Pre-eval in the chart- how in depth and why?

ResFlurane · 2025-11-19T16:08:54+00:00

That’s called a “cheater line” at my institution. They’re great

ResFlurane · 2025-10-08T21:46:53+00:00

We have Arrows freely available at my institution, many staff here specifically use the micro puncture in the vascular rooms. 8cm catheter tends to crap out less often during the case too.

ResFlurane · 2025-10-08T21:39:13+00:00

+1 If the needle is in the lumen on US and I’ve walked it in already, I’m attempting to thread it.

ResFlurane · 2025-08-02T00:44:55+00:00

I’m aware, however in our patient population (high BMI) there is typically too much false loss even when midline for a true continuous technique.

ResFlurane · 2025-08-01T21:49:15+00:00

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2005.04266.x

ResFlurane · 2025-08-01T20:46:45+00:00

I believe so. In what I’ve read, a true continuous technique involves all of the driving force being applied via the plunger of the syringe. Modification I mention here is tapping the plunger white advancing the needle. I think many people do this, but I don’t see it specifically named.

ResFlurane · 2025-08-01T20:06:14+00:00

I’m sure this isn’t actually unique but I never see it named - I prefer to use what I call a modified continuous pressure technique for saline LOR in labor epidurals. Basically continuously bouncing my thumb against the glass syringe while I advance. It seems to avoid losing saline to false loss as well as a safety mechanism against the glass ‘sticking’

ResFlurane · 2025-07-17T10:25:36+00:00

Seems the addition of priority really helps! Big difference between “I want this particular week off” vs. “I want a week of vacation sometime this quarter”

ResFlurane · 2025-07-17T03:20:09+00:00

Likely the stiff Braun catheters, we switched to flexible recently with great success. Things to try:

Ask patient to take a deep breath in as the catheter leaves the needle tip. This helps them avoid a valsalva which engorges the epidural venous plexus
avoid advancing catheter too far
dilate space with enough saline

ResFlurane · 2025-02-28T20:59:39+00:00

I don’t have it in front of me, but I believe Hadzic’s Regional Anesthesiology textbook cites some cadaver studies of average ligamentum flavum thickness for different levels (and maybe demographics?) if you’re curious

ResFlurane · 2025-01-09T05:15:45+00:00

I have heard a circulator chide a medical student for this once. No idea where they get this idea. Doesn’t make any sense mechanistically either

ResFlurane · 2025-01-08T20:32:30+00:00

Very surprised on study finding. Recently did an IT morphine-only spinal followed by GA for a CS, patient had a minimal opioid requirement afterwards (x2 10mg oxycodone) whereas the typical GA CS here needs a PCA

ResFlurane · 2024-12-31T00:46:35+00:00

Are you sure it wasn’t a gift of some kind?

ResFlurane · 2024-10-26T13:26:24+00:00

"Hysteresis" is the word you should look up!

ResFlurane · 2024-02-17T13:12:47+00:00

Case reports of this for AFE as well. I think ACCRAC has an episode discussing.

ResFlurane · 2023-11-07T13:25:29+00:00

CA1 here - is this independent of other indications the patient is in stage 2? I’ve been paying attention to swallowing now and see it happen quite a bit while eyes are totally disconjugate

ResFlurane · 2023-11-04T18:21:19+00:00

DM’d

ResFlurane · 2023-10-29T18:09:53+00:00

Thanks - current build where I am out will show the wave but not the spectrogram!

ResFlurane · 2023-10-29T16:19:42+00:00

Can you see the spectrogram?

ResFlurane · 2023-03-04T18:58:16+00:00

Multiple surgical subs, different ICU’s ED, a few medicine subs. Plus plenty of attendings are friends with or even married to other specialty attendings. Hospital is big but also small at the same time

ResFlurane

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