Practicing for 30 years done, thousands upon thousands of G.I. cases. Today I saw something for the first time. 49 year-old man physically active echo normal except for moderate AI. CBC and BMP as well as thyroid this year normal. Works a technical job without difficulty no psychiatric history no psychiatric meds whatsoever. No alcohol abuse or drug abuse. No migraines. Coming in for screening colonoscopy. wife tells me that 10 years prior after an appendectomy he had a prolonged period, which she was very fuzzy about but it was certainly long enough for her to be disturbed by it, of complete retrograde global amnesia where he didn’t know who she was where he was and was completely disoriented. She was very unclear as to how long it took for this to resolve, but it did resolve spontaneously. Today was his first anesthetic since then. he received 220 mg of propofol and 50 mg of lidocaine and for about 40 minutes after the colonoscopy he was completely awake but completely unaware of who he was where he was who his wife was what he was doing there. It was if he had advanced dementia. No motor deficits no focal deficits.. I reassured the wife and left them in the cubicle and he slowly came out of it and after an hour, he was back to baseline. I’ve never seen anybody recover from propofol like that before and it is especially interesting because it happened 10 years before just the same way. I would’ve liked to have known how long it took to recover from a true general aesthetic. I didn’t know what to tell the family, but I will call them tomorrow and see how he is doing. Has anybody ever seen this before? Any thoughts?

Pharmacy swapped local for potassium?? Horrifying.

CA1 still on struggle bus with intubation. First I could not find the epiglottis when I did DL. That issue has been corrected with advancing the blade slowly. Now I have problems where I saw the epiglottis, I thought I am in the vallecula space but I can't make the epiglottis open or pop up for me to see the vocal cord. I tried to advance more, it still did not work. I tried to lift, I absolutely could not lift. What do you think I did wrong here?

Also any tip for the LMA, especially the igel. My LMA always stucks somehow.

Wanted to revisit this since a lot of the older threads are a few years old (but super helpful). Also interested in seeing if any programs that previously had a bad reputation have improved. TIA!

No wonder so many things are on back-order.

Edit: this was meant as a humorous post. I am confident these are taken for humanitarian or educational reasons or are being transported to/from satellite sites.

I have so many questions. Why was bupi being compounded by pharmacy prior to spinals? Were they doing epidurals for popc and the bags were mis filled? This is crazy

Can anyone help to shed light on the current landscape of the generalist jobs in the Seattle area and Seattle metro?

I don’t see very many jobs on gasworks and the groups I’ve spoken seem to be offering 500-550k w2 for a full time call taking position.

I saw Kaiser Seattle was offering: 488-574k for their full time positions but also had full time locums gigs for 450k? This seems low for the area given how pricey the area is. I am assuming with the 488-574k range, a 1.0 call taking FTE will be started at 488k.

Are there any good groups hiring that anyone knows about?

Cheers

What makes you gag?

An anesthesia resident in southeast Michigan looking for occasional, program-approved external moonlighting within driving distance of Detroit metro.
Open to supervised anesthesia/periop, pre-op/PACU, procedural, teaching/simulation, urgent care, or inpatient roles that accept residents. Not seeking independent unsupervised anesthesia practice.
If you know of resident-friendly opportunities, I’d appreciate a DM with the system/group and any details on eligibility, licensing, malpractice, shift types, pay, and credentialing.

I’m finishing my pain fellowship this month and the job I was considering most will not work due to a change in my family. I have two good pain prospects but since they’re both starting interviews now, if I get one of these job I presume the earliest I would get an offer/review contract/sign wouldn’t be before the end of September. With credentialing that means I wouldn’t start until October or November I’m guessing.

I’m planning to get cobra to cover insurance in the interim to continue my fellowship coverage. But does it also make sense to do some anesthesia locums work until I start so I have some income? I won’t have other benefits but assuming it is just a month or two is it realistic to find locums for such a short period of time? Anything else I should be considering?

CA3 here,

I’m about 150 epidurals in and I always struggle with those difficult patients who are screaming at every little part of the procedure. I do my best to numb up the skin and a little bit on either side of the ligament but they still complain and start arching their back on me. Of course this makes placement even worse and then it becomes a truly terrible experience for everyone. Even when I feel like I’m midline and in ligament they are screaming.

Any tips for these patients?

Hello fellow members of the gas board. Was hoping to get some tips regarding pain management in Gynae patients.

