Anesthesia Humor

This video was sent over anonymously.  Funny stuff:

Jan 25, 2012 | 0 comments View Post

Survey of Anesthesiologist Injection Practices

A survey by the New York State Society of Anesthesiologists (NYSSA) and the New York City Department of Health and Mental Hygeine was published and picked up by the press.  The findings do indeed raise some eyebrows as do the reporting of the findings.  This isn’t the first time this blog has drawn attention to this matter.  I guess we are on somewhat of a mission to spread the word: Syringes, needles and (most) vials are not be shared….end of story.  The vast majority of anesthesia providers, even those in training, understand and respect this notion. It is truly unfortunate that this is still an issue.

The survey results are summarized (albeit a bit strangely) in this months Anesthesiology News:

Nearly half (49%) said they sometimes used the same vials of medication for more than one patient—a strict no-no for many kinds of drugs, including propofol.

But perfectly acceptable for many other drugs and this factoid doesn’t distinguish making it worthless imho.

(Indeed, 31% of clinicians who reported using propofol said they had used the same vial on multiple patients.)

When? Last week? In their lifetimes?  It is perfectly acceptable in many institutions for a pharmacist to aseptically split a large vial into smaller ones.  We did this during the great propofol shortage of 2010.

Roughly one-fourth said they did not always use a new needle and syringe when drawing medication from a vial

While technically bad from if it going to the same patient it is less of an issue.  Again, not delineated and the reader should hold there disgust until the facts are clear.

And about the same proportion reported using an open vial of medication even though they had not directly observed someone else opening the container.

Again not uncommon if it is timed, dated, signed and kept locked up this does not violate any rules I know of or the “treat everyone like your mother” doctrine I subscribe to.

Perhaps most concerning, the survey also found that four anesthesia residents in the state (8%) said they had reused syringes on different patients, although the researchers who conducted the survey expressed doubt that everyone who said they did so understood the question. Attending physicians were much less likely to admit to reusing syringes—2%, the survey found, which is in line with previous reports.

Ok what?  They didn’t understand the question?  Then what information should I be taking from this survey? Nothing? Ok.   Less likely to admit to?  Isn’t that journalist code for calling someone a liar?

This is serious business and we at The Anesthesia Blog hate to make light of it but the survey results, if they are true, are disturbing to say the least.  Seriously people if you can’t get your crap together I’m going to force y’all to watch this video on an endless loop:

Thoughts?  Are these results what you have observed in clinical practice?  Comment below.

 

Image: dream designs / FreeDigitalPhotos.net

Jan 23, 2012 | 0 comments View Post

Noninvasive Continuous Total Hemoglobin in the OR?

Tech-y things that should happen in the OR but don’t:

1) Electronic record accessible via touchscreen that shows a given patient’s entire medical history including every radiologic study they ever had and every encounter with any health care provider at any institution.

2) Voice recognition bed control so when the surgeons asks for the table up it happens without anesthesia intervention.

3) Wireless ASA monitors.

4) A reliable noninvasive way to monitor analgesia, CBC, lytes, Blood gases, cardiac output, cerebral/myocardial perfusion. etc etc.

It would be fairly reasonable to assume the many of these things won’t happen anytime soon.  Or will they?:

From Masimo press release:

Irvine, California – January 9, 2012 – Masimo today announced FDA 510(k) clearance and full market commercial launch of the Masimo Pronto-7®—a palm-sized handheld device designed for quick and easy noninvasive spot-checking of total hemoglobin (SpHb®), SpO2, pulse rate, and perfusion index.

This is not the first effort by our friends at Masimo to make most monitoring non-invasive.  Keep up the good work and I sincerely hope to see same papers testing the efficacy of this product in the OR.

Product info.

Jan 19, 2012 | 0 comments View Post

Handbook of Clinical Anesthesia iPhone App Review

The Handbook of Clinical Anesthesia for iOS is an app available via the Skyscape platform. The largest anesthesia “bibles” (Miller and Barash) have companion texts designed to summarize the salient details and make them portable versions of their parent text. This lends to a very portable, easily searched reference for any anesthesia provider. This format also happens to lend itself quite nicely to the iOS platform.

Review:

Navigation of this app is intuitive and easy to use. The relevent tables and graphs are not resized for the screen and are instead made scrollable. This may be good or bad depending on your eyesite and what type of information you are looking for.

Overall, if you use The Handbook of Clinical Anesthesia already and are looking for a reference you can have with you everywhere then this is the app for you. As of this writing there is no other app of this size and breadth. Might be better suited for reinforcement of the main text rather than as a stand alone reference but it is worth the somewhat large price tag for this well-regarded textbook of anesthesia. Unfortunately Baby Miller is only available electronically online and in the Kindle format.

