Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable.
Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine.
Welcome to r/anesthesiology!
This is the place to discuss the art and science of the medical specialty.
Anesthesiologists are physicians who specialize in providing safe and effective perioperative medicine, pain management, and critical care medicine.
This is NOT the place to ask questions about how to become an anesthesiologist, help with getting into residency, or to decide if a career in anesthesia (Certified Registered Nurse Anesthetist, Anesthesiologist Assistant) is the correct choice for you. This includes asking questions about the residency application outside of the monthly thread. Posts along these threads will be removed and users may be banned.
This is also NOT the place to ask medical questions unless you are somehow professionally involved with the practice of anesthesiology. Violators may be subject to a permanent ban without warning.
Rules in Brief
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This subreddit is for professional discussion about the medical specialty of anesthesiology.
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Moderators reserve the right to moderate.
Important Dates:
Physician Anesthesiologists Week: Last week of January
Annual Meeting of the American Society of Anesthesiologists: October
Ether Day: October 16, 1846
Useful Links:
American Society of Anesthesiologists
/r/medicalschool post on anesthesiology
Wood Library-Museum: History of Anesthesia
Related Subreddits:
/r/anesthesiology
I am a 2nd year resident at a smaller regional hospital. I like it very much at my hospital and love the team but I have spoken with some friends of my family who are attending at different hospitals and they have expressed concern that our scope of practice is too little to become a good anesthesiologist.
So I would like to ask if you think that through.
What we have at our hospital:
Ortho (Does almost eveything but little to no spines)
General surgery (No livers, pancreas or thyroid and other „special“ stuff like transplants)
Vascular surgery (Little to no aorta stuff)
ENT (Strictly no tumors, mostly small stuff)
Ob/Gyn (Mostly C-Section and other small stuff, again no tumors)
Ophto (almost alwqys without anesthesia)
Urology (Shares a robot with general surgery, no tumors except for small endo stuff)
IR (maybe once a week and in emergencies)
We have 2 thorax surgeons but they operate maybe once a month on smaller stuff
We take kids above 1 year (mostly ENT and uro stuff)
We do more regional stuff than other hospitals that I’ve rotated through as a med student
Normally residents rotate to a bigger hospital for children and neurosurgery rotations for 3 months. But that might not be possible in the future.
The attendings that I spoke to were concerned because I won’t get to experience hearth/ thorax and maybe neurosurgery and smaller kids. They said I should look into switching hospital maybe in 3rd year so I get to experience more, if I don’t want to work in small hospitals my whole live. The caveat is that they are all from academic hospitals.
I would appreciate your input in this situation. Do you think switching is really necessary to become a good anesthesiologist?
P.S. posting from a throwaway so I dont doxx myself and this is not in the US so changing hospital is pretty common and not such a big deal.
Is this typical? Every job I’ve had before this has automatically had tail insurance and I didn’t even have to talk about it. But this job isn’t. They’re saying that I can pick whatever policy I want, but if it is a higher premium than what everybody else has, I have to pay the difference out of my paycheck. Is this a red flag? Everything else about the job seems good.
CA2. Looking for jobs in flyover country as a 1099. Coming from a big name workhorse residency known for its strong training.
Is $325-350/hr too high to demand as a generalist?
I was just looking around on doccafe for locums gigs and I’m seeing a ton of offers around $265-300 range. On Reddit people say never take less than $400 an hour. I was surprised to see so many sub $300 offers for locums for MDs. I’ve seen CRNA with higher rates.
What are your thoughts? And how do we find the good gigs people be talking about here on Reddit?
Today during a colorectal surgery the patient’s (with ischemic cardiomyopathy with significant reduced ejection fraction) heart rate suddenly dropped unter 30/min after a new skin incision probably because of vasovagal reaction. It was probably ventricular escape rhythm. Blood pressure dropped just a little bit. Since it persisted for a 30-60 seconds and I gave 0,5 mg atropine and it went to AIVR with frequency of 65/min. Should I have waited a bit longer? This patient had already sinus bradycardia of 47/min pre-op and recieved 0,4 mg glycopyronnium during the induction.
New attending here. Wondering if anyone has any experience on how to do something akin to an inspiratory hold on the drager fabius? I’ve done it on the apollo by shifting the Tiinsp to 30% from 10%, not sure how to do it on the fabius
I was wondering how the reputation of residency programs has affected job prospects in the past. Since the market is hot right now, it seems employers don’t care where people train because there are more jobs than people but in the past when the market wasn’t as favorable, where employers more concerned with where you did your training? I’m putting together my rank list and the closest programs to my home that I have interviews from are all small community programs (ruhs, riverside community, kaweah delta) but I also have interviews from programs that have more “name value” and better overall training such as UT Houston or Loyola. Would appreciate any thoughts you all might have or if you have seen any effects of your choice of training institution. Thank you!
