Preventing cerebral hypoperfusion is crucial for patient safety. Avoiding cerebral hypotension during the Beach Chair position can be difficult. Although a MAP of 50 is often considered the minimum for cerebral autoregulation. However, this level could lead to hypoperfusion or potentially stroke in anesthetized patients. It fails to account for Read More …
Intraoperative hypotension—defined as a decrease in blood pressure during surgery—is a common and potentially serious complication. Recognizing intraoperative hypotension is crucial. Effective treatment is vital to prevent adverse outcomes such as organ hypoperfusion, myocardial ischemia, and postoperative morbidity. But what constitutes intraoperative hypotension? When is a “good” BP bad? Case Read More …
The Case My OR table almost seriously injured my patient. We had just completed a rotator cuff repair on a healthy 50-year-old man, performed on a Captain’s Table. After dressing the wound, with the patient still in the beach chair position, I extubated him. He was awake but drowsy and Read More …
Unplanned extubation is a serious risk that can occur in various medical settings, particularly in the OR. The article outlines three cases illustrating challenges and strategies for managing unplanned extubation during surgeries. It highlights prevention measures, potential complications, and the importance of vigilance in securing endotracheal tubes to enhance patient safety. Read More …
The ability to tactfully and effectively challenge another provider when you see a problem is key to patient safety. Challenging another provider is difficult. We all have egos we protect. You will often be called upon to stand by or to help a colleague. But what if you don’t agree Read More …
Deciding when to extubate a patient safely can sometimes be a difficult decision. Removal of an endotracheal tube when you are not sure of the diagnosis is a risk not to be taken lightly. This case discusses assessing extubation criteria in the face of ambiguous respiratory symptoms. Read More …
The text discusses common pitfalls in intubation, emphasizing the significance of proper patient positioning, especially under stressful circumstances. It highlights a case where distractions, time pressure, and inexperience led to complications. The author stresses the importance of adhering to protocols, teamwork, and continuous learning to ensure effective and safe intubation practices. Read More …
Operating room (OR) fires pose a significant risk during surgeries, often overlooked. Common causes include oxygen leakage, flammable substances, and ignition sources. Proper precautions, like assessing fire risk factors, mindful oxygen use, and ensuring flammable materials are dry, can prevent fires. Awareness and readiness are crucial to safeguard patients and staff. Read More …
Content describes significant greenhouse effect of anesthetic waste gases on global warming. Practical steps to limit waste gas exposure. #FOAMED #anesthesia Read More …
Anesthesia waste gas exposure carries health risks. Article provides a comprehensive overview of waste gas exposure and strategies to minimize exposure. #FOAMED #anesthesia Read More …
This article provides a comprehensive overview of the risks and disadvantages associated with Nitrous oxide in anesthesia. such as inhibition of methionine synthetase, immune system suppression, increased risk of infection, myocardial ischemia, CNS risk, and pre-existing vitamin deficiencies. Scenarios to limit or avoid N2O exposure are discussed. #FOAMED #anesthesia Read More …
Acute withdrawal from mood stabilizers risks short and long term neurologic dysfunction which could impact our anesthetic management. Case report discussed. #anesthesia #FOAMED Read More …
Given the difficulty of working with a volunteer team in the developing world, how do we take strangers and quickly transform them into a cohesive, well-functioning team in a difficult environment? Let’s look at some of the tools we use. Read More …
Airway disasters during volunteer medical missions to Developing World are often preventable if you screen carefully, prepare, & communicate. Read More …
Anesthetic mortality during volunteer medical missions overseas is 20X higher than US statistics. Article discusses risks inhalation anesthesia/Halothane. Read More …
Going through your anesthesia checklist before starting a case isn’t exciting. However the anesthesia checklist can potentially save your patient’s life by allowing you to find risks and correct them before they cause harm. I found early in my career that if I skip this step, unwelcome surprises can occur. Read More …
Drug shortages force us to use clinical calculations to mix what we need with ingredients on hand. Clinical Calculations: Epinephrine & Local Anesthetics. Article shows how to understand drug concentrations for epinephrine and local anesthetics as well as how to perform the calculation to epinephrine and local anesthesia into different concentrations Read More …
I’m concerned to see a growing lack of common sense in the care of elective surgical patients during the COVID-19 pandemic. This lack of common sense in the time of COVID endangers the healthcare providers caring for patients. It can also put patients at risk. I remind my OR nurses Read More …
Healthcare workers are at high risk of infection from respiratory illness during intubation and other aerosol generating activity. Article discusses risk and strategies to improve personal safety. Contains links to helpful on-line materials. Read More …
My review article has just been published in Anesthesiology News: 10 Common Pediatric airway Problems — And Their Solutions. The trend to only use pediatric providers has a seriously negative unintended consequence: It deprives other providers of routinely caring for children, making them less prepared for when they do inevitably have to care for a small child. This reviews the most important pediatric airway differences. Read More …