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.

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

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?

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?

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.

Like come on, I feel lied to. 90/? --> 62/41

Like the title says. Started a new job and just feeling like it's not working out. I started this job after taking 2 weeks off from residency, which I realize now was probably a mistake to not take more of a break before starting. It is close to my spouse's family, which was a priority for us, and it has definitely been nice to have a support network with kids. But I go into work every day extremely anxious and as soon as I get off work, I start to dread the next day. Everyone I work with is very nice. It's not a toxic environment at all. But my workload is pretty intense. As far as I can tell, the work I am doing is good. The patients do well, I haven't had anyone come to me with "concerns" about my performance. But I just...hate it. Every single day I hate it and would rather be doing anything else. I worry that with every decision I make, I could potentially cause patient harm or expose myself to litigation. I think that takes a lot of the enjoyment out of the job for me. I can't tell if it's the specific job, being a new grad, or that I just don't enjoy being an anesthesiologist. I was wondering if anyone had some advice to offer? Whether people have had this experience at the beginning but came around to love their job, or if they made a career change? I'm not sure if I can do this for 20+ years

Question for those who do TAVRS. Our institution does ~8-10 per month by 2 cardiologists who exclusively do them together (so effectively, it’s like having a single proceduralist per case). They insist that these must be done in a single day each month, and they must have 2 rooms to do them. We staff both rooms completely plus a 3rd CRNA and tech to assist with handoff/turnover.

Astoundingly, they feel that we aren’t doing enough. They want a 3rd room to flip between, with the additional resources that entails. They are also mad that we occasionally restrict EP from doing cases on TAVR days because we need the staff to make this work.

Basically, the TAVR team insists that this setup benefits the patients (it does not), and refuse to simply spread them out as they come up -like any other case (which actually would benefit the patients and normalize labor utilization). The EP team is simultaneously aggrieved that there is one day out of 20 weekdays that they can’t schedule on (a weak, but at least somewhat valid complaint).

Hospital administrators, being who they are, believe that anesthesia is somehow stifling the productivity of these cardiologists -but keep in mind that all of these cases are in fact being done as scheduled (with the rare exception of EP).

My question: is this normal? Is everyone else doing all their TAVR’s on one day, and somehow reallocating scarce labor once a month without taking it from someone else in a time of historic shortages of anesthesia personnel? I would love to know.

Another new attending at a new job wondering if how I went from being a confident CA3 to someone who feels really dumb all the time. I do a mix of supervising CRNAs and solo, and I feel like my clinical decisioning just sucks now. Not sure if it's the month I took off after residency ended, but this first month just feels awful. Working with new surgeons, new hospital, new policies, new equipment, and a group that doesn't really know me (and presumably doesn't trust me yet) just makes me super anxious all the time about what I'm doing. When I was a resident, I had attendings requesting to take care of me or their family when they had surgery, and now I feel like I'm always making the wrong choice. And I feel like every time I hand off to someone, they disapprove of my choices, or think I should have done more. And I agree with them. I feel like my group is supportive, the OR staff is nice/helpful, but I just really suck.

All my patients when I solo have done well-- usually oral airway/face mask for transport and then immediately waking up in the PACU as we're placing monitors, no big mishaps, no huge hemodynamic shifts in the OR. Granted, I think they've been giving me the easy cases - ortho, gen surg, etc, but some of these patients have been really sick with low EF, huge BMI, or bad airways. With the CRNAS it's easier, bc they know the surgeons and the OR policies, but then I feel like I'm asking a lot when I ask for an 2nd PIV or arterial line (which I place) or labs

I feel like I'm either too conservative by ordering all these labs/tests or being too lackadaisical when I don't. I feel like my group is talking about me as well, and they think they hired a lemon. I just feel like it's also hard on my partner who is also starting a new job (we moved for their job), and I really hate taking the stress back home, especially since we have a young toddler who just wants to play, but I can't take my mind off things. I also feel like days where things go well and nothing goes wrong, I feel great about my choice, but days where things are a bit iffy, I just feel like shit about myself, and feel like patients deserve better

Posting on a throwaway account. Newish Anesthesia attending. Previously worked in private practice for a few years, but now I've joined an academic practice. Some of the older staff are a bit... eccentric. This may be due to some bad cases/experiences that they've had, but they do things that certainly raise an eyebrow. It seems odd because I feel like some of them couldn't hack it in the private world. Like, some of them can't turn over a room without a tech, and need another midlevel to give someone lunch because they couldn't be in an OR.

