine

Waking Up Costs — Sun, 16 Sep 2007 01:11:20 +0100

Dr. Wes' post on the proper way to inject lidocaine got me to thinking about how I do it and I think I have some tips to share, too. I inject lidocaine in people's back while they're in labor, in their groins, necks, and arm pits when I do blocks, and of course in their hands and arms when I place IV's. (I inject it into their IV's, too, but there's no trick to that, really.) When I have time, I like to add about a one fourth volume of bicarbonate to the lidocaine I'm injecting. (This doesn't work with bupivicaine as it will cause it to precipitate out.) I've testing this on myself, on nurses in labor, and in patients in labor and I am convinced this removes most of the burning sensation that comes with injecting lidocaine. After having selected my injection site and cleaned it (with a...

Nothing can stand between me and my bluegrass

Waking Up Costs — Sun, 09 Sep 2007 13:44:29 +0100

On call at the hospital today. The work is done and we're getting ready to order Chinese food. Time for some computer work and bluegrass. But wait! The hospital has decided to block XM streams! Thank you iTunes: Bluegrass Radio 128 kbps 100 Percent Pure Acoustic Bluegrass Life is good (again). (Source: Waking Up Costs)

Mini Mall

i'm so sleepy — Fri, 27 Jul 2007 19:54:00 +0100

Ever heard of grand mal seizures? It's the type of seizures most think about as seizures, with unconsciousness and violent jerking movements.I'm in clinic today. On her history form she has written "mini mall seizures".I usually shop at mini-malls, but I think she means petit-mal seizures. These are also known as absence seizures and not associated with jerking motions. (Source: i'm so sleepy)

Poor historian

i'm so sleepy — Mon, 16 Jul 2007 10:35:00 +0100

I'm in clinic again... the bane of the non-pain anesthesiologist. A 60-some year old woman is here for surgery. She's had a history of heart failure. (Her heart is damaged so it doesn't pump very efficiently) She's a terrible historian.Now for non-medical types, this doesn't mean she didn't know that Washington crossed the Delaware. It means that she's a terrible reporter of her own medical history. For different patients it means different things. To some it means that they can't remember what they've had done in the past or what medical conditions they have. To others it means that they ramble on so much it's hard to separate the medical information from random stories about their puppy. And my favorite group is the group where they're so vague about things that it takes 14 follow-up que...

Safety Tip: Nerve Block Needle Disposal

Waking Up Costs — Wed, 04 Jul 2007 23:43:42 +0100

I most commonly use a 2 inch B-bevel insulated needle for nerve blocks. It is often not convenient to dispose of the block needle right away after completing the block, so I started placing it in the barrel of the empty syringe from the plunger side and holding it in place with by depressing the plunger. Like this: Safer for myself and my assistant (when I have an assistant). (Source: Waking Up Costs)

Study Says Chatty Doctors Forget Patients

i'm so sleepy — Mon, 02 Jul 2007 17:45:00 +0100

Funny... except for the patients. Published in the Archives of Internal Medicine via the New York Times (Source: i'm so sleepy)

The Ether Way on the Preop Interview

Waking Up Costs — Thu, 28 Jun 2007 14:54:03 +0100

Right on, brother: "Long ago, my preop interview became less pre-flight check-list and more gut-check and sniffing for smoke. (I'll write more about sniffing for smoke in another post) Paradoxically perhaps, the most important thing to me is to bond to the patient; it's the second part of that WCW observation. I might do eight or ten cases in a day; the consequence of treating my work as a technical exercise is the risk of inattention and the sort of boredom that drives the desperate discontent that I see in so many of my colleagues." [The Ether Way] (Source: Waking Up Costs)

Wireless In The OR

over my med body! — Thu, 21 Jun 2007 03:32:26 +0100

Wanna be a rich man or woman? Work on wireless monitoring of EKG leads and heart rate, pulse oximetry, blood pressure, and temperature. The cords and wires in the OR are always a ridiculous mess, but the anesthesiologists are great at untangling them. (I’d love to see their Christmas lights and computer desks.) Me? I’m working on an even more revolutionary invention: the wireless IV. (Source: over my med body!)

The Eyes Have It

over my med body! — Sat, 16 Jun 2007 06:45:14 +0100

On a 2-week rotation of Anesthesia recently, hence the not posting. I find myself using my eyes to pretty much express every emotion, since the rest of my face is masked. (This happened while I was on surgery, as the surgeons do it too, but I’ve become quite skilled at it recently, since the nurses and attending and I will often try communicate silently in the OR, since that whole “people with scalpels and needles should probably be able to concentrate if they want” mentality is quite popular around these parts.) Figured I’d give my little rundown of expressions that I use through the power of the YouTubes. Video is below. If you’re viewing the feed or get the email and want to see the video, just click on my page or the Youtube link. (Source: over my med body...

