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 …
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 …
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 …
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 …
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 …
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 …
We routinely use ETCO2 to provide information on ventilation. But ETCO2 can also provide valuable information on the adequacy of cardiac perfusion. It can be an essential tool in ensuring optimal, high quality chest compressions during cardiac resuscitation. Read More …
Conscious sedation can alter respiration, which can lead to the vicious cycle of hypoventilation, hypercarbia, and hypoxia. If you don’t recognize inadequate respiration —and treat it— the patient can suffer injury or die. This article discusses the continuum of sedation and its effect on consciousness and respiration. Read More …
Tension pneumothorax is a life-threatening emergency. This article discusses several iatrogenic bilateral tension pneumothoraces occurring during intubation and emergency airway management. Read More …
Having a tidal volume close to, or smaller than the patient’s dead space can lead to significant hypercarbia, hypoxia, and respiratory failure. This article discusses the concept of dead space and it’s clinical use in recognizing hypoventilation and preventing hypoxia and hypercarbia. Read More …
When I’m teaching airway management to my Perioperative/OR nurses, I often recount the story of management of a young child’s postoperative respiratory depression. In addition to illustrating the importance of evaluating ventilation in addition to oxygenation, this case shows how good communication makes management of a critical event more effective. Read More …
During a recent volunteer medical mission to Honduras, we had a close call with a blood clot in the airway following nasal surgery. This article discusses that event. Read More …
During intubation, any liquid in the mouth that obscures the view of larynx not only hinders visualization, it risks aspiration. We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate? This article discusses two prior cases and offers suggestions on intubation when massive emesis or blood interfere with visualization. Read More …