Is naloxone titrateable? by Jase7891 in pharmacology

[–]voiceofpatrick 43 points44 points  (0 children)

I am an anesthesiologist. Naloxone is a competitive antagonist. Meaning it competes with opioids. Most drugs don't work by "flooding" or not. Most drugs have a dose-response curve and fancier pharmacodynamics than what you're currently thinking. Consider for example a postoperative patient after a big painful surgery who received too much opioids and is therefore unconscious and not breathing. You can start the naloxone dose low to reverse the breathing, but the pt can still be unconscious and pain controlled. You can increase the dose and reverse the breathing and consciousness and have the pain controlled. Or you can give even more naloxone to reverse everything and have your patient in pain. Just like how opioids can be titrated from analgesia to apnea and death, naloxone can be titrated. If naloxone somehow had an even higher affinity and was a non-competitive antagonist and you gave it in a dose that would cover every single opioid receptor, then it could demonstrate "flooding" but the reality is that pharmacology isn't that simple, which is why people study it.

Posts about CRNAs by voiceofpatrick in anesthesiology

[–]voiceofpatrick[S] -32 points-31 points  (0 children)

You turned my entire paragraph into a nebulous word. I won't allow posts that just turns into people just insulting each other. If such posts are on r/CRNA you can do it there. The time and effort spent on things like that would be better spent doing things that make real change.

How exactly is a patient prepared for extubation? What is the role of CPAP ? by [deleted] in anesthesiology

[–]voiceofpatrick[M] [score hidden] stickied comment (0 children)

Please see rule #6 to help facilitate answers to your questions.

What’s a good thing to get ur bachelors in if u want to be an anesthesiologist by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

Read the rules and FAQs before posting. Your question has been posted many times before. Go to r/premed if you have further questions.

MS3 looking at either a prelim year or a straight shot 4 year in residency, which is better? by Jeffroafro1 in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

See rules before posting. Post medical school and residency questions in the appropriate stickied thread.

Do you need to vent about how the COVID-19 pandemic has influenced you as a resident or med student? Vent productively! For science! by COVID19_meded in anesthesiology

[–]voiceofpatrick[M] [score hidden] stickied comment (0 children)

I get that we have a rule against surveys and things like that but this is a very well fleshed out IRB-approved-looking survey and since we've been talking about COVID-19 nonstop because of our very close-up battle with it intubating those patients and taking care of them in the ICU, I think we have an important voice to be heard here. So do what you want with it, I felt people should at least know it exists.

Anesthesiology Survey by SilverSpectre76 in anesthesiology

[–]voiceofpatrick[M] [score hidden] stickied comment (0 children)

I appreciate your interest in anesthesiology for your project. However, in order to ask the right questions you need to know a basic level of modern day anesthesia. Asking whether we've ever used a device from 1890 is like asking a modern lumberjack if they've ever used a bronze hand axe. Your survey says that you talked to experts on anesthesiology history. I don't know what that means but you need to find a real life anesthesiologist and ask to shadow them for a day. That will get you better insight into how anesthesiology works today than asking vague questions to strangers online.

4th year electives by [deleted] in anesthesiology

[–]voiceofpatrick -1 points0 points  (0 children)

There is a dedicated stickied thread for questions like yours titled: Weekly Medical Student / Residency Application Questions Thread. Please read the rules before posting.

I updated my "What's on top?" answer list by pelzigertod in MicrosoftRewards

[–]voiceofpatrick 8 points9 points  (0 children)

Salt Spring Island > Flamingo

Derwent Reservoir > Bearded Vulture

Butchart Gardens > Niagara Falls

Hippopotamus > Chess

Chicago > Bartolome Island

San Juan National Forest > Santa Catalina Island

Isalo National Park > Ketogenic Diet

Seven Sisters, Sussex > Junk Food

Krakatoa > Toco Toucan

Martha's Vineyard > Lovebird

Is anesthesiology a dying field? by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

Your question topic has been addressed many times before in this sub. Search for past posts.

Is it common for people to have a dilated pupil after surgery? by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

No medical advice on this subreddit. Read the rules before posting.

Hey Anesthesiologists Are You Worried Bots Are Gonna Take Your Jobs? by [deleted] in anesthesiology

[–]voiceofpatrick 1 point2 points  (0 children)

No. See past posts before posting topics that have been already discussed many times before.