Staffing shortage

i'm so sleepy — Thu, 14 Jun 2007 23:07:00 +0100

This week we opened a new building... brand new operating rooms, new offices, etc. beautiful place. Still some growing pains as we are somewhat short staffed.Yesterday, we had an urgent case to start. No residents or CRNAs were available since it was a lecture day and the available people were giving breaks so other people could go to their lectures.Anyway they had an available OR, and I myself was giving lunch breaks....So I just went ahead a did the case myself.I know this doesn't sound too strange to most of you. It's probably the norm in most places. But being at an academic institution I haven't done a case by myself, well ever. In the few years I've been staffing, I always work with a resident or CRNA. Before then I was a resident so I worked with a faculty member supervising me.It's...

Preop Hijinks

i'm so sleepy — Tue, 12 Jun 2007 20:48:00 +0100

So I'm in clinic today and I'm talking to a patient about his health problems for some surgery or another. All of a sudden he stands up, unbuckles his belt buckle, unzips his pants and starts tucking his shirt in. Now I've done this before too, but usually it's in my bedroom before I go to work or if I'm in the bathroom or if I'm alone somewhere with no hope of someone walking in.Weird and unsettling.I just acted like nothing was happening and averted my gaze. (Source: i'm so sleepy)

Condolences

i'm so sleepy — Wed, 06 Jun 2007 17:49:00 +0100

As you no doubt have heard by now. A plane with an organ transplant team crashed into Lake Michigan on Monday. All six aboard were lost.Condolences to the families of the two doctors, two organ donation specialists, and two pilots.They perished in the quest to save the life of another. (Source: i'm so sleepy)

Tragedy

i'm so sleepy — Tue, 05 Jun 2007 00:16:00 +0100

I don't really want to talk about it now but do me a favor.Go home, kiss your wife or husband, boyfriend or girlfriend, hug your children. You never know when it's the last time.More later... maybe (Source: i'm so sleepy)

Keywords

i'm so sleepy — Thu, 31 May 2007 13:51:00 +0100

So I've realized for the last few posts that you can add keywords to each post and people can read those posts with those keywords only.I'm anal enough that I'm going back and adding keywords to all my old posts. Hope this makes reading more enjoyable.(I'm assuming people are reading) (Source: i'm so sleepy)

Random walls

i'm so sleepy — Wed, 30 May 2007 13:34:00 +0100

Image from freefoto.com I'm walking out of work late yesterday. I'm tired. I'm on cardiac call i've been here for 12 hours. Not bad hour-wise but i've had to work with one of the stressful surgeons and just finished helping code a patient in the operating room.I just want to go home and put up my feet...All of a sudden there's a wall along the corridor where I usually walk out. It was open this morning "Detour -->" I guess they're finally connecting the new building to the old one.Now I wander through the basement and finally get to my car.Perfect ending to a long day. Hope I don't get called back in. (Source: i'm so sleepy)

Yay!

i'm so sleepy — Fri, 11 May 2007 04:02:00 +0100

I got a page from a friend today saying oral board results were posted.I passed!It's about a week and half earlier then they said scores would be up, but I'm glad.Relief. (Source: i'm so sleepy)

I'm a Better Anesthesiologist Today Than A Year Ago

Waking Up Costs — Sun, 06 May 2007 04:00:00 +0100

At the end of this busy week I began to reflect on how this week was different than an average week would have been even a year ago. It was different both for me and for a significant number of my patients. Hopefully, it was as good for patients as it was for me.For the first ten years after I finished my training I did not believe nerve blocks for extremity surgery were worth doing. Surgeons didn't want to wait for me to do them or for the blocks to 'set up.' Blocks failed a certain amount of the time. There were complications that just didn't happen when 'numbing the big nerve.'My thoughts on all this changed, not because of a journal article or discussions with a colleague, but because of an article in Wired magazine. The Painful Truth was an article ...

Oral Boards - Done

i'm so sleepy — Wed, 25 Apr 2007 03:27:00 +0100

I've been back from DC. Oral boards are done.Yay!Topics were anticipated. Did I study enough, hard to say... would studying more been more helpful... doubtful.I think I did okay... but who knows for sure. I'll find out at the end of May.At least it's over, for now. (Source: i'm so sleepy)

Transvaginal Cholecystecytomy

i'm so sleepy — Tue, 24 Apr 2007 02:18:00 +0100

In a word -- Yuk! These words together mean removal of the gallbladder through the vagina. Yuk yuk yuk.If I had a vagina, you're not removing my gallbladder through it.And to boot there's a Natural Orifice Surgery Consortium for Assessment and Research. You can leave my natural orifices alone... I mean look what great scientific advances there are in this decade.New York Times online via Book of Joe (Source: i'm so sleepy)

USFDA New Drug Application (NDA) of Anesthetic Reversal Agent NV-101, Submitted by Novalar

PharmaGazette — Tue, 17 Apr 2007 08:22:44 +0100

Novalar Pharmaceuticals, Inc.’s NV-101 is a local dental anesthetic reversal agent that has shown efficacy in pivotal studies. Novalar has already applied for NV-101’s marketing approval to the USFDA. According to Donna Janson, President and Chief Executive Officer of Novalar: "The submission of the NV-101 NDA is a key regulatory milestone for Novalar and we will maintain a close interface with the FDA throughout the NDA review process. We will also continue to put in place the necessary marketing and commercialization infrastructure to ensure a successful product launch. In addition, we have intensified our business development efforts to identify and evaluate promising in-licensing opportunities to add to our product pipeline."Phase 3 studies of NV-101 demonstrated ...

