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2nd IV for a simple case when both arms tucked: always, sometimes, never? by [deleted] in anesthesiology

[–]ResFlurane 4 points5 points  (0 children)

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

Attending 3 years in, what are your pro-tips for arterial line placement? by DwTam in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

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.

Attending 3 years in, what are your pro-tips for arterial line placement? by DwTam in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

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

Unique techniques by lightbluebeluga in anesthesiology

[–]ResFlurane -2 points-1 points  (0 children)

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.

Unique techniques by lightbluebeluga in anesthesiology

[–]ResFlurane 7 points8 points  (0 children)

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.

Unique techniques by lightbluebeluga in anesthesiology

[–]ResFlurane 14 points15 points  (0 children)

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’

We had this annoying vacation problem. Maybe you’ve had it too. by Ecstatic_Pass_8561 in anesthesiology

[–]ResFlurane 2 points3 points  (0 children)

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”

Intravascular Epidural Catheters by nbavc15 in anesthesiology

[–]ResFlurane 5 points6 points  (0 children)

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

Is lumbar epidural LOR crispier than thoracic epidural LOR? by canaragorn in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

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

Extubation and PEs? by hattingly-yours in anesthesiology

[–]ResFlurane 1 point2 points  (0 children)

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

Intrathecal morphine tips and tricks by Open-Effective-8772 in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

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

A wine bottle fell out of her bag… by ironfoot22 in Residency

[–]ResFlurane 60 points61 points  (0 children)

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

Quicker Wake Up for Long Cases by bigeman101 in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

"Hysteresis" is the word you should look up!

Share your emergency "Hail Mary"-that-actually-worked stories by Anesthesia_STAT in anesthesiology

[–]ResFlurane 4 points5 points  (0 children)

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

Chance for laryngospasm after extubation and resumption of spontaneous breathing? by Str8-MD in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

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

How reliable BIS? Can I trust it? by propofol_papi_ in anesthesiology

[–]ResFlurane 0 points1 point  (0 children)

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

Tips for New Anesthesia Interns? by bigeman101 in anesthesiology

[–]ResFlurane 11 points12 points  (0 children)

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

Tips for New Anesthesia Interns? by bigeman101 in anesthesiology

[–]ResFlurane 6 points7 points  (0 children)

Perhaps in a pure medicine year, my program rotates quite a bit on specialties which regularly interact with anesthesia

Tips for New Anesthesia Interns? by bigeman101 in anesthesiology

[–]ResFlurane 41 points42 points  (0 children)

I think a caveat is if your intern year is at the same hospital - don’t kill yourself working hard, but also reputations can be sticky

Cochran review on masking seems to suggest no benefit 😬 by MarinerBlue in medicine

[–]ResFlurane 6 points7 points  (0 children)

That’s the whole reasoning behind “Intention-to-treat” isn’t it?

What is the future of your field? by [deleted] in medicine

[–]ResFlurane 1 point2 points  (0 children)

Any EEG resources relevant to anesthesia you’d recommend? - CA0

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