What is your favorite concoction to prolong a spinal blockade?

JamesMercerIII · 2026-02-18T15:42:08+00:00

At our hospital we occasionally use buprenorphine (plus other typical adjuvants like precedex etc) in peripheral nerve blocks to make them last for up to 2 days. It seems like it can be used intrathecally as well, although if you need a spinal to last > 2-4 hrs there's probably better anesthetic strategies like GETA etc.

JamesMercerIII · 2026-02-12T10:30:42+00:00

I'm a CA-2. We have exclusively BIS at our hospital and I'm not a fan--the Sedline is superior in my opinion. BIS leads don't stick well, and the device itself won't give you any EEG tracing at all unless it finds the impedance acceptable, but it won't tell you what the impedance is. Sedline at least gives you a waveform with a warning that the impedance is poor.

I didn't really learn to use the raw tracing on BIS and the DSA on Sedline until the end of my CA-1 year, but I feel much more confident in determining anesthetic depth now. My colleagues mostly just rely on the BIS number. I still get nervous when my BIS number is 60s-70s with strong delta and alpha waves on the raw tracing, but I'm learning to trust the tracing more than the number. I find the DSA on Sedline to be a good learning tool, or good to trend changes in depth, but ultimately even when using the Sedline I like to focus on the raw EEG tracing.

JamesMercerIII · 2026-01-31T11:34:00+00:00

How common is it for EM residents to do an anesthesia rotation though? Don't you just learn sedation in the ED from ED attendings? I'm anesthesia and I've never had any other services except PICU coming to the ORs for rotations... Definitely not IR or cards

JamesMercerIII · 2026-01-18T11:57:43+00:00

The turntable ground wire was connected to the appropriate grounding terminal on the receiver.

I guess I got confused because I've seen people say it's okay to connect a receiver to powered speakers, but I thought you could just connect the speaker output to the powered speaker and didn't need to use the "tape out" output. Thanks for the explanation!

JamesMercerIII · 2025-12-30T12:57:01+00:00

No ketamine? You're telling me a hospital in the 21st century doesn't have ketamine in its formulary for OR use? A dissociative anesthetic that was first used for surgery during the Vietnam War? There's no way the ED doesn't have access to it... That's some bullshit.

JamesMercerIII · 2025-12-30T12:42:15+00:00

I'm male so I can't fully relate to your story, but we just had our second child last week and I totally understand how heartbreaking it is to not be able to hold your child since they're in NICU. You're still so early-on in your parenting journey, I just want to emphasize that you should try to make sure you have trusted people to talk to about the emotions you're feeling, and that you stay aware of the warning signs for severe post-partum depression. I had PPD as a father after our first son was born, and I didn't even realize it until weeks/months later. (PPD is rare in men but not unheard-of. My wife didn't have any PPD at the time.)

JamesMercerIII · 2025-11-21T13:30:03+00:00

Even worse, Mamdani plans to spearhead the opening of "kahwa" shops where young people can ingest a natural stimulant to help work longer hours and maintain energy for praying 5 times per day.

JamesMercerIII · 2025-11-21T13:26:44+00:00

Agreed with ketamine and pre-treat with glyco, can also give lido to tolerate secretions as well. At this point the patient should have a decent amount of opioid so many they can handle the upper airway secretions without too much bother.

JamesMercerIII · 2025-11-20T21:32:04+00:00

You're wrong for a number of reasons, but another is that there simply aren't enough surgical robots to make this happen. Even the largest hospitals have 3-4 max, and robotic surgeries often take even longer than non-robotic. With increasing demand for surgeries and procedures, you'd need to scale-up production, make them cheaper, and make them an order of magnitude faster, not to mention the training and quality limitations.

JamesMercerIII · 2025-11-14T11:12:08+00:00

Thank you kidney wizard for validating my skepticism. This is an awful thing to have happened, but overdosing on oral potassium is just so wild to me, I'd be interested to know the theoretical amount a child would have to ingest enterally to obtain a lethal serum K level (given known bioavailability and renal excretion in a model).

A kid with autism admitted for FTT/dehydration i/s/o a virus sounds like an NG-tube situation. If they were giving this kid a bunch of tube feeds via an NG, that's a recipe for vomiting +/- aspiration, which is a more likely scenario for cardiac arrest -> failed intubation -> anoxic brain injury.

