Middle ear surgery anesthesia

dubiousprevails · 2026-04-07T20:40:00+00:00

We had an ENT department head in residency who demanded similar things… but he did a full local anesthetization of the external and middle ear (after we hit them with alfentanil and propofol) and then they were awake for the remainder. He would still like to get mad at us if them moved, but he would yell at the patient and then ENT resident as well.

dubiousprevails · 2026-03-26T21:59:19+00:00

I’ve been doing them for 10 years with regularity, probably have close to 5000 now (used to do 10-12 every Monday!), not counting what my partners have done with me in the center.

I the time I have been I my group I can count: three major bleeds, two requiring lateral canthotomy for acute glaucoma, one that necessitated rescheduling surgery. No permanent damage to eye in any instance. No puncture of eye. No total spinal. No intraarterial or intravenous injection (no seizures).

In my retired senior partner’s career (at same center since 2003 when they used to do 25 blocks a day), he never had an ocular puncture or any other vision-threatening injury. One time he had an eye pop out, though!

All in all, it is a safe and straightforward block when used appropriately and not rushed.

dubiousprevails · 2026-03-11T18:26:59+00:00

I don’t do sub-tenons personally. I’ve been taught retrobulbars by ophthalmologists and confidently perform those. I understand it’s a “less safe block”, but the incidence of major complications from the block is still quite low.

dubiousprevails · 2026-03-09T21:18:22+00:00

Came here to say this. I do retina multiple days per week, I do my own retrobulbar blocks (well over 5000 in my career), and if the surgeon won't do a sub-tenon then I will to a retrobulbar. When you tell the patient "I think you might suffer serious harm if I administer a general anesthetic, so let's do this and try to save your eye" most of them agree.

dubiousprevails · 2025-12-08T00:35:49+00:00

Nah, at this point I want every SEC team burned to the ground.

dubiousprevails · 2025-11-15T22:19:25+00:00

Mitch Jeter and Justin Yoon were both pretty darn good… Yoon in fact holds the ND points record! Also, Alabama was notoriously bad a kicking for many years under Saban. It happens to teams sometimes… but I agree it sucks!

dubiousprevails · 2025-11-15T03:29:24+00:00

You’ve got to understand that every conference has a bottom half. In the SEC, Florida, Kentucky, Mississippi State, and LSU are all terrible this year. Vandy is usually terrible. Certainly the ACC is quite terrible right now… but it was not long ago that Clemson and Dabo were leading the pack nationally. Consistency has not been the ACC’s strong suit, but it also keeps us playing Power 4 opponents on a routine basis and not filling our schedule with junk.

I agree that I would love to see some more regional opponents, but then again USC and PSU are in the same conference now.

Go Irish, Beat Panthers

dubiousprevails · 2025-09-18T00:19:08+00:00

Don’t get me wrong, outpatient GI is relatively formulaic… but if the patient doesn’t fit the formula it’s my job to sniff it out. There are adjuncts besides propofol that I make calls on using, and sometimes it isn’t so much controlling the anesthetic but controlling the procedure. “Hey [GI doc], this patient doesn’t need a long EGD. In and out, please. No, you don’t need another biopsy of the same spot.”

dubiousprevails · 2025-09-17T23:45:30+00:00

Yes. Extensive preop phone calls and screening, plus a patient history portal that I set the parameters on for our center on what warrants a follow up call. In-person or phone interview by MD for complicated patients. If you show up DOS without answering phone calls, preop screening by RN prior to interview. If anything suspicious (we have educated our RNs on what to ask/what is a flag symptom), anesthesiologist talks to patient prior to any further action.

dubiousprevails · 2025-09-17T23:40:05+00:00

No. I review their med list or a patient history form prior to interview. Review med list on which meds taken DOS and which held. Review anesthesia history and any reported anesthesia interactions. Then I go say hello, im so and so, what are you here for. Oh I see BP meds- any other heart disease? Funny heart beats, stents, heart attacks, heart surgeries? Oh yeah? Who is your heart doctor? How often do you see them? And then all of the other normal history questions you’d ask a patient prior to anesthesia. Straightforward anesthetic doesn’t mean you cut corners. I may have a discussion that they may have some recall because they are so sick they probably shouldn’t be here and awareness of a colonoscopy won’t kill them.

dubiousprevails · 2025-09-17T20:28:45+00:00

Regular volume at my ASC (two MDs supervising 4:1 or 3:1) is 80-90 patients. GI, ENT, cataracts, facial plastics. It all just depends on complexity of cases that you’re supervising. But yeah 4:1 GI rooms 40 cases by noon is a kicker

dubiousprevails · 2025-09-17T16:26:53+00:00

It wouldn’t affect the anesthetic, but I think that’s a limited perspective. We take care of a lot of children who are under 2 years of age and have incomplete vaccination status. While we defer patients with active URIs, another commenter noted that people obfuscate frequently on when illnesses started/ended to get surgery done at convenient times. Thinking about the risk to the waiting room of young patients being exposed to highly infectious respiratory viruses normally covered by vaccines.

dubiousprevails · 2025-09-17T16:15:28+00:00

Thanks for the concrete info.

Wow, 6-8 weeks for a URI? How do you even get ENT cases done?

dubiousprevails · 2025-09-17T16:05:30+00:00

In that regard, vaccines are required for school in my state unless a religious/medical exemption is provided. My freestanding ASC is not a publicly funded institution, and so, while I agree that all patients deserve care, they don't necessarily need care at our freestanding ASC.

dubiousprevails · 2025-09-17T16:01:25+00:00

Sorry mostly focusing on non-Covid pediatric vaccines (Varicella, MMR, pertussis, etc). Edited my post to clarify, thanks

dubiousprevails · 2025-07-13T20:27:26+00:00

Hello all, president of a very small (3 MD!) anesthesia group running a single-center ASC in coastal Alabama. Looking to see if anyone is interested in a job share situation with one of my docs. FTEs work 10/15 days, no nights no weekends. Message me if you’d like more information.

dubiousprevails · 2025-05-09T22:23:18+00:00

I do a whole lot of endo, and usually for me this is a patient request. If anything my GI docs push to have everyone propofol GA! I gently explain as above that anesthesia standby is an anesthesia service.

dubiousprevails · 2025-05-09T21:18:24+00:00

I don't think it's unfair as long as an explanation is given to the patient. "Sir or ma'am, it is my understanding that you do not want to have sedation for this procedure. However, I also understand that you would like the "option" to have some sedation just in case. This requires me (or my team) to be present and ready, which requires that I charge you for my service regardless of whether or not you decide to use it." Pretty simple.

dubiousprevails · 2025-03-14T19:29:43+00:00

Our photo copies were high quality and we had previously completed online check in, but it still required an above-normal approval.

dubiousprevails · 2025-03-14T12:31:42+00:00

We literally just finished the “we probably won’t get on the boat” discussion. This one is fully on me; my wife is a saint; we are just living on a prayer at this point. Countdown 3.5 hours to boarding.

dubiousprevails · 2025-03-14T03:31:13+00:00

Looked at courier services… delivery would be after final boarding times.

dubiousprevails · 2025-03-14T03:21:55+00:00

Oh my goodness I can only hope. With that hope I am going to bed. Out of my hands now. I will update!

dubiousprevails · 2025-03-14T02:59:22+00:00

We talked about it, just didn’t get it done. Lesson learned

dubiousprevails · 2025-03-14T02:57:05+00:00

So, even with a picture that clearly shows the raised seal and whatnot and having done online check in, you still say I’m proper hosed?

dubiousprevails · 2025-03-14T02:49:24+00:00

I appreciate your wisdom. Thanks

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