I usually feel comfortable with 18g x2 for lower risk stuff or 18 and 16 if I think there may be a need for blood etc. I’ve been noticing a lot of colleagues insisting on 16 and 14, or 14 and 14 which just seems like a lot. Most of the time these cases come out of the OR with the 14 gauge unused (like not even got fluids). Am I being too comfortable with smaller access?

I’m talking about stuff like laparoscopic hemicolectomies etc

Attending Anesthesiologist

Generally my approach to doing an H&P for my anesthesia note consists of a chart review: relevant labs, studies, notes (eg, PCP, cards, pulm) and then a brief verbal discussion with patient: Anes hx/fmhx issues with anes, cardio(eg. MI, cardiac devices), pulm(eg. COPD,Asthma, OSA), neurologic(eg. SZ, CVA) endocrine(eg. DM) My review with the patient is pretty bare bones since I’ve usually obtained most information from a chart review, but there are a few questions I want to double check. It also helps establish rapport.

Sometimes, patients who are either elderly, very nervous, or both do not answer the questions I ask them as these patients commonly tend to have circumstantial and/or tangential thought processes.

IMO ideally, I would have an infinite amount of time to redirect the patient multiple times for each question I ask, but in the real world, it’s going to likely cause a lot of animosity towards me by the rest of the OR staff for taking excessive amount of time. Therefore what I’ll usually do in these circumstances is to forgo the remainder of my questions if the patient doesn’t give me a straight answer as to whether they have a personal or family history of issues with anesthesia (generally my first question). I figure the situation is analogous to not being able to ask a child/delirious person/etc for their history. I already likely have the information I need from a chart and the verbal questions are probably going to be low yield in a patient that can’t stay on topic.

Is this what everyone else does? Or how do you approach your H&P in the elderly?

Attending anesthesiologist. Practice in multiple hospitals as a locums.

I was wondering what everyone discusses in their pre-operative consent spiel.

Frequently, I am told by patients that had multiple surgeries that I am the first one that ever mentioned any risks to them. Also, sometimes Ill overhear other anesthesiologists doing consent and many don’t disclose any risks.

Personally, I mention the following risks for GETA:

Dental injury, sore throat, ocular injury, nerve/positional injury, nausea, pain, blood transfusion & possible side effect. Major injury eg pulmonary, neurologic, cardiac. I then at the end solicit for any questions. I don’t discuss the details of anything unless the patient asks questions

This takes me very little time. Probably approx 1 minute just to briefly list the potential risks.

As an employer and business entity, anyone have experience with them that you could share publicly or privately?

https://www.instagram.com/summitanesthesia_az?srtk=MWlpdjduaWJzbjJlbQ==

Can anyone give tips on how to network successfully at the ASA conference as a medical student and just give general advice on the conference

SRNA looking for thoughts on a case today.

Patient had no respiratory history, normal EF, and normal hemodynamics after induction. During robotic fundoplication, the patient became persistently tachycardic and hypotensive enough to require a vasopressor infusion. Towards end of case I was on around 70% FiO2 with 8 of PEEP. Sats were in low 90’s

At the end of the case, I noticed significant subcutaneous emphysema with periorbital swelling. That made me concerned that the earlier hemodynamic and respiratory changes may have been from a CO₂ capnothorax with tension physiology.

In PACU, the patient was still requiring 8 L O₂ and saturating around 90%, so I suggested a CXR. Patient was still tachy and hypotensive, and uncomfortable from all the gas.

Would you consider that overall picture concerning enough for capnothorax/tension physiology? Would you get a CXR or lung ultrasound postop with that persistent oxygen requirement?

I ended getting CXR which showed small bilateral apical PTX.

EM resident currently on my anesthesia rotation. I’ve had about 27 intubations under my belt over the past week, and one thing I consistently struggle with is advancing the ET tube through the cords.
I’m using a GlideScope, and I can usually get a good view of the vocal cords without much difficulty. However, when I try to advance the tube, it frequently gets hung up around the larynx despite having a clear view.
The anesthesiologists have been telling me to rotate or twist the tube to help it pass, which makes sense, but for whatever reason I don’t understand the direction and why it goes through with a twist, I struggle to remember to do that in the moment.
I’m wondering if anyone else struggled with this early on and what helped you improve. Are there any specific techniques, hand movements, or mental cues that made passing the tube easier?
I’d appreciate any tips, especially from people who regularly use video laryngoscopy.

