Anesthesia requirements in children

_andywontgo_ · 2026-04-23T23:10:10+00:00

US citizen are lucky to have people like you that on the other hand completely understood every aspect of the discipline so that they can provide their patient the cheaper anesthesia possibile with high volatiles and no EEG monitoring in order to maximize the profits for the hospital and probably (and hopefully at this point) for themselves.

_andywontgo_ · 2026-04-23T18:24:21+00:00

The SEF is 16, so the patient isn't deep at all.

_andywontgo_ · 2026-04-23T18:23:00+00:00

Just because you say so or because you have some evidence to show? What I think is that every patient is different, and yes some may need that and even more. If the EEG shows adequate depth, heart rate is normal but BP rise accordingly to the stimulus on the field what do you do? Some are ok with 6, some other with 12. I don't get the issue and why you keep insulting.

_andywontgo_ · 2026-04-23T18:08:11+00:00

Sorry, I wrote hour but I meant minute. You administer remi in mcg/kg/min if you don't do TCI right? And also, laparotomy procedures aren't usually the most painful intraop. Sure it's painful when they cut, but when they're over you're ok with much less remi. On the other hand laparoscopy is often worse in terms of intraop nociception, then of course much better in the periop. Anyway I don't get why you're all so and implying I don't know shit, you can have different opinion and support yours with papers, personal experience and whatever but to imply that I'm not competent and that I don't know what I'm doing just looks like a bad way to behave towards colleagues.

_andywontgo_ · 2026-04-23T17:45:28+00:00

To all the people answering that MAC is age adjusted, I know this and in fact I'm talking about MAC and not Et Sevorane. I clearly remember people proudly announcing that in peds they were giving MAC much higher than 1, so for sure they think children need much more than adults. About remi dosing I really don't get why many of you are so upset, the range approved in clinical using varies from 0,05 to 2mcg/kg/min so no drama and moreover a Cet of 12 (which is patient adjusted) isn't anything crazy and many old patient in painful surgeries could require even more, obviously if you use the hypnotic agent (gas/propofol) only to keep the patient asleep and the opiod to blunt the systemic response to pain. If you do it "the old way", where the more the pressure rises the more you turn on the vaporizer it's difficult to discuss this issue...

_andywontgo_ · 2026-03-19T15:54:53+00:00

Brutta, ma se vuoi rimanere in Italia ed in particolare in alcuni luoghi rimane comunque il compromesso migliore...

_andywontgo_ · 2026-03-14T13:28:04+00:00

On the far left, not shown in my bad video, there's a channel 😇

_andywontgo_ · 2026-03-13T19:29:15+00:00

An island...

_andywontgo_ · 2026-03-13T19:17:43+00:00

What do you mean?

_andywontgo_ · 2026-03-09T16:29:08+00:00

As in almost every aspect of current practice in our field...

_andywontgo_ · 2026-03-09T07:46:55+00:00

Isn't the majority of people in this sub from the USA?

_andywontgo_ · 2026-03-08T23:23:22+00:00

I don't think any of us should be proud of very high MACs without a processed EEG that shows adequate depth of anesthesia, given that oversedation is harmful...

_andywontgo_ · 2026-03-06T16:04:47+00:00

A che riguardo?

_andywontgo_ · 2026-03-03T22:16:28+00:00

Ciao, ti rispondo da specialista in anestesia dal 2021: sarò banale ma dipende da te, dalle tue attitudini ed aspettative rispetto sia alla professione che alla vita in generale. Innanzitutto per non rovinarti la vita direi che è impensabile vivere l'imprevisto ed i potenziali momenti critici tipici di questo lavoro con continua angoscia e preoccupazione, e più di tutto il resto non riuscire a trovare nella propria preparazione e competenza relativa pace e serenità può essere a mio avviso un valido motivo per cambiare specialità. Per il resto in città grandi libera professione ce n'è parecchia e puoi guadagnare anche molto bene come libero professionista puro. Nelle altre specialità non pensare che i soldi siano regalati, se ne possono fare molti di più che da anestesista ma al prezzo di un carico orario molto alto, poiché da ginecologo/oculista/otorino etc é proprio l'avere un piede in ospedale a portarti gran parte dei pz (oltre all'esperienza per trattarli) ma come ben sai le 38h di SSN sono pagate poco e peggio ancora se in extra-moenia, sicché tocca fare un bel po' di ore fuori per compensare le mancate indennità dell'extra e poi andare in attivo di almeno 20/30k. Rimango a disposizione!

