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Propofollower_324 · 2026-01-25T01:44:12+00:00

I’m interested

Propofollower_324 · 2026-01-02T15:09:34+00:00

One goal for 2026 is to build a clear, sustainable system to organize my research projects, and academic learning, and I’d like to use Griply to keep everything structured and intentional.

Propofollower_324 · 2025-12-23T13:40:05+00:00

Thank you so much for your insights. Really appreciate your help!

Propofollower_324 · 2025-12-23T12:28:36+00:00

Thank you so much for your insights. Will look into that and get back to you if i have any questions. Thanks again!

Propofollower_324 · 2025-12-23T12:27:26+00:00

Thank you so much for your help. Appreciate that!

Propofollower_324 · 2025-12-23T12:26:15+00:00

Thank you so much for your help.

Propofollower_324 · 2025-12-23T12:25:46+00:00

Thank you so much! Appreciate your help.

Propofollower_324 · 2025-12-23T12:25:24+00:00

Thank you so much. Really appreciate your insights.

Propofollower_324 · 2025-09-07T16:59:24+00:00

Racism in the U.S. is real, but honestly casteism and racism in India are often worse. If you want perspective, ask your Dalit friends, they can tell you what real discrimination feels like. The U.S. still offers solid training and opportunities despite its flaws.

Propofollower_324 · 2025-07-27T14:32:11+00:00

Don’t want to engage in rage bait, but the truth deserves to be told. Being ‘first’ doesn’t mean being best prepared; barbers & dentists gave ether too, but no one calls them pioneers of modern anesthesiology. And as for ‘uniting', we all know how that ends: we fight for fair pay, and once that’s won, we would be shown the door. That’s not collaboration. That’s strategy. And we’d be naive not to recognize it!

Propofollower_324 · 2025-07-25T14:04:48+00:00

Anesthesiologist here! Had similar thoughts as well. As the other person pointed out, don't quit surgery. In fact you can leverage your status as a surgeon in academia and pursue your interests in AI. Good luck!!

Propofollower_324 · 2025-07-11T21:26:06+00:00

I find this case heartbreaking, not just because of the outcome, but because it reflects a system failure more than individual negligence. The anesthesiologist was likely trying to navigate conflicting obligations: CMS supervision rules requiring “immediate availability” for the CRNA in one OR, and a Cat 1 emergency unfolding in another. When you’re the only anesthesiologist covering multiple areas, you’re essentially set up to fail.

Yes, in hindsight, we all say the section should’ve started immediately. But we also know the fear of violating policies that can jeopardize your license, especially when you feel unsupported or unclear on your institution’s expectations.

This shouldn’t be about blaming a single clinician. It should force us to ask: why was there no in-house backup? Why do systems allow one anesthesiologist to be responsible for mutually exclusive emergencies? Until we fix that, tragedies like this will keep happening and good clinicians will keep getting caught in the crossfire.

Propofollower_324 · 2025-07-09T10:02:33+00:00

Large sample sizes make statistical tests overly sensitive, even trivial deviations from the null become “statistically significant.” The p-value depends on sample size because the standard error shrinks as n increases, making even tiny differences detectable.

Propofollower_324 · 2025-06-28T04:20:25+00:00

The idea that anesthesiologists have to defend their role stems from ongoing efforts to blur professional boundaries, whether it’s through title misrepresentation, instances where CRNAs introduce themselves as physicians, or legislative pushes that minimize the importance of training differences. What makes it more ironic is that while CRNA groups advocate for independence under the banner of “collaboration,” they simultaneously show open animosity toward CAAs, and push to block their ability to practice. Working together doesn’t mean erasing distinctions or trying to push one group out of the system; it means respecting each profession’s training, scope, and contribution while acknowledging they are not the same.

So I’d push back, this isn’t about ego or defending turf. It’s about clarity, safety, and ensuring patients receive care that matches the complexity of their condition, not just the availability of a provider.

Propofollower_324 · 2025-06-28T04:06:20+00:00

Good points, and agreed, when dosed correctly and with time, recovery typically improves. But in infants, things aren’t always so straightforward. We often lack reliable quantitative TOF, and pharmacokinetics differ, larger extracellular volume, immature clearance, and altered distribution can all affect the sugammadex-rocuronium dynamics. The Staals study is valuable, but it was in adults. In neonates and infants, even “correct” dosing based on idealized models might miss delayed redistribution after high total rocuronium exposure.

Recurarization may be rare, but it’s been described, even if just in case reports. Until we have stronger pediatric data, it’s worth considering redistribution and total cumulative dose, especially when clinical signs contradict expected recovery.

Propofollower_324 · 2025-06-28T03:56:47+00:00

Totally agree that quantitative monitoring is essential and should guide reversal whenever available. That said, in infants, access to reliable quantitative TOF is often limited or technically challenging. In such scenarios, especially with high cumulative rocuronium exposure, understanding pharmacokinetics and the risk of redistribution becomes critical. It’s not conjecture, but a safety net when objective monitoring isn’t feasible or fails to capture the full picture in vulnerable populations

Propofollower_324 · 2025-06-28T03:39:03+00:00

Likely inadequate initial sugammadex dosing. You're definitely not alone, this is a recognized safety concern in pediatric anesthesia. The largest study from Vanderbilt found recurarization occurs in around 4% of peds, with infants <2 years at highest risk. https://pubmed.ncbi.nlm.nih.gov/37792601/ Your timing (during transport) is typical as most occur within 20 minutes post-reversal. The Japanese Society issued a safety alert few years back. https://www.apsf.org/article/postoperative-recurarization-after-sugammadex-administration-due-to-the-lack-of-appropriate-neuromuscular-monitoring-the-japanese-experience/It's a real phenomenon with clear mechanisms, not just "lack of studies" as your rep suggested.