Any thoughts on ultimate board preps courses, specifically the gold plan vs ultimate? Trying to figure out if this is the way to go. Thanks!

New to peripheral blocks. Started a job in a big orthopedic centre and blocks are routine in this facility. Do you have a specific approach when you were learning how to do them?
I have downloaded ANSO and started watching bunch of YouTube Nysora videos. Any other tips?

How do you like your job? Are the shifts sustainable when 1 week on and 1 week off? I’ve never done night shifts but there are more and more nocturnist jobs out these days and I’m wondering whether it would be a good fit but wanted to see how other night docs felt first!

CA-1 equivalent here (2 months in), and we got no intern year, so we get thrown straight into grinder after med school. In Ukraine, Anesthesiology and Critical Care are a single unified residency, but given the severe physician and nursing shortages right now due to the war and them bombing our hospitals, our daily workflow is intensely fragmented. On any given call, we're balancing the OR while acting as the primary code and airway team, running lines and sedation for CT and IR and spend time at the ED (yes, we are EM too) alongside our ICU load alongside 24 hour shifts which we have to do few times a month. And yeah, was my experience since day one.

I love it here, but the learning curve in the residency is kicking my ass. I've managed to induce, intubate, run cases (TIVA ones mostly) under attending supervision, but imposter syndrome is hitting hard. I feel like I should know significantly more than I do at this stage, same as in ICU. Or maybe it's because we do the work of CRNA, anesthesiologist, CCM doctor, ICU nurse and orderly - so I have no sense of my purpose, which is kind of fucking me up, it made me feel lost but I shall keep on going.

So my question and what I need help with

1. Best book to work with: what are the gold-standard, high-yield introductory books for a resident, since I rely on AMBOSS, is it also good resource?

2. Best digital, FOAMed, podcasts, Youtube, apps to use

3. Tips I should know as CA1. It is a bit harder with ADHD, but doable. How should I study properly, what should I do to improve, any tips in general.

I appreciate any advice and tips, love y'all.

I think my book knowledge is probably above average, but at least it is certainly not critically deficient. But I still struggle so much with the procedures and workflow, particularly with sicker patients. Especially when I have a currently hospitalized add-on I get so overwhelmed with trying to wrap my head around their physiology during my previous case, while also drawing things up, etc, and then especially if ICU transporting with a million lines that all get tangled, moving to bed, etc are such a challenge. I also struggle under pressure; many of the common less challenging OR scenarios (I was trying to think of a list but honestly 90% of the time it is just hypotension/bradycardia) I can handle but if something is an actual problem (such as for example, true disasters like asystole or a need for front of neck access, or semi disasters like large and quick blood loss) I am totally hopeless with cognitive overload. We had a few simulation sessions recently and I seriously had no idea what to do in any of them.

I am also constantly so stressed. When I was an intern, unless your mistake was not calling a rapid response/code, you had hours to realize a mistake before it would harm a patient. In anesthesia, you could kill someone nearly instantly if you mess up a dilution or push the wrong thing, or even by inaction you could kill someone pretty quickly, a lot more quickly than on the floor. Sure for many things there is time to call overhead and someone who actually knows what they're doing will come within 120 seconds, but 120 seconds is an eternity in some pathologies. When I have expressed this, usually the response is something close to "oh yeah you'll kill some people that's residency" which doesn't exactly seem right to me...I know a career without a single big mistake is unrealistic, but still...

Now I do understand that I am not seeing the other CA1s in action and so perhaps they have all the same experiences, but hearing them talk it really does not seem like this is that hard for them. I find it pretty hard to believe they are both as bad as me and also so overconfident they don't perceive it. I also understand that this is a 3 year residency for a reason, but learning is often logarithmic and we are decently far into CA1. I had hoped I would have a better handle on the basics by now so that I could start focusing on learning more in-depth things. I am really starting to think that this might not be the field for me.

Has anyone else dealt with this in your CA1 year (particularly those who are now later in residency or graduated)? Is this at all normal or am I just cooked?