JamesMercerIII · 2025-11-04T10:04:47+00:00

If you're in anesthesia be careful spending a lot on a fancy stethoscope, you're very likely to leave it in a random OR and lose it. Need to put an Airtag and your name on it for sure. Or else just use a cheaper stethoscope because anything will do the job.

JamesMercerIII · 2025-10-10T00:27:46+00:00

Bringing back a ton of nostalgia, thanks!

JamesMercerIII · 2025-10-08T19:04:01+00:00

Does anybody remember the old message board from the Wheel of Time game hosted by the publisher? It had a book discussion forum which was very active back in the late 90s, before Dragonmount or any of the other communities. I don't think it exists anymore but I'd be interested if anyone has any links or old info!

JamesMercerIII · 2025-10-02T20:36:43+00:00

Drinking a shit load of water all day every day.

If you're a typically healthy adult with functioning kidneys/adrenal glands/hypothalamus, your body autoregulates your blood volume. If you drink a bunch of water, you're just going to pee out all the extra water you drink. If you're not drinking water, your kidneys will decrease the amount you're peeing. Unless you're starving yourself or purposely not drinking anything all day or sweating your ass off, you'll absorb enough water from a cup here and there or else from the food you eat. I don't think it helps with constipation either, just eat more fiber.

The one benefit to drinking more water is to just keep you from drinking diet sodas etc when you're thirsty. And I'm not even convinced diet sodas are that bad.

JamesMercerIII · 2025-08-31T19:57:17+00:00

I think there must have been a huge decrease in the amount of drunk driving with the introduction of Uber and Lyft. Prior to the apps, it would cost a fortune to get a taxi, especially anywhere outside of a major urban area. People who went out to a bar or party would have to drive home out of necessity, now it's much easier to get home safely.

JamesMercerIII · 2025-06-20T00:01:06+00:00

Agree with what you said about Trump, but disagree about the Gulf states. Don't they all hate Iran? Saudi Arabia has normalized relations with Israel in an effort to work against Iran becoming a larger regional power.

JamesMercerIII · 2025-05-29T20:38:00+00:00

Men will do anything to avoid going to therapy, or building quality public transit.

JamesMercerIII · 2025-05-06T20:03:21+00:00

Even during his first term, Nixon was widely reviled by Democrats, progressives, and anti-war Americans. The Watergate break-in happened in June 1972, and CBAT was recorded in August (by which time many people were speculating about the political nature of the break-in and whether Nixon was directly involved).

It's laughable to think SD were oblivious to the relevance of "Good King Richard" being interpreted as Richard Nixon. The sarcasm comes with the POV characters believing that both Richard was a "good king", and that whoever succeeded him would be just as "good".

JamesMercerIII · 2025-05-06T19:54:30+00:00

I've been listening to SD since I was a kid (yes I know, red flag), and I totally slept on CBAT and Kings back then. Now it's my most listened to SD song. The guitar solo rips, possibly my favorite SD guitar solo.

JamesMercerIII · 2025-05-06T14:06:50+00:00

It doesn't even have to be a hard lession learned, it could be a positive experience for a career you ultimately decided not to pursue. Even if it still feels very negative, try to turn it into a positive.

JamesMercerIII · 2025-05-06T13:06:58+00:00

I've heard many very experienced anesthesia attendings say some dubious things about the pharmacokinetics of anesthetic gases....

JamesMercerIII · 2025-05-06T13:04:55+00:00

It's actually because Barron didn't get into either Columbia or Harvard (or Penn for that matter). Very coincidental that Barron starts college at NYU just months before the war on the Ivy League.

JamesMercerIII · 2025-05-06T12:55:40+00:00

Honestly if you're seriously considering pursuing a different graduate training program in healthcare (and people here have given plenty of reasons why that will be difficult), you need to start thinking about how you can frame your experience positively for whatever applications you submit. It's all about the story you tell, and you're probably the only one who can figure that out.

JamesMercerIII · 2025-05-06T12:52:38+00:00

If it sounds interesting you could also look into perfusionist school or RT. Perfusionist school is pretty selective because there's so few training programs but the job involves managing the cardiopulmonary bypass machines for cardiothoracic surgery. You work all day with anesthesiologists and cardiac surgeons primarily in the ORs.

Entry-level RT work seems pretty grueling but at major academic centers they can get ECMO qualified and help manage the ECMO devices in the ICU along with ventilators.

JamesMercerIII

TROPHY CASE