Placed an arterial line the other day without complication. Positive Allen’s test prior to insertion. Placement was without complication and a-line had good waveform. When flushing the line, however, that patient reported severe “burning” pain approximately 3 seconds after the flush. Has anyone experienced this? Digits remained warm and appeared well perfused throughout. Pain subsided after several seconds.
What are people’s thought on 1-AI in terms of how you use it in practice/ on the job? 2-How do you see the future of AI integration into anesthesiology occurring? 3- fears or opportunities?
I use it fairly often I find it fun, interesting and usually helpful
I know lots of people who do chronic pain or ICU as well as anesthesia. I have been interested in palliative care lately. Wondering if anyone on here also does this on the side? Curious to hear your experiences with it if so.
Hi Folks, what are your thoughts about perioperative intravenous lidocaine infusion?
Evidence regarding postoperative pain reduction/bowel movement improvement due to opioid reduction/less PONV is quite bad as far as I am informed. But if any of you have a different opinion, a well established regime you use etc. I would be very interested!
Hey everyone,
Wondering if anyone has any info on this residency program? Ive read some negative things about the program (malignant toxic culture etc) that I'm not sure are outdated. Was hoping to get some details from current/former residents.
Thanks!
Surgeon has a few patients with very bad peripheral disease leading to terrible foot pain and are planning AKA. They have other comorbidities that would make general anesthesia pretty dangerous. AKA would let them better enjoy their last few months. Bed bound. He is asking about doing a popliteal sciatic nerve ablation. Is this anything someone has done?
Hey all,
Have had zero opportunity to work with Anesthesia CC. I've always heard anesthesia-trained intensivists often bring a different approach to CCM than the IM-trained intensivists.
Curious if there was something you could tell/teach/drill-in/ask of your PulmCC colleagues, what would it be?
EDIT: big thing seems to be to not forget that people hemorrhage sometimes
We're having an issue in our hospital that seems to be quite common: surgeons always want more muscle blockade. However, they often use rationale for this that doesn't seem to be lege artis. During intestinal surgery, they're often bothered by the peristaltic movements of the bowel. Not sure exactly how this impedes them but basically they want the intestine to be completely motionless. To achieve this, they want us to give the patient more rocuronium, even with TOF 0. As rocuronium is supposed to primarily affect nicotinic receptors and not muscarinic, I'm not convinced this is a sound strategy. Intestinal motility is mainly affected by M2 and M3. Rocuronium seems to have a little bit of affinity for these, but probably requiring very high doses link1 link2. Clinically, this should also result in cardiac effects, which I can't say I notice when administering rocuronium. To me, it seems more reasonable to administer something like glycopyrronium for this purpose, which we know has antimuscarinic effects. My suspicion is that what is really happening is that peristalsis is a periodic process, so basically no matter what intervention you do, the peristalsis will lessen by itself. This could lead to superstition.
Basically, this practice smells like bullshit to me, and has real risks in the form of increased probability of residual paralysis with increased rocuronium dosages. However, I just want to check with you guys if this is something you've handled in your clinical practice. Perhaps our surgeons are actually more clever than I give them credit for?
Do your surgeons complain about excessive gut motility?
Do they want you to do something about this?
Do you think rocuronium could help with this?
Anyone read this?
https://www.barnesandnoble.com/w/anesthesiology-keywords-review-raj-k-modak/1100557775
Worth trying to find an ebook of it?
Hopping over from the world of PM&R- For those in residency rn what’s the general consensus about pain fellowship within Anesthesia? Are a vast majority jumping ship?
Any thoughts on if this new huge lack of interest will create a future supply/demand problem like the GA market is seeing rn?
Thanks in advance guys!!
Yesterday I encountered a female pt, scheduled for cholezystectomy. She had a panick attack and was very affraid of the procedure. Made her feel better by talking a bit about her children, then the whole spiel I always do for anxious pts about hiking up a beautiful mountain, drinking wine in the sun. Pt went under smiling and emerged smiling, what a satisfying and wholesome moment that was.
What are satisfying and/or wholesome moments you had this week? Would love to hear some stories.
