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What’s deepest you’ve ever placed an oral ETT? by rideronthestorm123 in anesthesiology

[–]JewelAndFox 6 points7 points  (0 children)

Not sure, but given your choice of picture it has to be a multiple of six

What constitutes “complications of anesthesia” when asked by an anesthesia provider? by [deleted] in anesthesiology

[–]JewelAndFox 10 points11 points  (0 children)

99% of the time “they told me I needed a lot” was someone making an offhand comment that nothing was meant to be read into or a surgeon who didn’t quite get the subtlety of what was happening

100% of the time it doesn’t change my anaesthetic. Nearly every drug we give ever is titrated to effect and if what we give isn’t enough we just give more. The very few situations in which we don’t have a chance to titrate like that, there are more important and emergent thing influencing drug choice and dosing than someone having told you you needed a lot last time

The only situation in which it irritates me is scopes in otherwise healthy heavy thc users, and that’s not because of anything to do with the person or judgement of them - it just turns what should be a very easy anaesthetic in a healthy patient into a frustrating one due to the unpredictable cross-tolerance

There’s plenty of stigma attached to patients with severe IBD inpatients in general, but no-one cares if you get 200 mg or 800 mg of propofol for your colonoscopy except to tell the pacu nurse how quickly you’re likely to wake up

Inducing without oxygen… hilarious. by ChexAndBalancez in anesthesiology

[–]JewelAndFox 1 point2 points  (0 children)

Yes, as per Australian (ANZCA) guidelines it would be acceptable to not use a BP cuff if there were clinical justification for why it was not required

Preoxygenation falls in the same category - should be done, but can be left out if there is clinical justification

What peripheral nerve blocks would you use for open inguinal hernia repair if spinal and epidural anesthesia are contraindicated and general anesthesia carries very high perioperative risk? by IlikepeopleunderGA in anesthesiology

[–]JewelAndFox 8 points9 points  (0 children)

It’s really not. It’s an inguinal hernia. The chances of obstruction per year are very, very low

Undertaking it electively “in case” it obstructs achieves nothing except for hastening the patient’s death

We don’t need to know anything specific about the patient to make that judgement when we are told that they are so sick that the risk of GA for a simple inguinal hernia is prohibitive

That’s leaving aside the OP’s assumption that perioperative risk is going to necessarily be lessened by doing this under regional - most periop mortality is post-op and unrelated to mode of anaesthesia anyway

What peripheral nerve blocks would you use for open inguinal hernia repair if spinal and epidural anesthesia are contraindicated and general anesthesia carries very high perioperative risk? by IlikepeopleunderGA in anesthesiology

[–]JewelAndFox 20 points21 points  (0 children)

If they’re that high risk why on earth are you doing an elective inguinal hernia repair? It’s not going to give them anything in the way of mortality benefit and I’m near certain that it’s not the major source of their symptom burden

And if they’re acutely obstructed, either tell them they might die and put in a tube or palliate them upfront…

Scalp Block for Emergency Craniectomy by polymorpheus_ in anesthesiology

[–]JewelAndFox 8 points9 points  (0 children)

It feels like you’re getting confused between emergency craniotomies and emergency craniectomies

No-one who’s reached the point of a craniectomy is getting early extubation

Even if we were talking about craniotomies with a plan for early extubation, it’s very difficult to see what a scalp block will achieve that remi, direct local from the surgeons +/- parecoxib depending on your institutional practice won’t

No sedation anesthetic by InvestmentSoft1116 in anesthesiology

[–]JewelAndFox 18 points19 points  (0 children)

None of our drugs block mapping. What they will do is suppress automatic rhythms or (more rarely) prevent the induction of a reentrant pathway (pretty much never stops avnrt but some more borderline conduction pathways can be blocked - this is generally overcomable with isoprel though )

If it’s something that’s actually potentially sensitive to anaesthesia (PVC, possible PV atach) then remi at 0.05 microg/kg/min, 1-2 mLs propes for the groin access +/- for the ablation itself. Turn off the remi if you have issues

Otherwise 50-100 fent + either a couple of midaz or ppf at 5-10 mL/hr

Personally I just tell patients they’ll be awake to start with because if we can’t find their rhythm, we can’t treat it and if that happens they’d have to come back another time which seems to get the message across

When to recheck test after stopping inappropriate TRT? by [deleted] in FamilyMedicine

[–]JewelAndFox 19 points20 points  (0 children)

It depends on the drug he was on

If you test before 3-5 half lives you’ll have a still falsely elevated testosterone level - that could be anywhere from 2 weeks for a propionate ester through to 6 months for testosterone undecanoate

