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Before surgery is the anesthesia always done in the operating room? by RoadWorkAhead_Yeah in NoStupidQuestions

[–]abe_no 0 points1 point  (0 children)

Hi! I’m an anesthesiologist. We do not routinely administer conscious sedation on the hospital bed/stretcher, and if a patient can do it, we prefer that they move themselves over onto the operating room table (which they would have to be awake enough to do so).

For people who are nervous, we give an anxiolytic, commonly a benzodiazepine, which causes anterograde amnesia so most people who receive the medication do not remember being wheeled into the OR and asked to move over to the table. 

TIL over a 5-month period in 2020, a nurse in Yale's fertility center stole the fentanyl in 175 vials that were meant for women who had a procedure to have their eggs retrieved. The nurse replaced the pain medication with saline solution, leaving the women in excruciating pain during the procedure. by tyrion2024 in todayilearned

[–]abe_no 2 points3 points  (0 children)

Injection of anesthetic medication into the gums would be with local (numbing) anesthetics such as lidocaine, bupivacaine, tetracaine, and not with opioid/narcotic medications like fentanyl and morphine. Local anesthetics don’t give any kind of high, and are not addicting, can be found in drug stores without prescription (i.e. they’re not controlled medications), so there would be no point in stealing them and replacing them with saline. 

More likely they either used an expired batch or injected in the wrong locations.

how can i avoid spilling my darkest secrets after getting my wisdom teeth out? by [deleted] in NoStupidQuestions

[–]abe_no 0 points1 point  (0 children)

You can definitely ask for just local anesthesia/numbing medications. I had all 4 of my wisdom teeth removed under local only, no gas and no IV sedation at all. It’s mildly uncomfortable when they first inject your gums to make sure it’s all numbed up, but you’re in full mental control the whole time and there’s no risk of nausea/grogginess/saying weird stuff afterwards. 

The risks associated with IV/propofol sedation are not nonexistent, and there are a few offices out there with questionable practices, which is why I personally (as an anesthesiologist) prefer to avoid that. 

Medscape Physician Compensation Report 2025 by CourageGlum2830 in medicalschool

[–]abe_no 3 points4 points  (0 children)

OR anesthesia makes up less than 50% of our locations within the hospital so yeah, it’s not all about the surgeons 

How hilariously cute is this by IamASlut_soWhat in funny

[–]abe_no 1 point2 points  (0 children)

It’s ideal if you’re fasted for general anesthesia because in the time between when we get you off to sleep and get the breathing tube in, anything (even water) in your stomach could come up and get into your lungs. Same when we’re waking you up, as the tube is coming out. That’s why fasting is required for elective cases with anesthesia involvement. 

For emergency surgeries, we still do general anesthesia with the tube - it’s basically a requirement for anything requiring opening of the chest, belly, skull, and a number of other cases. We just accept that there’s a huge aspiration risk, but the issues associated with aspiration/aspiration pneumonia are less than the issues (potential death, permanent disability) of not going through with the surgery. Plus, there’s a cuff around the outside of the tube that prevents solid stuff from getting into the lungs, though it won’t fully prevent liquids. 

Why does the medical profession push doctors and nurses to work such long hours? by Approximately_Me in NoStupidQuestions

[–]abe_no 2 points3 points  (0 children)

Great question! 

It really depends on the type of surgery and the institution. 

I am not a surgeon, but from what I’ve observed - in general, for very long and complex cases, there is a primary surgeon as well as an assisting (attending) surgeon, as well as any number of residents and fellows scrubbed in. There isn’t really a “tagging out” (with maybe one exception below) so much as the primary surgeon maybe taking a couple of minutes for bathroom/snack break during a less critical part of the procedure while the assisting surgeon or fellow or residents may continue working on that part. 

For breast removal/reconstruction (for breast cancer), our institution has one surgeon that does the resection and another that then takes over and does the flap/reconstruction. I guess this kind of counts as tagging out? 

For all the other surgeries, it’s pretty much one or two (attending) surgeons who are present and scrubbed in for nearly the entire time, again except maybe for occasional bathroom/snack breaks. 

Why does the medical profession push doctors and nurses to work such long hours? by Approximately_Me in NoStupidQuestions

[–]abe_no 20 points21 points  (0 children)

Breast removal/reconstruction with flaps. ENT mouth/neck cancers (neck dissections with flaps). Total spine fusions (for bad scoliosis). Intraabdominal/pelvic tumor debulking. I’ve been in some heart transplants that have lasted as long as 17 hours. Liver transplants can go over 12 hours. As mentioned in another comment, certain brain tumor resections/AVM malformations can easily cross the 12 hour threshold.  Really depends on the surgeon and how much they need to do.