Hello friends, i am about to start my ICU rotation and i am looking for video lectures or podcasts resources that explain the different topics in critical care medecine. Although i have some books to study from but i find myself enjoying the videos and podcasts more and thus going through them faster. Thanks for your help.
I’m reading this book on how perverse incentives have made healthcare exorbitantly costly called American Sickness by Elizabeth Rosenthal. Rosenthal was a part time emergency room physician turned full-time writer. She lumps pathologists, radiologists, anesthesiologists, and ED docs together, but notably calls the former three “no patient contact” specialties. She’s posited a lot of things in this book about physicians I disagreed with or balked with, but I thought this was particularly funny so I thought I’d share.
I just had a patient on this medication for the first time and have never seen it before. Last dose was this morning so we told him that likely our narcotics wouldn’t work on him. Any other side effects or interactions people have seen? Patient was having a PVI so no need for narcotic anyway
Hi everyone, I’m exploring ways to make our OR practices more environmentally sustainable and would love to learn from this community. I’m curious:
Hi, I’m currently an intern in a categorical anesthesiology residency program in the United States, so I start in the OR in 6 months. I’m reading miller, Morgan and Mikhail and doing my true learn questions, but I’m still so nervous that I’ll have to look up the dosing for every medication, or not be fast enough reacting in an emergency situation? Any tips on cheat sheets or knowing the real things you need to know before you start? I do like the Vargo anesthesia app too. Seems like such a divide between theoretical and practical application! Thank you all for your guidance.
Don't know how I keep getting updates from this sub, but since I do, I thought I'd drop in to say THANK YOU to all you kick-ass doctors out there!
I'm a 50 yo female and have had two procedures under MAC this year in two different Chicago area hospitals (UChicago Hospital in Hyde Park and UChicago/Advent Hinsdale Hospital).
I appreciate you for keeping me asleep, keeping me breathing, and waking me up! :)
Happy Holidays!
I know this has probably been asked a million times so forgive me, but for the attendings and graduating residents, I do have a few questions.
Realistically, what is like working PP vs academics? Is there a big pay difference? Is there a big difference in flow of the days and just the general culture?
I know the general rule is do a fellowship if you truly like it but not for the money. But will specialization in cardiac or ICU have any sort of career benefit in the future? If I do cardiac, am I pigeonholed into it? For those who have done ICU, have you liked the balance between OR vs floors? I’m saying this bc I really like the variety that ICU provides.
When looking at all these attractive job offers, what are the smart questions to ask that won’t be stated in these job offers? I’m uneducated in knowing even WHAT to ask lol.
We do total joints without foleys at our hospital and we use mepivacaine for the faster surgeons. If you do a similar anesthetic, I’m curious to know how much mepivacaine and how much fluid you typically give? I’m trying to cut down on my post up straight cath rate and any advice helps.
Hi, do you have any tips for intubation when using a videolaryngoscope with a stylet, but the laryngeal inlet is too cranial, and you can't maneuver into it? (And you don't have a view with direct laryngoscopy). Thanks!
Many years ago my wife and I were showing her dog at a dog show. One of the dog handlers showing a dog in another ring collapsed and I joined the EMS people trying to resuscitate him.
He was a middle aged obese guy in V fib arrest, multiple attempts at defibrillation were unsuccessful. There were other physicians helping the emergency medical service people, I believe a cardiologist and/or an emergency medicine doc, who were running the defibrillator. Given the patient's body habitus, the effectiveness of mask ventilation via Ambu bag and mask was dubious at best so I suggested we should intubate him. The EMS kit on hand was a bit thin, it took a second to scrounge up a stylet and a syringe to inflate the ET tube cuff but we managed to find all of it. A guy who had a concession selling dog grooming shears was a recently retired respiratory therapist who assisted me.
I intubated the guy lying prone on the ground, luckily no issues with laryngoscopy or intubation. I am pretty sure the intubation was instrumental in achieving ROSC, the code had been going nowhere for a number of shock attempts, but he was successfully defibrillated right after intubation. I accompanied the patient in the firetruck to the nearest hospital, and we were greatly encouraged to see him start to move purposefully.
I did visit him in the hospital where he was fully awake and neurologically intact. Turns out he had a history of aortic stenosis from a bicuspid valve and if I recall had had a valve replacement previously.
Edit: in case there was any confusion, I was lying prone on the ground during the intubation, the patient was supine, as would be common in a “patient coded on the floor” hospital situation.
GI is the one that gets me all the time because I know they did internal medicine first.