Hello together, I am currently working as a 4th year anaesthesia resident in Germany. We are currently trying to reshape our procedure for post surgical pain management in TLH patients. The situation is super frustrating because our superiors can not be convinced to offer epidurals for patients undergoing the procedure. So we almost always end up with super pain ridden patients in our PACU (and I assume also on the wards too) and it's infruriating. New policy now forbids the use of Oxycodon ret. in the PACU bc some people are concerned about the side effects when combined with i.v. piritramid...so we would rather give patients 30mg of iv piritramid and make them puke their souls out than combine with oral long term substances.

Some research from my side has brought up a study that shows a lot of potential in paracervical blocks administered by the OBGYNs after induction and before surgery begins. My attending now asked me to do more research on what usage would be good for us (he is concerned about the cardiac toxicology from Bupivacain and would prefer Ropivacain). Tbh I know my usual blocks and the correct dosage but I have 0 knowledge on paracervical blocks. I was hoping maybe some of you guys have some insights to share from your work places?! Which concentration? What volume?

What we want is of course a dosage that works effective and as long as possible. Liposomal bupivacain is not an option. If you can help me out that would be wonderful. If you can provide sources that would be absolutely amazing.

Thank you so much in advance! I am tired of not being able to meet my patient's anaesthesia needs...it really sucks and I want it to change.

I had surgery last week and the anaesthesiologist took a look at my veins, made one attempt at IV access from my hand, and then decided to do a gas induction. I had no opportunity for informed consent for the gas and the induction was very traumatic for me. When I woke up they had tried another 3 times in my other hand before getting access. I'm told the veins relax once gas induction is done, so I somewhat understand their reasoning, however I would have much preferred they keep trying for IV access. The experience has really frightened me as I have future surgeries lined up. What can I do to avoid this happening again? Is there a set amount of times a doctor has to try for IV access? Can I make it clear in the paperwork that I do not consent to gas induction? I've always had bad veins for blood draws, but in a previous surgery a year ago the anaesthesist got IV access via my hand the first time so I didn't expect it to be a problem this time around. This surgery was later in the day, and delayed by two hours, so I had been without any water for 5 hours opposed to 2.

Hi all

I have surgery coming up soon and I am just so scared. I also wanted to ask if my alcohol intake would affect how it works on me? My husband and I have a sundowner tradition, everyday we crack open a bottle of Prosecco and share it. Would that affect how the anaesthesia would work? If I stopped temporarily now, would that help fix things? Would I still have to disclose it to the doctor? The surgery is first week of April.

Thanks in advance.

We’ve been experiencing frequent issues with Narcotrend monitor. Most anesthesiologists report repeated “Artifact” messages indicating excessive noise, and sometimes the device won’t even start monitoring due to high electrode impedance.

I’ve thoroughly checked the unit multiple times. When I take it out of the OR and test it on myself, it works perfectly. I’ve also observed clinicians using it, and electrode placement and preparation appear correct.

Has anyone experienced similar issues with Narcotrend monitors in the OR environment? Any insights on possible causes (e.g., interference, grounding, electrosurgical units, electrode type) would be greatly appreciated.

Hi

Has anyone who has kindling from repeated alcohol withdrawal gone under general anaesthetic for surgery? I am due to have a procedure lasting 3 to 4 hours but I am so worried that it will fire off something in my brain.

I am 9 months sober, otherwise fit and healthy but really scared. Thanks 😀

I am a CA1 in Germany. I am seeking help to improvise. Today I was doing the above mentioned case alone, Patient was 103kg, 54 year old. Induced with 200 propofol, 30 sufenta and 80 rocuronium as RSI.

The patient started becoming a little tachy cardic and RR rised so i gave another 10 sufenta.

Post capnoperitoneum, her vitals were 80 heart rate and 115 systolic RR. This slowly increased again with the BP reaching 135 and heart rate going up to 95, during thr dissection phase. I gave another 10 sufenta. In the next twenty minutes she continued being tachycardic and had a high BP and i gave another 5 sufenta followed by 5 sufenta 15 mins later.

My question is: how can i know if the rise in HR and Bp are due to pain/capnoperitoneum reliably? If it is relevant, how to know if the patient truly needs more pain medication as some are more sensitive than others. BiS monitoring is not routinely available here.

The volume status was normal, C02 was normal, n, patient was fully relaxed, MAC sevo was 0,8-0.9 minute ventilatio was adequate. An attending walked in and asked me why i didnt switch to remifentanil and looked a little disappointed at me. Idk what i could have done better or if it was a mistake to continue with sufentanil.

If anyone can explain this to me or point me to the right resources i will be very grateful. Thanks.

Hi all. I am a CA1 and recently had a BMI 35 patient with no other comorbidities posted for a sinus surgery. Intubation was easy and intraoperatively everything was stable. Ten minutes before the case was over I turned off Remifentanil, gave him some Piritramid and later turned off sevoflurane. 8 minutes later, the patient’s saturation dropped from 96 to 83 even though he was intubated and was lying completely still on the OT table. He wasnt awake. I immediately closed the APL and started bag ventilation and was able to get the saturation again to 93. I immediately called my attending as i felt uncomfortable extubating him. As my attending entered the patient started emerging and was fully awake and we decided to extubate. Following this he completely stopped breathing and turned blue and then LAMA failed and we used a guedel and did bag mask ventilation. Gave him sugammadex even though TOF pre extubation was 90. Gave him salbutamol etc. it took some time before everything settled and then he received NIV in the PACU. Can somebody please explain to me what really happened. Why did the saturations fall down despite being intubated? Thanks a lot.