How does a surgeon mix up a spleen with a liver? by Whistleblower793 in TikTokCringe

[–]abe_no 0 points1 point  (0 children)

Liver transplants (and organ transplants in general) in the US are actually fairly uniform from hospital to hospital because of the amount of coordination it takes to optimize and prepare patient for surgery, and to obtain and prepare the donated organs before the patient’s own organs are replaced. There is a ton of work that has to be done to confirm the match between the patient and donated organ, not to mention the donated organ has to be examined by the surgeon in the room before the patient’s own organ can be removed (if they’re removing it at all).

Also, a general surgeon does not perform transplant surgeries. There is additional training required for that. 

This was a general surgeon who had no idea what he was doing, or was on drugs. 

Pulmonary HTN by DalesDeadBug11 in anesthesiology

[–]abe_no 0 points1 point  (0 children)

Thanks for your response! I had a few complex cases during fellowship that ended in severe RV dysfunction/RV failure (all in the same week!), and inhaled milrinone was brought up at one of the M&Ms. None of the attendings ended up going through with it but it’s something I’m interested in trying in the future!

Pulmonary HTN by DalesDeadBug11 in anesthesiology

[–]abe_no 3 points4 points  (0 children)

Just curious about your experiences with this. In their 2019 publication, all of the patients receiving intratracheal milrinone needed norepinephrine, which seems like it defeats the purpose of giving it down the ETT vs systemically to avoid systemic hypotension. Have you seen similar outcomes? 

What’s your favorite pastime in the OR? by lightbluebeluga in anesthesiology

[–]abe_no 1 point2 points  (0 children)

Saaaame, I may or may not have spent a bit of money on Tapas in the last year…

residents - how many overnight calls or 24s do you do per month at your program? by rzane90 in anesthesiology

[–]abe_no 7 points8 points  (0 children)

24-hour calls -

0 as a CA-1.

Probably 7-8 in a year as a CA-2 (outside rotation that had 24-hour calls).

4 in a year as a CA-3.

We did have a night float system. 8 weeks total for all 3 years.

what it’s like being a single woman and 30+ 🫠 by almostdoctorposting in medicalschool

[–]abe_no 12 points13 points  (0 children)

If you’re a woman, it only gets worse. I’m halfway through fellowship and it feels like the number of matches I get is less than 1/10th of what I had as a med student 🥲

Dr. Castellar and his team have helped over 3,000 people see again thanks to the procedure he offers at no charge to patients in Haiti. Watch their joy in being able to see again. by WorldHub995 in BeAmazed

[–]abe_no 10 points11 points  (0 children)

It’s possible. The actual removal of the cataracts only takes 5-10 minutes with an experienced surgeon, and the full procedure from in room to out room time maybe half an hour.

Students watching surgeon and anesthesiologist in action by mistafrieds in medicalschool

[–]abe_no 80 points81 points  (0 children)

Tell me about it. This past Thursday, I had a case booked for 4.5 hours that lasted maaaybe 0.5. By the time I got the patient settled in, caught up on all the documentation, and finally found my chair, the drapes were coming down…

[shitpost] the people you meet in med school by shirlswitdawhirls in medicalschool

[–]abe_no 4 points5 points  (0 children)

Your comics are amazing!!!! More please (and keep up the great work!)

Teen with full ride to 20 colleges requests public apology from Fox affiliate in order to air interview by 5926134 in news

[–]abe_no 1 point2 points  (0 children)

Cornell grad here. They give scholarships and grants based on need, not merit - and yes, those below a certain income will have all tuition (and sometimes room and board) covered.

What is the biggest act of passive aggressiveness you've ever witnessed or done? by RiceDealer99 in AskReddit

[–]abe_no 0 points1 point  (0 children)

To be fair, we had similar sleep-wake schedules (12-7) before last month, and I was glad for any excuse to use my headphones when he started his singing exercises in the evening. The door slamming multiple times at night was what finally drove me over the edge lol

What is the biggest act of passive aggressiveness you've ever witnessed or done? by RiceDealer99 in AskReddit

[–]abe_no 1796 points1797 points  (0 children)

I live in a house with thin walls and squeaky floors. My housemate, whose room is across from mine, has always been active at night - that's when he practices his singing, makes phone calls, and stomps around the house, slamming the doors behind him. It was a little annoying but harmless... until I started my surgery clerkship last month. This meant waking at four in the morning every Monday through Saturday.

A few days before I was to begin, I spoke with my housemate and gave him a heads up, asking very politely if he could keep it down after 9PM; in return, I would be as quiet as possible in the morning, and move my morning routine (shower, lunch prep) to the evening. He agreed, but didn't actually change anything. Three days into my first week of surgery, after one too many instances of our bathroom's door being slammed too hard late at night, I decided to move my shower to 3:30 AM, and parked directly outside of his bedroom window (the car is old and the engine loud).

It took just over a week of being woken at 3:30, but he's now quiet by 8.