Acoustic Respiratory Monitoring: What Is It?

Waking Up Costs — Tue, 17 Apr 2007 04:00:00 +0100

An intriguing press release last week from Masimo (known for their motion artifact-resistant pulse oximeters) begins as follows: "Masimo, the inventor of Pulse CO-Oximetry and Read-Through Motion and Low Perfusion pulse oximetry, reported that three new independent studies, including one presented the recent International Anesthesiology Research Society (IARS) Clinical & Scientific Congress in Orlando, concluded that Masimo Acoustic Respiratory Monitoring technology (ARM) is "at least as accurate as capnometry" and "significantly more reliable" for monitoring respiration in spontaneously breathing patients."The release then refers to "an adhesive bioacoustic sensor applied to the patient's neck and connected to a breathing frequency monitor prototype" which in turn accurately ...

DC in the spring

i'm so sleepy — Mon, 16 Apr 2007 19:15:00 +0100

Ah to be in Washington DC in the spring.Blossoms on the trees.Spring is in the air...NO!I'm in DC for anesthesia oral board examsIts 40 degrees outside. There's a wind advisory...The plane was shaking like a laundry dryer as we were landing... and I swear we were going sideways for several seconds.AND I'm taking oral boards tomorrow.I'm a little stressedI'm back to the books for last minute cramming... maybe a short nap.More later. (Source: i'm so sleepy)

March 30, 1842: The First Ether Anesthetic

Waking Up Costs — Fri, 30 Mar 2007 17:38:02 +0100

Wikipedia "Although William T.G. Morton is well-known for performing his historic anesthesia on October 18, 1846 in Boston, Massachusetts, C.W. Long is now known to be the first to have used an ether-based anesthesia. After observing the same effects with ether that were already described by Humphry Davy in 1800 with nitrous oxide, C.W. Long used ether the first time on March 30, 1842 to remove a tumor from the neck of his patient, Mr. James M. Venable. Long subsequently removed a second tumor from Venable and used ether anesthesia in amputations and childbirth. The results of these trials were published several years later (in 1849) after Morton's publication. " (Source: Waking Up Costs)

MINRAD’s Sevoflurane, Approved in Japan

PharmaGazette — Mon, 26 Mar 2007 03:40:24 +0100

MINRAD International, Inc.’s exclusive distribution partner in Japan – Merck Seiyaku – has received marketing approval from Japanese Ministry of Health for Sevoflurane. An interventional pain management company, MINRAD International, Inc. (AMEX: BUF) has real time image guidance and anesthesia and analgesia product lines. Sevoflurane is an inhaled general anesthetic. Read the full report.[photo credit: Baxter Sevo] (Source: PharmaGazette)

Jim’s Pediatric Sheet Update

Nurse Anesthetist — Sun, 25 Feb 2007 02:19:03 +0100

One of the pleasures that I have today is to work with really great people. One of those individuals is Jim Carey who just happens to be the Vice-President of the California Association of Nurse Anesthetists (CANA). Jim has revamped his pediatric reference sheet and I just put the new version up on the web site here under Clinical Documents. The new version of Jim Carey’s Pediatric Sheet in PDF format can be reached here for your downloading pleasure. This little sheet is very helpful as a reference and general guideline when considering pediatric anesthetic choices. It must be remembered that anesthesia is an every changing applied medical science and any reference sheet is just that - a reference and does not replace sound clinical judgment so user be forewarned. I was in the loca...

There, I Said It Tells All

Nurse Anesthetist — Tue, 20 Feb 2007 00:25:46 +0100

The longer I am exposed to the great anesthesia practitioners the more respect I have for what we do in the OR. I feel so privileged to be where I am today with the opportunity to do anesthesia and to teach - I am really blown away every day. One of my former clinical instructors and true mentors has confided in me concerns about what it takes to do well as an incoming anesthesia student and I wanted to share their concerns with you. If you want to know the truth it may hurt but it will set you free. Thank you so much “There, I Said It”. You rock TISI! For those of you that want to be CRNA’s take heed and follow the advice of a pro and you will be well prepared for clinical residency. Why I think year ICU experience isn’t enough by “There, I Said It”. I am a...

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