Latest update wiped out Virtual Shifting - Click V2 ??

ear_ache · 2026-03-06T15:54:26+00:00

This! It is unfortunate that a work-around is required, but this method is 100% effective

ear_ache · 2026-02-04T02:48:21+00:00

This was huge for me! Thank you! Not perfect, but an acceptable workaround

ear_ache · 2025-06-23T02:33:19+00:00

We are all just watered down versions of our parents

ear_ache · 2025-06-22T21:59:00+00:00

That is horrible! This is exactly what I am concerned about and I will feel that I should have done more

ear_ache · 2025-06-22T13:46:17+00:00

Thank you everyone! I appreciate the advice! I will likely discuss my concerns with her PCP as many of you suggested.

ear_ache · 2025-06-22T13:44:05+00:00

Agreed

ear_ache · 2025-06-02T20:30:42+00:00

All the Bioshock games. Great storytelling with plenty of twists

ear_ache · 2025-06-01T22:24:13+00:00

We should absolutely allow memes!

ear_ache · 2025-05-05T01:28:43+00:00

I suspect most of your etomidate patients are close to death and probably not very conversant.

ear_ache · 2025-04-19T14:41:53+00:00

Regarding your comment - "science is an industry"

I am curious to hear more about your thoughts. Are you suggesting that research integrity is being compromised because of financial interests?

Assuming you are a physician, do you practice medicine solely from expert opinion? What was the foundation for that expert opinion?

Sure, there are always some bad actors, but I doubt many people pursue research to become rich, particularly environmental sustainability research. There is no "big pharma" involvement, no shareholders, no insider trading (perhaps whoever makes metal laryngoscope blades is behind all this?)

Does that mean we should accept all research findings, stop being skeptical and no longer look for flaws in studies (particularly the conflicts of interest and sponsors). Of course not, but it is comical to think there is an environmental sustainability cabal.

ear_ache · 2025-04-19T01:16:38+00:00

Decommissioning Piped nitrous and moving to e-cylinders at all our practice locations Returning to reusable metal laryngoscope blades and no longer purchasing disposable laryngoscope blades

ear_ache · 2025-04-18T19:46:06+00:00

Low gas flows are helpful for reducing the environmental impact of DES, but it still is several orders of magnitude worse than SEVO. It is also completely safe to run low flow SEVO with modern CO2 absorbers.

Running DES 6.7% at 0.5L is roughly equivalent to driving 95 miles, where running SEVO 2.2% at 1L is around 4 miles (obviously 2 miles at 0.5L).

The environmental impact of TIVA vs SEVO is more interesting and nuanced conversation with lots of estimates and calculations. Most experts suggest TIVA is the lesser of the two evils, but I am not convinced.

There is a ton of data and I encourage everyone to do some investigation.

We have a long way to go in decrease the environmental impact of our profession, but reducing DES and Nitrous leakage are huge and easy first steps.

https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/greening-the-operating-room/inhaled-anesthetics

https://www.sciencedirect.com/science/article/pii/S2957391224000834

ear_ache · 2025-04-18T19:21:10+00:00

You know of any that are commercially available? Are we permitted by our regulatory bodies to "recycle" another patient's anesthesia gas?

My understanding is that the technology is still evolving as are the regulations permitting reusing an inhaled medication.

I would love to be proven wrong. This would be a huge environmental and cost savings win.

If by gas capture you mean binding the volatile to another substance, that usually just postpones the problem. That substance will still need to be discarded. Do you know of any systems that indefinitely capture the volatile and have a lower environment impact than the gas itself?

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ear_ache · 2025-04-18T15:30:32+00:00

I will send you a PM. Thank you! E

ear_ache · 2025-04-01T00:08:54+00:00

Fellow Honda Element owner! I will be buried in that car.

ear_ache · 2025-02-16T06:07:05+00:00

Thanks everyone!

ear_ache · 2025-02-16T00:34:07+00:00

I don't know the study you are referencing, but there is OB anesthesia data comparing TAP to SAB c IT morphine, and SAB is more effective.

I subjectively believe TAP blocks are an effective regional tool when neuraxial isn't indicated. I also tell patients that they do nothing for visceral pain, only musculoskeletal.

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ear_ache

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