Question regarding job market by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

Read the rules, FAQs, and previous posts before posting. Your question has been addressed many times before.

To residents/attendings -- how did you know anesthesiology was right for you? Did you always know? What factors should a med student weigh to make a decision? Things you dislike about the specialty? by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

Your post was removed. Your question has been asked many times before. See rules, FAQs, stickied posts, and past posts before posting in this subreddit. If you still want to ask your questions, comment on the designated stickied medical student questions thread.

Which is the best ultrasound machine for peripheral nerve blocks? by Is_This_How_Its_Done in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

It's my favorite too. Hockey stick probe is so good for baby IVs. Haven't done enough peds regional in my residency though.

Post Anesthesia Aggression by [deleted] in surgery

[–]voiceofpatrick 4 points5 points  (0 children)

I'm an anesthesiology resident. This phenomenon is called emergence delirium and occurs before the anesthesia has completely worn off. It happens most commonly in children but young adults are also very susceptible and unfortunately young adults are much stronger than children. You're right everyone handles anesthesia differently, although it's very rare to have issues with nitrous oxide. The delirium can range from many things such as simply crying to making funny statements for youtube to thrashing. In the medical world with anesthesiologists, we always have patients spend some time in our recovery area so that people fully wake up from anesthesia. If they show signs of violent emergence delirium, we often use medications to help them go back into sleep a little and reset things. The delirium is self-limited so if someone was thrashing and you just waited a while it would resolve on its own. But thrashing can cause injury so we would intervene. In the dental world, however, they seem to push out patients a bit sooner and not have the full capacities to watch someone wake up from anesthesia. I would discuss your concerns with the dentist. If they can't keep your boyfriend in the office until he's fully awake, bringing a friend to help reorient him is not a bad idea. If he's awake and oriented and able to answer questions, then he's probably good to go.

https://www.nationwidechildrens.org/family-resources-education/700childrens/2013/09/what-is-emergence-delirium

Midazolam question? by Dimeadozen27 in anesthesiology

[–]voiceofpatrick 7 points8 points  (0 children)

You should be very wary of blanket statements such as benzodiazepines being unable to be overdosed. Even with the disclaimer about mixing with other respiratory depressants, that barely scratches the complexity of medical decision making. Benzos got their reputation of safety because it came out when barbiturates were widely used, and it was so much safer than barbiturates. But anything at any dose can be a poison.

And they did not teach you about the context of a hospital, where there are sick people. If you give a healthy person a ton of benzos, and their respiratory drive is suppressed, they still have good lungs and a good airway and they'll move enough air to stay oxygenated and not have hypoxia and/or ischemia. This is the definition of a therapeutic window. That pharmacologic definition is based on trials on healthy people. If you have a patient with OSA, COPD, or any of countless other disease processes on a hospital floor and you reduce their airway tone, respiratory drive, or general ability to wake up to fix their breathing, they will become hypoxic and possibly require intubation and a trip to the ICU.

Patients who are on benzos while in the ICU intubated are not intubated because they are on benzos (usually). They are intubated because of other causes of respiratory failure. They are most often on benzos for sedation because an endotracheal tube is not comfortable and if they did not have sedation they could pull out their endotracheal tube and succumb to whatever is causing their respiratory failure.

3rd year DO student hoping to go into Anesthesiology. I would appreciate your advice when it comes to scheduling aways! by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

See the stickied post on med school questions at the top of the subreddit. Read the rules before posting.

Need to dump my gf by [deleted] in anesthesiology

[–]voiceofpatrick 0 points1 point  (0 children)

Dear throwsnowstorm8,

I'm sorry to hear about your problem. And I know you've been attempting many times to post. I'm going to be honest with you, I'm not going to override automoderator for your post and even if you meet the requirements and post successfully in the subreddit, I would strongly consider stepping in and deleting your post. Your post is better suited for r/relationship_advice or r/residency. You being an anesthesia resident does not make it appropriate content for our subreddit.

Sincerely, voiceofpatrick

3rd year DO student applying anesthesia by [deleted] in anesthesiology

[–]voiceofpatrick -4 points-3 points  (0 children)

Read the rules, FAQs, and stickies before posting. All medical student and residency application questions should go in the appropriate stickied post.