ALS and Anesthetic Management

Two weeks ago, I had a patient who came in for exploratory laparotomy s/p peg tubal insertion. She has unrelieved pain after the peg tube placement. Patient is in her mid 30’s. Needed the ped tube due to losing weight. She has been bedridden for a year and exhibited muscle atrophy in her extremities. She…

Using Muscle Relaxant with LMA

Have you ever used muscle relaxant with LMA? Is muscle relaxant contraindicated with the use of LMA? We all know what is the answer in the textbook: the use of muscle relaxant in LMA case would not be supported. But recent studies have shown that the use of muscle relaxant with LMA cases are beneficial…

Healthcare Reform

The media has been focusing on the healthcare reform for a while on whether to repeal and replace OBAMA’s healthcare with something more sustainable. Today, I am going to talk about something bigger than just anesthesia. I feel that as a healthcare provider, it is my duty to give feedbacks on our current healthcare system….

A Great Combo: Food Poisoning and My First Clinical Day!

I got food poisoning this week when I finally had me time. Sighs…… when I was laying in bed, it reminded me of my last food poisoning on my first clinical day in the OR….. I can still remember vividly the night before my first clinical day in the OR. It all happened when I…

Does Pretreatment of Non-Depolarizing Neuromuscular Blocker Prevent Myalgia?

I had a discussion the other day with one of the attendings at work on whether pretreatment of rocuronium prevents myalgia. We all know that the most common practice is to administer a small dose (10–30%) of the ED95 of a nondepolarizing neuromuscular blocker such as rocuronium a few minutes prior to administration succinylcholine, with…

Epidural Fever?! Have You Heard of it?

Have you seen this in your clinical practice that a patient you placed an epidural 10 hours ago developed a fever? You may not have thought into it too much. After all, there are many possibilities that laboring woman can develop fever. There are many etiologies that can cause  intrapartum fever such as maternal chorioamnionitis and…

Students and the Darn Grades

“What should I write in my blog this week?” I asked myself this morning on the way to work. I feel that it is time for me to write about SRNAs and their grades since it has been on my mind for a while. I have been teaching a class to SRNAs this semester. It made me…

Keep the Physical Youth!

I know this post is not directly related to anesthesia, but it is important to us because we want to take care of ourselves first. What I want to advocate here is caloric restriction diet. The reason is that calorie restriction without malnutrition increases not only longevity but also delays the onset of age-associated disorders in multiple species. Don’t we…

CSE Practice Points/Tips

A couple of weeks ago I was on OB, I was called to assess the discomfort patient experienced in her perineal area. Patient was in early stage of labor, 4cm dilated and had epidural in place. Patient had a good bilateral sensory block, suggesting that the epidural was working well. As we know, labor epidural…

What Does the Airway Assessment Really Tell You?

Every time you see a patient in preop, you do your routine airway assessments to predict whether patient has an easy or difficult airway. Have you ever asked yourself  what the assessments really tell you and why some patients would have difficult airways based on your Mallampati score, neck circumference mouth opening or the protruding teeth? It…

Tips with Glidescope

Some of the students asked me the tips with the glidescope for the anterior airway when I was in clinical the other day. I remember I had struggled with the glidescope for the anterior airway when I first started using it. I had to do some research online to figure out how to get the…

KCentra, Have You Used it Before?

Today, I have learned a drug Kcentra which can be useful in emergency cases for patients who need a quick reversal with high INR. I figured I would share it with you in case you haven’t heard it before. We have a patient today who is coming in for an emergent abdominal I&D. She is…

Hyperoxymia, good or bad?

Some students have asked me about the reason of using FiO2 80% in my clinical practice. I figure I will list my rationals for using high FiO2 80% during most of the GA cases I do. First of all, people may worry about absorption atelectasis with high inspired FiO2.  Akca et al found that the…

Ditch the Needle? Not in Pediatrics

Thank you everyone for the best birthday wishes today! I am very grateful to have friends around. It wouldn’t be the best birthday without a new post. Here we go! Someone commented on my post entitled Ditch the Needle, Teach the Knife Part II regarding the applicability with cricothyrotomy in pediatrics. The previous post was intended for adult…

Factor VII and Postpartum Hemorrhage

Today, we had a presentation on OB hemorrhage management. It touched on the use of TXA, but it didn’t mention anything about recombinant factor VII in PPH. Although it has mixed results on the outcome with the use of factor VII, it seems that it still has its place in severe PPH based on the recent…

Exparel, what do we need to know?