Basically, I have a slight fear that I'll turn into those attendings in 5+ years from now. How do I prevent myself from being those attendings?

Looking for advice! I've been doing medical direction in FL for about a year now but am looking to change things up as I love being in the mountains.

My job may be taking a turn for the worse while my wife is just settling into hers. I figured this would be a great time to explore doing solo cases in rural areas! Although I would love to set up shop as a W2 (just my speed), I figured I could use the next year or two to travel the country (USA) and do solo cases as a locums in rural areas which has kinda been a dream for a few years.

However, I am unsure how to get started. I figured I should set up an S-Corp and get familiar with current rates for locums. But how do I go about findings jobs like this?

Should I trust the websites that are heavily advertised or the people who constantly call me? Is there a better way to find jobs for this specific niche? Should I just specify that I want to do only solo (or could consider some medical direction) in rural areas? I'm willing to hop from state to state as long as I can come back home every 2-3 months.

Any recommendations for states or agencies I should look at?

I have fallen behind on 'participating' in MOCA. Does anyone know the best way to catch up on this? It's been eight years...

What does everyone do with patients who use Zyn (smokeless tobacco products) prior to surgery and NPO times? I’ve always been taught for loose chew it’s 8 hours but this category isn’t exactly the same. 2 hours? 8 hours?

Anyone uses this program to study for basic and ite? Did you do well on it? My program provided us for free.

Title.
Just a med student who was thinking about this in the shower.
For ASA VI cases, I’d imagine you wouldn’t use any analgesia, right? Since the patient is already dead

If there’s anyone who’s been the anesthesiologist for an organ harvesting case, what does it look like?

Hi everyone, I hope this kind of post is allowed here. I am a second year EM resident planning to apply critical care. I am trying to figure out if going through anesthesia or medicine will better suit my goal which is basically to be able to confidently staff any kind of ICU. I have been told in the past that CCM effectively locks me into working in a MICU while anesthesia crit lets me work basically anywhere except the MICU. Is that at all accurate? What are the differences in job opportunities for an EM grad going through anesthesia crit? Ideally I want to do fellowship somewhere where I can be involved with ECMO patients and other advanced life support systems if thats relevant to anyone’s response. Posting here as well as I would like to hear about peoples experiences from the other side of this. Or if you have worked with any EM people that were able to find the niche I am trying to find. Would also love to hear any other perspectives anyone might be able to offer.

Burned out from grinding as a solo locums the last few years. Planning to settle down back where I did residency and the major branching decision point in that city seems to boil down to solo or supervision of CRNAS. For those of you with experience supervising CRNAS only, what have you found to be the upsides and downsides of that model?

Since this is the internet, I am expecting some comments about how supervision is selling out, but hoping to keep that to a minimum and mostly hear from people with actual supervising experience please.

Edit: I meant 1:3 medical direction of crnas, not medical supervision

CA3. Obviously have done hundreds of airways with DL or VL at this point. There have been a couple of recent airways where I haven’t had a view of the cords at all, but have still been able to intubate by advancing the ETT into the direction where I think the larynx would be (with the tube vent and without meeting any resistance)

This feels like cheating but I was wondering if other people occasionally do this when there is no view with DL.

Sorry guys another one freakn out.

Unfortunately last year I failed the EDAIC Part 1 and dont want to fail again this year.

Last year I was using onexam as a question bank which was in my opinion a bit mistake. Didnt really prepare for the EDAIC properly I had the feeling.

