Operating without CRNA
Hoping for some honest advice here: For reasons I won't get into, my employer is asking me to perform upcoming phaco cases under "nurse anesthesia" while we look into replacing our CRNA. Employer also owns the ASC and a few of us operate there. I have serious hesitations about letting the nurses administer fentanyl without a CRNA present. Versed, fine. Propofol, obviously not. Am I crazy to put my foot down on this? I'm not comfortable with recussitation and my patients are often elderly... Read more
BACKGROUND: The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a...
This study explored factors associated with normal physiologic birth for women who labored in water.MethodsWe conducted a secondary analysis of a UK-based prospective observational study of 8064 women at low risk of childbirth complications who labored in water. Consecutive women were recruited from birth settings in England, Scotland, and Northern Ireland. Planned place of birth, maternal characteristics, intrapartum events, and maternal and neonatal outcomes were measured. Univariable and multivariable logistic regression modelling explored factors associated with normal physiologic birth.ResultsIn total, 5758 (71.4%) of...
Have we finally reached the other side of the pendulum? We started with a deadly disease that we knew nothing about, and the crazies were most likely those that wanted to do absolutely nothing to protect themselves. Then as time progressed it seemed to be a fairly balanced argument, freedom vs a lesser public health threat, risks of shut downs and mandates vs unsure benefits, etc. Now I feel we have completely finished the swing the other way to the other extreme such as unnecessary... Read more
Anyone have experience and interested in performing CSF catherization for a phase 1 clinical trial in New Jersey? Or do you know anyone interested? If interested DM me please.
So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety... Read more
However, most costs are paid out of pocket
Draeger Fabius MRI Anesthesia Machine, Catalog Number 8607300
Any of you guys getting on, or in discussion about getting one? Inflation was something like ~9% on 2021.
ConclusionsCT-guided TPAC is feasible and safe in a porcine model, serving as a potential alternative pathway for pulmonary artery intervention.Key Points•TPAC is feasible and safe in a porcine model, serving as a potential alternative pathway for pulmonary artery intervention.• This novel approach allows for faster access to the pulmonary artery, and it might be easier to operate the tip of the catheter to super-select the intent branch of the pulmonary artery.• TPAC can be an alternative pulmonary artery intervention pathway in patients with mechanical right-heart valves, great-vessel transposition, and other obstacles.
AbstractPurpose of ReviewMechanical ventilation is an essential part of anesthesia for trauma surgery, but there are few recommendations for intraoperative ventilator management. This review examines the limited evidence for intraoperative ventilator practices during trauma surgeryRecent FindingsMost recommendations for surgical ventilator management are derived from ICU guidelines, but trauma surgery includes considerations not always present in the ICU. During trauma surgery, normoxia or mild hypoxia should be maintained. Permissive hypercapnia may be beneficial in the absence of metabolic acidosis, but priority should b...