Sorry guys I haven’t posted for a little while. I was doing some reflection on myself. Anyway, I am back. A friend of mine suggested a topic on Exparel and it is getting more widely used within the last couple of years. So I figure it is a good topic to discuss as it is relevant to…

Cricoid Pressure – Friend or Foe?

This is another dogma I feel overdue for discussion. This is one practice that was instilled in our training when we were students: trauma/NPO non-compliant would get RSI with CP.    Cricoid pressure was originally described by Sellick with the patient in a head down, tilted to the left position back in 1960’s. It was claimed that…

Can We Use Peep with LMA?

Lately, I have seen some threads discussing whether it is safe to use LMA with Peep. I remember when I was in school, some of the preceptors would take out the PEEP after I inserted the LMA. The reasons they gave me were insufflations of stomach. But in the back of my mind, I wondered whether…

Fun Facts for Today

Just some fun facts to refresh our memory for NCE certification/recertification in case you need to take it soon. Morphine: 10mg IV = 1mg Epidural = 0.1mg Intrathecal (1/10 ratio; very hydrophilic) Hydromorphone: 1mg IV = 0.2mg Epidural = 0.04 Intrathecal (1/5 ratio; intermediate) Fentanyl: 100mcg IV = 33mcg Epidural = 6-10mcg Intrathecal (between 1/3…

Are We Afraid of General Anesthesia for Cesarean Section?

Are we afraid of general anesthesia for cesarean section? I remember when I was in school, I learned from the lecture that there are 3 reasons for avoiding GA besides decreased patient’s satisfaction and sleepy baby with GA. They are (1) difficult airway management (2) increased risk for aspiration (3) increased risk for uterine atony. I…

CRNA School and Kids

This is the topic that I haven’t tackled which I should have a while ago. I am sure you have wondered whether it is possible to get through the school when you have a family and small kids. Dealing with the demands of anesthesia school and parenthood simultaneously is by no means easy. But it is doable….

Should We Ausculatate After Intubation?

Since I graduated from anesthesia school, I have given up the time-honored habit of routine chest auscultation after passing the tracheal tube through the glottis. This is another practice that we have been taught in school as one of the best ways to confirm tube placement. I still remembered the first time I was asked…

When Can We Use Tranexamic Acid?

Lately, I have noticed some changes on the usage of tranexamic acid. In the past, it would be contraindicated to use on patients who had a history of stroke, DVT, A-fib, valvular disease, or SAH. Recent studies have shown that the use of TXA doesn’t significantly increase the embolic event in surgical patients. In our institution,…

Gifts For Anesthesia Folks on Valentine’s!

Happy Early Valentine’s! I figure I will post some ideas for the anesthesia folks today. First on my list is this coffee mug shown below. This phase is the one we often hear in our daily encounters with other departments or personnel. The second one on my list is this t-shirt which I find quit…

My First Spinal Placement

Hello SRNAs out there. I just realized haven’t posted much for SRNAs lately. So, this is a long overdue post for you who just started doing spinals in either OR or OB. It has been almost 3 years since I got in my first spinal as a student. I feel that it is time for…

Sugammadex is Coming !

Our hospital is finally getting Sugammadex. I am so thrilled that we have something else to use to quickly reverse patients other than neostigmine. I figure it it time to write a post about the medication to give you a quick summary of what the drug is, how it works, and the side effects etc….

Ditch the Needle, Teach the Knife Part II

Dr. Larson, a well-known anesthesiologist at Stanford once stated that an emergency cricothyrotomy is much quicker, easier, safer and more effective than any needle-based technique. I can state with confidence that there is no place in emergency airway management for needle-based attempts to establish ventilation. As you all can tell, I love airway topics as…