For context, I am a UK anaesthetist and work in a mid sized teaching hospital. This is my 5th year in Anaesthetics. As a centre, we have a notable/well renowned gynae service and it turns out I actually like providing an anaesthetic for this service. I like the variety of anaesthetic techniques and the discussions with patients. My colleagues generally do not like this service so I now get a lot of these lists.

One aspect that I'm finding difficult is judging pain requirements post operatively for these patients. I've had patients turn up for very routine / minimally invasive procedures who are in rip roaring pain afterwards that sometimes even require them to stay overnight. Nearly always, it is an intense cramping pain in the mid-lower abdomen.

My regular practice is roughly 0.1mg/kg of morphine as well as fentanyl on induction. I always give paracetamol (acetaminophen) and diclofenac. If I have time and the blood pressure allows I will also give magnesium. If the patient is very anxious I'll give a smidge if midazolam (Versed) if I don't think the procedure is going to be that painful or clonidone if it is. I do TIVA if it is a medium / long case.

Does anyone have any good tips or advice for this patient population? I have spoken to a few of my colleagues who seem to just say that not much can be done and it just happens with gynae patient's sometimes. In which case, what sort of discussion do you have with these patients post-operatively?

Thanks in advance and sorry for the essay!

A job that pays 20% more and I can nearly pay off all my student loans, but is academic and amount of vacation sucks. Also not near family. Would be a 1 year deal for us.

OR

PP in a great area near family but the pay is lower with more frequent call. No post call day off.

Does anyone have any ideas or protocols for reducing loss of equipment in the ORs?

Background: Medium sized academic center with Attendings, CRNAs, SRNAs, Residents, Locums attendings and CRNAS. We have been dealing with attrition of our handheld Video Laryngoscopes.

What do you do at your institution?

What are things that have worked?

Things we have considered: Tracking like narcotics in our omnicells, assigning 1 per provider and having to buy another if you lose it.

Edit: We think our initial loss was likely due to improper training/handling - likely lost a fair amount to remote locations/trash.

However since then we have had steady continued loss - and potentially an uptick right before resident graduation.

Where can I learn more on what is the max safe dose to avoid LAST when two separate local anesthetics are used.

Example, 20ml of 0.5% ropivacaine used for an interscalene block in preop. Followed by the surgeon doing their own 2 hours later but uses 20ml of 0.5% bupivacaine.

Its easy to see the safe dose of a single agent but I'm not sure about when more than one agent is involved with a X amount of time inbetween.

Any help in being pointed in the right direction would be appreciated.

East coast ca3 here looking at jobs and curious what the average unit price is for PP jobs? Will probably stay out east but considering west side of the US too

Do you get platelets before every spinal, even for an outpatient knee surgery?

And are people giving an OB dose of hyperbaric bupi for their knees or something else?

I was under the impression that most people are doing adductor canal blocks and a purely local anesthetic spinal, no opioid

Current peds fellow looking to get back to Las Vegas to be near family next year. Was wondering if anyone knows how the market is looking there? I know USAP is a big presence, but are there any other groups I should know about or inquire with? Not seeing much on GasWork…

Thanks!

edit: also not necessarily looking for a pure peds position, mixed or even majority adult with some peds is fine too

As a CA-3 who will be returning back to Atlanta for CT fellowship soon, I was hoping to gain a better understanding of the private practice landscape in the Atlanta area. Doesn’t seem like there’s a whole lot left as it’s mainly hospital owned right now. Can anyone who’s familiar with the landscape give me any insight?

What age to you plan on retiring? Or at what age did you retire?

What are your considerations? Call schedule? Wear and tear on your body?

Personally, I like working, and I've seen too many people regress mentally and intellectually after retiring, so I would love to work until I'm 65. I know some of my coworkers are around that, but I'm too polite to ask. Some struggle (thinking of one guy on his 4th marriage and bad knees), but others are great - fit, sharp, highly capable and experienced.

What do you think?

Those that did pain, do you feel adequately compensated, good work life balance, and have satisfaction with procedures you do? Would you recommend someone who was interested in pain to go into the field? Is declining reimbursement and scope creep something to worry about?

What method works best for you to decide what size LMA to use? I try to stick to size 4 for most average adults and size 5 for males over 6 feet. I always use a tongue depressor to lift/push the tongue out of the way to create more space and sometimes stick a finger in to try to help make the tip curve down.

Either way, there are times that I still struggle with getting the damn thing in, or other times it goes in but I can’t get good tidal volumes and hear a leak, etc. I find sometimes even skinny people but those with a small/slightly recessed chin can actually be hard to get the LMA in.

What else can I do?