Jan 10, 2012 | 0 comments View Post

Optical Blood Pressure Measurement Is Here

The monitoring of physiology is an important aspect of what we do within anesthesiology. It is almost unfathomable to the new trainee that pulse oximetry has only fairly recently become the standard of care. The measurement of blood pressure has evolved as well. A finger on the radial pulse slowly gave way to the sphygmomanometer. Subsequently, the anesthesia provider soon scoffed at the idea manually auscultating the Korotokoff sounds once oscillometric devices were invented. In what could be the next step in this evolution:

TLT [Tarilian Laser Technologies] has also successfully completed the outstanding break-through development of a stand-alone CUFFLESS device that can not only deliver highly accurate blood pressure readings almost anywhere in the body — but can also deliver key information about the entire arterial tree as well as the heart.

This device is in the preemie stages of development and is not likely to appear in an OR near you anytime soon but the demo looks pretty darn compelling:

Image: jscreationzs / FreeDigitalPhotos.net

Jan 08, 2012 | 0 comments View Post

Journal Watch: Postoperative Visual Loss

This months issue if Anesthesiology highlights a serious complication of surgery we all hope to never face…post operative visual loss (povl).  This dreaded outcome is most commonly seen in prolonged prone cases but up till now it was unclear what the exact mechanisms or risk factors were.  Dr. Lori Lee at UW in Seattle and  a multi-center group published the largest study to date regarding povl:

From Anesthesiology:

 In a case-control examination of 80 patients with ION compared with 315 matched control subjects, independent risk factors were:

  • Male sex
  • Obesity
  • Wilson frame use
  • Longer anesthetic duration
  • Greater estimated blood loss
  • Lower percent colloid administration

I have always suspected the Wilson frame was not our friend but had no idea of the relationship with povl.  The other variables in our control would be blood loss and colloid.  Intraoperative hypotension was noticeably missing from the risk factor list.  As I read it the best anesthetic plan for these cases would be for intraoperative hypotension with a higher colloid utilization over crystalloid performed on the Jackson table.  Comments?

Editorial by Dr Mark Warner here.

 Image: dream designs / FreeDigitalPhotos.net

 

Jan 02, 2012 | 0 comments View Post

Pain Injections Under the Microscope

Guest post by Dr. G Leibowitz:

The practice of pain management has a long history and has evolved over the years from anesthesiolgists running back and forth from the OR to the pain clinic to dedicated, fellowship-trained interventional pain physicians.  Then came the weekend course needle jockeys who desired to tap into the revenue that pain management  provided.  Hopefully this article will have them take pause and realize that a needle in the wrong place can indeed lead to disastrous consequences:

From Bloomberg:

A surge in steroid injections to alleviate back and neck pain in the U.S. is bringing with it an increase in severe and unexpected complications, including paralysis and death. Reports of the side effects have prompted the U.S. Food and Drug Administration to review the safety of steroid injections into the epidural space near the spinal cord, in consultation with an advisory group, the agency confirmed. Some 8.9 million Americans received the shots last year.

The article makes some eye-opening statements:

…pain, a market estimated to be as much as $300 billion a year. Epidurals are one of the interventional procedures — including implants of spinal cord stimulators and shots of pain killers — on which Americans spent $23 billion this year, 231 percent more than in 2002, according to Marketdata Enterprises

I’m aware of physicians of all specialties from Radiology to Family Medicine who have jumped on the bandwagon, took a weekend course and are now pain doctors.  I guess their share of $300 billion was to hard to resist.  Its quite sad really.  My guess is that once the money dries up the herd will go elsewhere (botox maybe?) and the real pain physicians will be left cleaning up their mess. 

 Image: digitalart / FreeDigitalPhotos.net

Dec 30, 2011 | 0 comments View Post

Top 5 Anesthesia-related Stories of 2011

The end of the season brings family, food and a times of reflection. It has been a good year here at The Anesthesia Blog. A new design and with it, a slew of new readers. Thanks for all the positive feedback and suggestions. 2012 looks to be exciting as well with more snarky posts and some added features.

2011 was another ever so interesting year in the ever changing world of anesthesiology. With a little help from from my friends at SDN forums, I have compiled the top 5 anesthesia-related topics for 2011:

1) Conrad Murray- The unfortunate demise of the king of pop drew quite the attention of the popular press. The press zeroed in on anesthesia and propofol in particular. Quick summary in case you have been living under a rock: Dr Conrad Murray, a cardiologist, was hired by MJ to administer propofol and other sedatives to cure his insomnia. Dr Murray obliged for a large fee, went to the bathroom somewhere mid-bolus and returned to an apneic, lifeless king of pop. He was tried and convicted for manslaugther and is set serve four years in jail for his negligience.