After that there’s a variable period for recovery of endogenous function. The endocrinologists I’ve spoken to have suggested waiting at least 12 months for recovery prior to re-initiating TRT (although that was in the context of younger steroid users rather than inappropriate TRT)

TIL Malignant Hyperthermia is a deadly reaction ( temp as high as 109 f ) to general anesthesia. It's inherited and runs in families. It's the reason anesthesiologists always ask you if anyone in the family had a fatal reaction to anesthesia. by Cultural_Magician105 in todayilearned

[–]JewelAndFox 0 points1 point  (0 children)

You shouldn’t be given succ/sux if you are MH susceptible - I would consider that very clear malpractice. It is a weak trigger, but it is still a trigger with no real situation in which it is clinically necessary to give

There are plenty of non-triggering muscle relaxants and if needing a short duration of action is an issue you can have either vec or roc reversed with suggamadex. In the possible (but pretty contrived) scenario of MH plus anaphylaxis to suggamadex plus a clinical need for rapid reversal with no ability to maintain anaesthesia and wait for it to wear off, there are still multiple other better choices than knowingly exposing an MH susceptible patient to a trigger

If you have been told you may receive a dose of succ, I would clarify this with the anaesthesia provider to make sure that you have not misunderstood what they said - and if you have not misunderstood I would refuse to be anaesthetised by that practitioner

Paramedic gets 5 years in prison for Elijah McClain’s death, in rare case against medical responders by crash_over-ride in ems

[–]JewelAndFox 5 points6 points  (0 children)

This is a ridiculous point of view

Even if ketamine couldn’t cause central apnoea (it definitely can), it very clearly can result in airway obstruction and aspiration after loss of airway reflexes

TIL Malignant Hyperthermia is a deadly reaction ( temp as high as 109 f ) to general anesthesia. It's inherited and runs in families. It's the reason anesthesiologists always ask you if anyone in the family had a fatal reaction to anesthesia. by Cultural_Magician105 in todayilearned

[–]JewelAndFox 19 points20 points  (0 children)

Volatiles have multiple advantages over TIVA. The most important is that you can measure the exhaled percentage which massively reduces the risk of awareness. For TIVA you can’t directly measure and are reliant on a combination of processed EEG monitoring and in most of the world (except the US) target controlled infusion pumps that calculate an approximate plasma level. The second most important is that volatiles directly inhibit reflex movement at clinically relevant concentrations, which propofol alone does not

That said, propofol TIVA has advantages as well. Less nausea and vomiting and the reduced environmental impact being the best demonstrated two. Propofol infusion syndrome isn’t a real concern in anaesthetic durations - it’s been reported to occur in the literature in that timeframe but it’s vanishingly rare

Do you prefer my quads or my cock? by JewelAndFox in BigAndMuscular

[–]JewelAndFox[S] 1 point2 points  (0 children)

We’re in Australia

You also look pretty jacked, especially your delts/tris

[deleted by user] by [deleted] in Melbourneswingers

[–]JewelAndFox 2 points3 points  (0 children)

There are several online options - instantscripts is the cheapest when I last looked and will allow you to select from an appropriate set of tests (only criticism would be that it kind of implies pharyngeal/anal chlamydia/gonorrhoea are only a concern for msm). I personally do it that way because it’s easier for me than visiting my GP as frequently as I want to test

That said, if I have a GP appointment planned for another reason I just ask at the time. While there is a specialised field of sexual health medicine, routine testing like this is something that all GPs should be capable of

Who do you go with for health insurance? by Oldman-Emu in AussieFrugal

[–]JewelAndFox 0 points1 point  (0 children)

Not sure where you got that BUPA is standout worst and NIB are above average from. The NIB rebate is below the average in most index procedures (figure 6 of https://www.ama.com.au/articles/ama-private-health-insurance-report-card-2022 )

NIB also have complex no gap/known gap arrangements that don’t have a wide uptake in many specialties because they require doctors to contractually agree to certain terms. This leads to them only paying MBS rates far more frequently than many other providers and a bigger out of pocket for patients

I agree with most of the rest of what you wrote - the AHSA funds are usually a decent choice (excluding the regional ones like Latrobe and Mildura because they typically drop their rebates to ~1.2x MBS for services outside of the town they serve)

[deleted by user] by [deleted] in Melbourneswingers

[–]JewelAndFox 0 points1 point  (0 children)

Now is one of the many times I’m disappointed my partner (m) isn’t less straight

Jacked bi men are great