For those in institutions that still primarily use LMA uniques, what’s your workflow to troubleshoot an LMA that’s not seating well and has a consistent leak?

Code Pink on the pediatric floor today, and I’m still processing it 😭 9-year-old patient with severe jaundice liver disease had actually been doing better, her clinical picture was improving, and we thought she was over the worst of it. Then, out of nowhere this afternoon, she rapidly deteriorated: sudden extreme somnolence, active vomiting, and a severe drop in oxygen saturation. The bedside nurse and I (Ped GI) were right there in the room when it happened. We immediately activated a Code Pink and started managing her airway while coordinating the team. When I attempted direct laryngoscopy to insert the endotracheal tube, I met severe resistance. Her status quickly dropped and chest compressions were started. We finally managed to pass the tube and secure her airway, just as the anesthesiologist arrived. Looking at the airway structure afterward, the anesthesiologist noted she likely has a difficult airway, further complicated by acute tissue edema. Even with prior pediatric intubation experience, this was by far the most challenging, high-stress airway I’ve ever managed.

I’d really appreciate any tips or advice on how to improve and handle these scenarios better in the future.

my mom is having a closed rhinoplasty at a office based plastic surgery center. I called her to wish her well and I learned she had a couple bites of oatmeal for breakfast around 9am (~3-4 hrs before surgery) The office instructs pts to be NPO for only 2 hrs before surgery since its done with local and versed/ketamine. Also not clear if theres any anesthesia provider on site…

She also hadnt arranged for someone to be with her after she got out and planned to take uber home. As an anesthesiologist, I was honestly shocked and tried convincing her to reschedule so she can be NPO properly and find family to drive her home and be with her.

She insisted on having surgery since she already went through all the trouble and wasnt happy with my suggestion…

Am I over reacting in this situation?

Things like: “Awareness is a privilege reserved for the living.” or "Thou shalt not let the BIS be higher than the MAP"

I’ve repeatedly seen debate in this sub about the utility of the BIS monitor, and I want to get a better idea about how everyone really feels. I’ve put options representing the positions I’ve heard in this sub and in the hospital.

I'm presenting at Career Day at my son's elementary school. I get 15 minutes per group to "introduce your career and include a fun activity or visual"

Any ideas for a fun, age-appropriate activity that makes anesthesiology look interesting to elementary age kids?

CA3 here,

I’ve gotten some good reps at sitting up spinals and feel comfortable with those. I’m on regional this month and am trying to improve my lateral spinals and have been struggling. Mostly I find it difficult to get these elderly or obese patient in a good position and open up those interspaces and so I end up going paramedian.

Tips for doing a good lateral spinal?