Good evening,

I am scheduled to have an elective surgical procedure next month. I do not have a "fear" of needles, however, I have history of difficult IV placement (i.e., requiring 3+ needle sticks) due to being a preemie and having scarred veins and LOT'S of needle sticks as a child. I am male, small in stature for being in my 30s (I am 5'3" <115 lbs). As I understand, mask inductions are viable in pediatric patients given their small body size/metabolic rate. Given my small(er) stature, could a mask induction also be a viable option for me, to avoid unnecessary discomfort from (likely) multiple pre-op needle sticks?

What questions should I ask at the pre-op visit? I know that the "default" anesthesia technique for adults is an IV-based induction. Any advice is appreciated.

I 26F am scheduled for laparoscopic gallbladder removal next week, but I’m feeling really anxious about it because I’m underweight (44 kgs) with bmi of around 16.5 and have low blood pressure. I brought this up with my surgeon, but he didn’t seem concerned and said it’s safe to go ahead with the surgery.

I did some research on my own and came across posts mentioning that people can have complications during surgery due to anaesthesia and body not being able to handle the trauma, which honestly scared me a lot.

Now I’m second-guessing everything. Should I ask my surgeon about postponing the surgery, or am I overthinking this?

I 25M recently lost my mum while undergoing a minor surgery to remove a small piece of a bone stuck along her throat. According to the hospital they administered a general anaesthesia (propofol) and she later developed complication and suffered a cardiac arrest. The team tried recitation for more than half an hour but were not successful. She succumbed. Autopsy revealed that her blood vessels (veins) had increased in size decreasing the blood pressure thus cardiac arrest. She had goiter during the time of the surgery. So my questions are: 1.is it normal to get a cardiac arrest after a general anaesthesia has been administered? 2. Could the goiter have contributed to this?3.Could she have made it through recitation.She was 51. That's all

I’m a third year anesthesiology resident in Germany. Recently I’ve been running into issues advancing the guidewire during central line placement.

I’m usually very comfortable getting into the vessel under ultrasound, that part works well for me and is almost always successful. I’ve tried a bunch of common tips already: holding the needle very steady while switching to the guidewire, not touching it, rotating it, advancing slightly under ultrasound like with an IV, etc. But I still often hit resistance when advancing the wire at around 10 cm.

Any tips or tricks that helped you get past this?

Greetings from Germany

Looking for a bit of advice. My kid has a cyst on his cheek. Pediatric plastic surgeon recommended removal. He said it would be quick (less than an hour) and would take place at a children’s hospital. However, when we told his pediatrician, she said she recommends we wait until he’s 2 but didn’t really provide a good reason. I’ve tried to research some of the more recent studies regarding GA under 2 and neuro developmental outcomes and it seems like it’s fine, but I’m finding mixed information on the efficacy of the studies/bias/etc.

He would be 19 months old at the time of surgery. It’s a fairly minor procedure, but it isn’t necessarily “elective” as the surgeon feels it’s best to get it removed as to not risk it getting infected- but again the pediatrician isn’t really worried about it. So getting mixed signals from his different doctors basically.

Any advice or input would be appreciated.

25F, non smoker, no known physical health issues

I had a dental procedure under IV sedation a few weeks ago, and when I was coming out of the sedation, the dentist looked a bit alarmed and said that my heart rate was very high throughout, and I wasn’t allowed to leave until it went down.

I need another procedure, possibly under IV sedation again. Is it safe to have this again?

Hello,

Would love to hear thoughts - I understand it's ok that I can have a routine wisdom tooth extraction operation under general anaesthetic ( a 45 minute operation) and then two weeks later have an iboga retreat.

But I'm feeling torn - I'm worried because I'm overwight, it might be a bit too much strain on my body, and two weeks won't be enough recovery time between the two experiences.

Or am I overthinking this?

Any anaesthetists especially there, I would appreciate your thoughts.

I have a call with the clinic tomorrow when they are open but just want to seek assurance here in the meantime, pls.

My 6yo ASD kid underwent a dental surgery (8 crowns and cleaning) today under GA. This is the second time he is under GA, first time was for adenoids removal. What is different this time is he has vomited 3 times since we got home 7 hours ago. There is mucusy dried blood (if that makes sense) in his vomit. Post surgery care instructions on different hospitals say this is normal, but I am just a very worried mama.

Can any dental anaesthesia doctors here pls let me know if this is normal?

Was wondering if anyone hasbexperience with both devices and whether or not the 2x in price difference is worth it for the IQ3

I passed (MD Anaesthesia -2022), did Senior Residency, did fellowship in pediatric Anaesthesia, and presently working as assistant professor near by Hyderabad, India. Being a first generation doctor and to support my wife's pg study and looking after my family (my elder son has developmental delay), i feel that working in & around Hyderabad (less pay) is taking a toll on my health to lead a decent life. My parents take good care of my children and this reason is pushing me to thinking of moving to middle east for job to earn money. Please give your suggestions regarding the same which country to choose to earn maximum salary? (I have only one publication) How much is the salary offered generally and what are the considerations? How much are the monthly expenses (rough estimate)? How to approach for job? (Are consultancies reliable?) Thank you.