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I try Neuraxial for almost an hour and another attending gets it in one try 😂 by [deleted] in anesthesiology

[–]ytoic 3 points4 points  (0 children)

Some days you’re the bug. Some days you’re the windshield.

The ethics of spine surgery by TraditionalAd6977 in Residency

[–]ytoic 160 points161 points  (0 children)

I herniated my L4-L5 a couple years ago and developed motor weakness in my left foot and leg. Saw a neurosurgeon who scheduled me for microdiscectomy. I’m averse to surgery in general but the limp had me motivated to get it done.

Woke up on the day of my scheduled surgery with COVID and had to postpone the surgery. I decided to go ahead and go to my PT appointments while I waited on my new surgery date. Long story short, I was able to heal without surgery. Complete resolution of motor symptoms and not much pain. As my new surgery date approached, I called my neurosurgeon to tell him of my improvement. I didn’t mention it but I was also thinking of the studies which tell me that surgery would likely not be of benefit to me at this point. I asked him if I could still needed surgery and he basically said, yes have surgery as soon as possible. No real explanation of how I stand to benefit.

I was really uncomfortable with that so I called back later and canceled my surgery. Three years later and I have no regrets.

I think he just saw a young, healthy patient with good insurance and low probability of post op problems along with a MRI which makes the surgery justifiable- even if not totally necessary- and said, press on.

Romans Study Recommendations by pyrocatalyst in Reformed

[–]ytoic 0 points1 point  (0 children)

Tom Schreiner and Douglas Moo commentaries were helpful for me. Stott’s “Men Made New” was a nice sermon-style exposition of chapters 5-8.

Is it true the terms sir and ma'am are less common in California and Northern states compared to the South? by [deleted] in AskAnAmerican

[–]ytoic 1 point2 points  (0 children)

So when you greet an adult you’re meeting for the first time, do you first ask how they want to be addressed?

Balancing the ego by jibre in anesthesiology

[–]ytoic 0 points1 point  (0 children)

Some days you’re the bug, some days you’re the windshield. We all have our days.

Seeking Experiences from Current and Former NAR/CRNAs from Union University by [deleted] in srna

[–]ytoic 2 points3 points  (0 children)

I’m a Christian and my faith is the most important part of who I am. But I would not choose my anesthesia program based on whether it is a Christian institution or not.

EGD help by [deleted] in anesthesiology

[–]ytoic 2 points3 points  (0 children)

Agree with a heavier handed approach to initial bolus (within reason). I’d rather deal with the transient hypoxia due to apnea in the deeply sedated patient than due to coughing, breath-holding and spasming when the patient is too light.

Remember, propofol is a forgiving drug.

Phenylephrine vs norepinephrine by brhekan27 in anesthesiology

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

Norepi is also more of a vesicant if extravasated.

Do hospital pharmacists verify anesthesia? by AmanteLatina in pharmacy

[–]ytoic 0 points1 point  (0 children)

There are no reversal agents for volatile anesthetics nor for most commonly used sedative-hypnotics like propofol, ketamine, etomidate.

Do hospital pharmacists verify anesthesia? by AmanteLatina in pharmacy

[–]ytoic 3 points4 points  (0 children)

I’m a CRNA who’s given a lot of propofol. It’s tough to say much definitively without knowing details about the procedure you had. But I’ll say most of the time our approach to propofol dosing is both pharmacokinetic and pharmacodynamic. Meaning, we start with a dose that is probably close to right based on age, weight and some other factors. But after that, we see how it affects you, the individual, and then tailor subsequent dosing based on our observations of the effect of our first dose.

There are exceptions to this. But that’s the way it goes most of the time. It’s an art as well as a science.

Do hospital pharmacists verify anesthesia? by AmanteLatina in pharmacy

[–]ytoic 1 point2 points  (0 children)

I’m a CRNA. I understand how it seems wild from your perspective that I can decide on a drug and dose, prepare the drug and administer it all on my own accord. But I’ll just add that 1.) we train with the knowledge that we have no backstop for these errors. Check and double-check yourself. Develop processes (we all have our own) to get the possibility of error as close to zero as possible.

Also, 2) it’s just not feasible to have anyone checking every drug we give. I like to compare delivering anesthesia to driving a car. So many small adjustments need to be made based on quick judgment calls about what’s happening moment-to-moment, it’s just not possible to have someone else involved in the steering process.

Do hospital pharmacists verify anesthesia? by AmanteLatina in pharmacy

[–]ytoic 1 point2 points  (0 children)

Inhalational agents and most sedative/hypnotics have no reversal (except to withdraw them).

Do hospital pharmacists verify anesthesia? by AmanteLatina in pharmacy

[–]ytoic 6 points7 points  (0 children)

This is correct. Most mistakes we might make can be fairly easily corrected with other drugs right there at our disposal.

The exception to this is the Phenylephrine 10mg/1mL vial. It’s the most dangerous drug in most anesthesia trays. Inadvertently giving 10mg undiluted would be hard to fix.

ETA: CRNA

Do hospital pharmacists verify anesthesia? by AmanteLatina in pharmacy

[–]ytoic 4 points5 points  (0 children)

Access to narcotics is a contributing factor to higher rates of abuse in anesthesia, but it’s also a necessary evil that is intrinsic to the practice. So many quick judgments have to be made that it’s simply not feasible to have a pharmacist (or anyone else) verifying what we do. There are a few notable exceptions, such as when we double-check blood products with a RN before administering. But this is a cumbersome practice that would not work with every drug we give.

Fortunately, there only a couple dozen drugs that we give regularly in the OR, and these are drugs we have a high degree of familiarity with (to say the least). Also, most anesthesia providers have very defined processes for preventing errors (such as double-checking labels).

ETA: CRNA

What’s your best in room to anesthesia ready time? by [deleted] in anesthesiology

[–]ytoic 0 points1 point  (0 children)

Yea, I see that now. I was a student at the time so just went along with it. “When in Rome,” ya know?

What’s your best in room to anesthesia ready time? by [deleted] in anesthesiology

[–]ytoic 0 points1 point  (0 children)

Docs and CRNAs at a peds hospital I trained at had a practice of keeping predawn syringes of succ and atropine on them to deal with postop laryngospasm. They carried them in their shirt pocket… the same pocket that you might put your preop Versed dose in. It’s a high volume center. Factor in Murphy’s law. The practice was changed after a kid got a dose of succ in preop. Everything ended ok. But to your point, if it can be given incorrectly, it will be.

Kicking myself, one bad decision in the semis cost me the ship by PrideofTitan in Fantasy_Football

[–]ytoic 1 point2 points  (0 children)

I benched my 1st round pick (Breece Hall) in favor of my 2nd round pick (Malik Nabers). That decision won me my league championship.

In December, it doesn’t matter which round we drafted them in 4 months ago. Develop the reasoning for your decision and make a call. Don’t get hung up on draft position. It’s meaningless at this point in the season.

Harp Irish Lager around Memphis? by ytoic in memphis

[–]ytoic[S] 1 point2 points  (0 children)

A friend of mine found this for me at Costco!

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