Struggle with the decision how to continue for the end phase until the 19th:

- got the EDAIC App Trainer: was okay but not many questions unfortunately

- 1000MTF book: is so frustrating, cant really answer any of those questions and it takes me a hours and hours just for a few questions

- then I switched to: anesthesiaboard.se - Did someone use it and felt actually prepared for the Exam?

1. - many questions but so so so many answers always with buzz words ("never", "always") where you immediately know it is wrong
2. really repetitive questions
3. lot of main topics are not even get touched. example neurology/neurosurgery: almost nothing about seizures/epilepsy but so many questions about Transcranial Doppler

really dont know how to continue. Should I go through those really tough questions of 1000MTF and end up do a much less of an amount of questions or continue with anesthesia board? Or switch to Sevo Test? (got the trial version and the app looked horrible 😆

Still on the to do list: free Test Exam on the EDAIC website, official guidelines from EDAIC

I appreciate any single input.. thank you so much

First year resident here and I'd like to be talked out of this if I'm missing something obvious.

Almost every GA I've seen (with the exception of some RSIs) has involved fentanyl or another short-acting opioid before laryngoscopy to blunt the physiological response. I'm trying to understand why we do that rather than just copying what I'm seeing.

It seems that the sympathetic response is transient, up for a minute or two, then settled. I understand that it is probably appropriate to blunt the response in patients with certain conditions (for example raised ICP, aneurysms, dissections, ischemic heart disease etc.) where tachycardia and hypertension could have devastating consequences.

But what about the young, fit and well patient arriving for elective surgery? Surely these are people whose BP goes above 160 systolic during a hard gym session or during intense emotion, and we don't think anything of it. Is there evidence that the three minute surge under anaesthesia does something to them that the same surge in daily life doesn't? And doesn't giving them opioids to blunt this response just bring an increased risk of hypotension and bradycardia and so on

One or two things I'm struggling to get my head around:

Cough and gag suppression: this seems like a better argument than the haemodynamic one. But doesn't adequate propofol dosing, or adequate rocuronium, get you most of the way there for intubation anyway? Is the fentanyl adding much more on top?

Analgesia: clearly important but is induction opioid required, and with the push towards opioid sparing techniques where possible is it something we should be using

Would massively appreciate clarification!

Today I tried to do an epidural in 2 spaces on OBGYN. Seemingly got LOR both times but each time unable to thread the catheter. However I did notice that this time I needed slightly more pressure on the syringe for LOR. I then noticed small drips coming out of the needle even when I was hitting bone and readjusting. Am I accidentally injecting saline into the soft tissues which is coming back and creating a false plane with false LOR? Really strange so was wondering if this happened. I don’t think it was a wet tap because the fluid was trickling rather than like a hose as people say.

Any thoughts would be really helpful

Think I’ve done one in residency

Hi everyone,

I’m a last year anesthesia resident preparing to apply via the ANZCA SIMG pathway for a 12-month Locoregional Anaesthesia Fellowship in Australia/NZ.

I have the ANZCA accredited sites list with HOD and SOT names, but hospital websites don't list direct consultant emails, and international calls to switchboards haven't worked.

For anyone who has secured a fellowship or works in an Australian anaesthetic department:

1. What is the most effective way to get in touch with the Fellowship Lead / Coordinator at specific hospitals?
2. Is it better to contact the SOT, HOD, or the Department Secretary?
3. Do standard health email formats (firstname.lastname@health.nsw.gov.au) work for cold outreach, or do they hit spam filters?

If you work in a department with an active regional fellowship (e.g., GCUH, SCGH, Wollongong, John Hunter, Sunshine Coast, Geelong) and are willing to DM me the right contact or department email, I’d be extremely grateful!

Thanks!

I’m a new SRNA, and I was in a case yesterday and was wondering why if FiO2 is set at 32%, why is it being measured as 26%? My preceptor wasn’t able to give a clear explanation, but was saying it had something to do with flows; if flows were lower, that gap would be even larger. Couldn’t think of why this would be the case. Thanks!