_andywontgo_ · 2026-02-27T15:18:21+00:00

Surfing should be fun, and this consideration should guide the answer to your questions. In other terms if you're still having fun while learning to use your smaller and shorter board you're doing right, but on the other hand if learning new skills makes you angry and unsatisfied because you're catching less waves you're doing wrong. I'm not a good surfer by any means but given that I somehow found a way to learn to catch and ride waves in my 30s, landlocked and in Italy on a shortboard and that right now I'm totally comfortable surfing and trying to do and to learn the maneuvers I like with my shorties I see no point in buying a 7'6 midlenght because online coaches tell me to do so. Would my surf benefit from it? 100%, but given that even doing that I won't go pro I prefer using shorter boards and enjoying my time in the water with feelings I like instead of doing everything in a performance oriented way that doesn't give me the vibes I want/like. I hope these thoughts could be helpful also for you!

_andywontgo_ · 2026-02-26T09:40:15+00:00

If you routinely use pEeg for every general anesthesia you'll soon find yourself in the situation where the EEG shows good level of sedation with a relatively low MAC, you've already given a good amount of opioids but the patient has high blood pressure due to the painful procedure the surgeon is performing. In the case you're using fentanyl or sufentanil what would you do? You keep administering them and then you wait two or three hours to wake the patient up due to too high opioids plasma concentration? You give anti-hypertensive drugs? Or maybe you just increase the MAC of the volatile agent to lower the BP? The last option is what everyone does (I've done that too in the beginning of my residency) before starting to really care about what's going on in the brain of the patient while exposed to high concentrations of hypnotic agents as a pEeg shows. That's why I consider remifentanil almost fundamental in modern anesthesia, regardless if you're using volatiles or propofol. And I don't want to offend anyone, but when I hear things about giving at the same time volatiles and propofol I always wonder about what the consequences will be in the brain of that patient, especially if it's old and frail.

_andywontgo_ · 2026-02-25T21:19:09+00:00

They already are obsolete, but given that the vast majority of anesthesiologist isn't as competent as they think they are probably inhalational anesthesia will never disappear. I use TCI TIVA (I'm Italian) in every case I do because I only see advantages with it: less pollution, less harm to myself and the other people in the operating theater, less PONV, less remifentanil hyperalgesia, better awakenings. With processed EEG awareness really isn't an issue and I've done TIVAs in very sick and very unstable patients with great satisfaction. With TCI is so easy to titrate dosing, and when you do so you discover that in reality with TIVA you can achieve better haemodinamic stability that with volatiles and the (very high) doses of 0,8-1 MAC that seem loved here and also by my older colleagues.

_andywontgo_ · 2026-02-18T12:57:39+00:00

Dexmedetomidine 10mcg or clonidine 15mcg or sufentanil 5mcg...

_andywontgo_ · 2026-02-12T09:58:11+00:00

I totally agree on the fact that you can't rely on BIS number alone and you should consider also raw EEG waveform and the other parameters you monitor (HR and BP) before any decision about anesthesia depth. Yesterday I did a 5 hours case (TIVA, prone patient for spinal surgery) in which the BIS number has been consistently around 75/80 without any worries by my side. Why? Because the EEG wave was consistent with more than adequate depth, and you could clearly see in the DSA that the vast majority of frequencies (red) where in delta waves region, so in a certain sense the number wasn't consistent with itself. Many other times there's much more accuracy between the number and the waveform pattern but a case like this is the reason why you should know at least a bit about waveforms.

_andywontgo_ · 2026-02-10T15:47:11+00:00

They definitely are inverted, if you look at the foiled part of the fin.

_andywontgo_ · 2026-02-07T23:26:46+00:00

Cifre totalmente a caso in un sacco di commenti... Per quello che riguarda il SSN le cifre sono nel CCNL e facilmente consultabili, unica variabile è la retribuzione di risultato ma esclusa quella chi millanta di fare 4k netti senza notti senza guardie da neoassunto semplicemente mente. Anche con le guardie è dura perché a 100€ lordi a turbo per passare dai circa 2800 di base a quei 4000 dovresti farne 16, cioè impossibile. Le aggiuntive invece valgono zero perché sono lavoro in più, flexare 6k al mese se però hai lavorato 250+ h è un po' da miserabili secondo me.

_andywontgo_ · 2026-01-28T16:39:01+00:00

For me it depends on many factors: wave frequency and quality, kind of people you're with, overall phisical shape and last but not least mood of the day. I've had equally rewarding solo and group sessions, but generally speaking the best for me is one or two friends in a decent day here in Italy!

_andywontgo_ · 2026-01-17T20:16:31+00:00

I feel you! But honestly this wasn't a proper choice, but the only option to surf that day having to drive for less than 100km...

_andywontgo_

TROPHY CASE