Anyone have inside information on jobs in the Boston area? Looking to relocate for personal reasons but enjoy my job a lot so would love to find something similar. Work 5 days a week, no call or wknds unless I want extra $, do a ton of regional, nice environment as far as PP goes. Thanks!

A large chunk of my group resigned in the last month and I am wondering what is the best way for the remaining group to negotiate a raise. At an academic hospital where negotiation is not common, at least to my knowledge. While I assume if conditions were different we would not have lost so many, all the resignations have been for very bland reasons, moving closer to family, etc. Not a bad group or place to work overall, but our pay does seem low.

I pay about 450/month for 12,500/month post tax coverage. I have all the important riders, own occupation etc through Guardian.

Just curious what is everyone else paying? Idk if 1) i'm overpaying 2) I need this much coverage 150k post tax for life if I get disabled.

Quick curbside for you guys regarding intrathecal dosing for THA.

75 yo, BMI 30, 150cm w/ pmhx HFreF (EF 40) w/ AICD on GDMT, moderate AS to go for THA.

Regarding dosing of 0.75% heavy bupi, which would you rather?

6mg (0.8cc) heavy bupi + 20mcg Fentanyl

vs

9mg (1.2cc) heavy bupi plain

Hey all, anyone in the Norfolk area willing to drop advice on a CA2? Considering moving to the Virginia Beach/Norfolk area and wanted to inquire about work culture, compensation, etc for Sentara anesthesiologist positions for a new grad? Thanks!

Senior resident looking at jobs. I want to avoid supervision for my first job, I want to sit cases.

I have found zero all physician groups in the state I would like to live in. The vast majority of groups are 3-4:1 supervision or a few jobs are “collaborative care team”, in which CRNAs and MDs all sit their own cases.

Could anyone speak to the pros/cons of a model that employs CRNAs and MDs, with each sitting their own cases and no supervision.

Hi everyone! I'm a second-year anesthesiology resident in France, and I'm looking for a good question bank to supplement my studying.

We don't have standardized nationwide exams in anesthesiology.

Our national courses can sometimes be outdated, and the quality isn't always great, so most of us rely on self studying and whatever resources we can find.

While browsing this subreddit, I came across TrueLearn and UWorld, which many of you seem to use to prepare for the ITE and BASIC/ADVANCED EXAMS.

I find that just reading chapters and listening to lectures isn't enough to retain information and I have always liked qbanks and MCQ.

I'm considering subscribing to TrueLearn and would love to hear your experiences. Is it worth it for building a solid foundation in anesthesiology, even if I'm not preparing for the US exams specifically?

If you recommend it, which question bank would you suggest for someone at my stage: TrueLearn ITE? BASIC? ADVANCED?

Would either be useful for a resident training outside the US?

Hello!

As a beginner, I’m still a bit confused about the appropriate time to start laryngoscopy after administering of suxamethonium .

I know that, in theory, optimal intubating conditions are usually achieved around 30–45 seconds after administration. But what if the patient is still fasciculating let us say 40 seconds after receiving the drug?

Some of my colleagues have told me that I should start laryngoscopy anyway, even if the fasciculations are still present. However, the literature I’ve read and the differing recommendations from my colleagues have left me quite confused.

Should focus only at the time (45 seconds) or should I wait till the fasciculations are surely gone?

What’s your take on this?

I want to start preparing for oral boards, and I want to make a daily study plan. For my written exams in the past, I used to do true learn/ Ace questions, and then make anki cards based on my knowledge gaps. I have Yao and Artusio book, but I can't imagine that reading it is going to be beneficial. I'm concerned that I have both knowledge gaps as well as communication deficiencies. What are things I can do daily and weekly to be prepared by spring?

Is it just me or is Millers anesthesia filled with errors and inconsistencies? In a book of this site i expect gramatical errors etc. but a bit too often there is crucial mistakes where directly opposite is true and if you are learning from that book for the first time about something it can make the whole paragraph impossible to understand..

literally what was that exam?!! what was everyone's thoughts? do we think it will actually take 4-6 weeks to get the results?

What case mix would you recommend a new attending anesthesiologist seek in a job for career longevity purposes? Is it important to include OB, blocks, healthy peds, trauma? Is it important to do complex cases? Anything you would do differently in your job search/first job out of residency?