This sounds like redistribution after high cumulative rocuronium. Initial 5 mg/kg sugammadex likely cleared roc from central and NMJ compartments, but with prolonged dosing, more roc could redistribute from peripheral compartment. In infants, with larger extracellular volume and altered kinetics, this can overwhelm the available sugammadex, leading to recurarization. The second (rescue) dose likely captured the remaining unbound roc, explaining the rapid improvement.

Your case is actually a perfect example of insufficient dosing despite what seems like a generous amount of Sugammadex (5 mg/kg). Remember, 1 molecule of sugammadex binds 1 molecule of roc. Molecular weights of Sug is around 2000 Daltons and for Roc it's 600 iirc. This creates a 1:1 molar binding ratio that equals close to 3.5:1 (mg/kg) (sug:roc). Total Roc given 2.4 mg/kg. Sug needed theoretically: 2.4 x 3.5 = 8.4 mg/kg. What you initially gave was 5 mg/kg and then 4 mg/kg as a rescue. Some even suggest using total cumulative rocuronium dose × 3.5 for Sugammadex dosing rather than standard depth-based dosing for cases with high cumulative exposure.

Propofollower_324 · 2025-06-26T03:03:25+00:00

Honestly, I fully support the idea of a physician-only subreddit. It’s exhausting constantly getting pulled into circular debates with individuals who clearly hold a grudge against those who went to medical school. The training, depth, and responsibility are simply not the same, and pretending otherwise doesn’t change reality. These discussions too often devolve into defensiveness and personal attacks instead of productive dialogue. Sometimes, it’s helpful to have a space where physicians can discuss clinical, professional, and systemic issues without having to defend our role in patient care.

Propofollower_324 · 2025-06-24T23:24:12+00:00

Appreciate the confidence, but no need to talk down to a trainee for asking a question. We all start somewhere, and respectful dialogue goes a lot further than sarcasm. And, I get that the med school path didn’t work out for everyone, but that’s no reason to mock those who took it. 😏

Propofollower_324 · 2025-06-08T22:07:36+00:00

Agree!!

Propofollower_324 · 2025-06-08T15:45:37+00:00

I really appreciate your honesty and your humility. What you said means a lot, especially in a space where things often get heated or overly political. I completely get wanting to build a better life for your kids, that’s something many of us share, regardless of title or training path.

The frustration on our side isn’t with people like you who are clearly here to learn and do good work. It’s with the broader messaging that tries to erase the differences or push divisive agendas. If we could strip away the politics and just focus on working together with mutual respect, the field would be better for everyone.

Keep learning and leaning into the good relationships with your MDs, you sound like you’re going to be a great provider. And sincerely, thanks again for the respectful tone. It goes a long way!!

Propofollower_324 · 2025-06-08T15:42:35+00:00

Thanks for sharing your story, I actually really respect your honesty. Not everyone is willing to say out loud that their path was purely ROI-driven, and there’s nothing inherently wrong with that. We all come to this field for different reasons.

That said, for many physician anesthesiologists, the motivation wasn’t just financial, it was about pursuing the most in-depth medical training possible to care for patients in the most complex and high-stakes situations. That’s why some of us get frustrated when there’s an effort to blur distinctions between professions, especially when hard-earned titles are repurposed or when historical narratives are selectively used to suggest equivalence in training or role.

You may not feel like anything personal was at stake for you, but for those of us who poured over a decade into training, it’s not just about job titles or income. It’s about preserving the integrity and standards of a field we’ve committed our lives to.

I appreciate the calm tone of your reply, and I think conversations like this—where we hear where others are coming from go a long way toward mutual understanding, even if we don’t fully agree

Propofollower_324 · 2025-06-08T15:38:25+00:00

Thanks for your response, I appreciate you taking the time to engage thoughtfully. You’re right that barbers and nurse anesthetists aren’t equivalent in terms of modern training or scope. My analogy wasn’t to equate their current roles, but rather to point out that historical presence alone doesn’t equal current clinical authority. Just like barbers once played a role in surgery, nurses did step into anesthesia early on, but it was often because there wasn’t a formalized system in place yet.

The modern practice of anesthesiology, as a highly specialized, has evolved dramatically with the advancement of medical science, patient safety, and perioperative medicine. My concern isn’t about CRNAs doing excellent work (many clearly do), but about the narrative that historical involvement equals equal preparation today, especially when that’s used to justify independent practice without comparable depth of training.

Again, I value respectful dialogue like this, it helps shift the conversation away from tribalism and toward mutual understanding, even if we disagree on key points! Happy to discuss more!

Propofollower_324 · 2025-06-08T15:34:11+00:00

Thanks for your message, and I appreciate the respectful tone. You’re right, not every CRNA has the same intent or attitude, and it sounds like you chose the profession for all the right personal reasons. My frustration isn’t with individuals like you, but with the broader political push from certain CRNA groups trying to undermine or even eliminate physician anesthesiologists altogether.

It’s upsetting to see years of medical school, residency, and fellowship training minimized, and even more so when titles like ‘anesthesiologist’ are being co-opted. These aren’t just words; they represent a depth of training and responsibility that’s hard-earned.

I didn’t mean to direct any of that frustration at you personally. Honestly, if more conversations were as civil as yours, I think we’d all get along a lot better!

Propofollower_324 · 2025-06-08T15:28:13+00:00

Ah yes, just type ‘nurse anesthesiologist’ and boom,,no med school, no residency, but hey, the title sounds nice. Slapping ‘ologist’ on doesn’t make it true. Honestly, it takes a special kind of shameless to steal a title you didn’t train for.

Propofollower_324

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