The anesthesia community was involved in his testimony. Dr Shafer gave an excellent testimony about propofol use and abuse. Dr White, the defense’s expert gasman was held in contempt of court twice and was seen signing copies of his book on the courtroon steps. Sigh. There were many mentions of the trial by anesthesiologists in the popular press as well as this here blog. Hopefully now that the trial is over and done we can all move on and our patients will stop asking us “Are you gonna use the Michael Jackson drug on me?”.

2) BIS no better than ETAG- Perhaps that scratchy sticker isn’t as useful as some us thought.

3) Drug Shortages- many an anesthesia drug was in short supply in 2011. We began the year with a resolving propfol shortage after some QA issues in the manufacturing plants. Subsequently we saw shortages of fentanyl, neostigmine, succinylcholine, labetalol, rocuronium, bupivicaine,,,etc. Pretty much every class of anesthetic was affected in some way shape or from. Even the president of the United States took notice.

4) Anesthesiologist elected to Congress – Andy Harris, M.D. (R-MD), an obstetric anesthesiologist from Maryland, became the first anesthesiologist ever elected to the U.S. Congress, defeating freshmen incumbent Democratic Frank Kratovil (D-MD). Dr Harris was heavily supported by the ASA PAC as well as the ENT, Optho and Neurosurgical societies. Go ASA PAC!

5) Reform and The consolidation of private practice anesthesia. The corporations are coming! The corporations are coming! Whether it be a reaction to Obamacare or just the natural progression of the business of medicine, 2011 saw many a private anesthesia group sell their souls to the ilks of the publicly traded. The pendulum is indeed swinging.

Anything we missed? Comment below!

Image: Salvatore Vuono / FreeDigitalPhotos.net

Dec 29, 2011 | 0 comments View Post

Anesthesia vs Orthopedics (print edition)

The practice of anesthesia can be difficult, hair-raising at times with occasional horror and little recognition. What many of us see as a lack of prestige later becomes a self-satisfaction in knowing that more often than not we are the smartest person in the room. Ok maybe not all the time.  At least we are during ortho cases right?…

From the BMJ:

Objective To compare the intelligence and grip strength of orthopaedic surgeons and anaesthetists.

Design Multicentre prospective comparative study.

Setting Three UK district general hospitals in 2011.

Participants 36 male orthopaedic surgeons and 40 male anaesthetists at consultant or specialist registrar grade.

Main outcome measures Intelligence test score and dominant hand grip strength.

Results Orthopaedic surgeons had a statistically significantly greater mean grip strength (47.25 (SD 6.95) kg) than anaesthetists (43.83 (7.57) kg). The mean intelligence test score of orthopaedic surgeons was also statistically significantly greater at 105.19 (10.85) compared with 98.38 (14.45) for anaesthetists.

Conclusions Male orthopaedic surgeons have greater intelligence and grip strength than their male anaesthetic colleagues, who should find new ways to make fun of their orthopaedic friends.

Still not clear if this was an attempt at humor. I have to admit it made me chuckle especially the citation of the anesthesia vs orthopedics video as a reference.  Touché Dr. Fracture Fixer, you may have won the battle but the war is far from over!

 

 

Image: Naypong / FreeDigitalPhotos.net

Dec 23, 2011 | 0 comments View Post

NYSORA 10th Annual Winter Symposium – The Recap

NYOSRA’s 10th annual winter symposium recently wrapped up in New York City.  In what apparently was record attendance, the conference was an important update in the world of regional anesthesia and was attended by yours truly. 

For those who don’t know, the NYSORA conference is held every winter in NYC and focuses on regional anesthesia and pain medicine.  The majority of attendees register to learn the latest and greatest in regional anesthesia.  I attended the hands-on workshops in the past and they are a great introduction to regional anesthesia for those with little or no experience in regional anesthesia.  There were also two sets of lectures.  One set focused on the basic science of the blocks and the other side on the latest research.

The sessions regarding the latest from academia were hit or miss as many of theses conferences tend to be.  My take home points are as follows:

  • The euphoria behind continuous catheters may be on the wane as their is little hard evidence at the moment of improved outcomes
  • Ultrasound is a nice tool and might help lower amount of local used but nerve stim just as good.
  • Exparel might very well be the game changer I half-jokingly said it’d be
  • Epidurals for unilateral TKR aren’t worth the complications if you are blocking the femoral nerve anyway
  • Multimodal good, esp Acetaminophen.
  • Don’t skewer the nerve with your block needle (duh).
  • Times Square around the holidays is a NIGHTMARE

There you have it, a six bullet point summary of the NYSORA conference…sorry no CME offered.  Anyone attend and want to chime in?  Comments are open.

Dec 19, 2011 | 0 comments View Post
Next Page »
Easy AdSense Lite by Unreal