Cosyntropin, An Alternative for PDPH

I was on the OB this week, and had a patient who developed classic PDPH on POD2. She was a difficult epidural placement with a success on the second attempt. She is 21 years old, BMI 43 otherwise healthy. Her headache started on POD1 and progressively got worse on POD2. She has the classic presentation…

Ask For Help! No. 1 Skill to Have!!!

I never thought I would write a topic on asking for help. But my experience recently made me realize that we need to emphasize asking for help in our training whether you are in school or in practice. Let me tell you the story first. I was giving lunch breaks to the providers. All of…

Pain Perception and the Role of ANS

This is a topic that I have been continuously exploring for the past 4 years. It all started out with a question that I had with an attending whether patient has pain under general anesthesia. It is a fundamental question but a key question that laid foundation to pain management. Based on the definition of pain,…

Application of Ultrasound in Airway Management

Hi everyone, I hope your week is going well. I have recently played with ultrasound more often at work and grow fond of it. The topic on airway is one of my favorites since we have to deal with this everyday. In addition, we had a lost airway case. This made me think what we…

Should We Do Tight Blood Pressure Control?

Recently I had a conversation with one of my colleagues regarding tight blood pressure control intraoperatively. I was told that the blood pressure should be strictly controlled within 10% of resting pressure based on this study from JAMA in 2017. As you all know me, I don’t take other people’s word for it. I like…

Pharmacology Revisit: Context Sensitive Half Time

I have been working at an University Medical Center for almost two years. Often times, I take over all day long cases as I am the late person in the OR. Most of those cases are spine cases. As we all know, ERAS protocol has been implemented in most of the big spine cases. They…

Serotonin Syndrome…more common than we think?

So, think about. You’ve just given this great anesthetic. During the pre-operative period, you were able to make your nervous patient laugh, smile and with the help of versed, become more comfortable with you. You have an uneventful intra-operative course and only used standard medications: fentanyl, lidocaine, propofol, rocuronium, sugammadex, decadron and zofran. Now, the…

Revisiting PONV Prophylaxis

Most of us routinely administer decadron and zofran in the OR. Recently, I started at an academic medical center and noticed providers frequently use Haldol for PONV prophylaxis. Initially, I was completely against using this anti-psychotic medication as part of my PONV regimen. However, with a little bit of knowledge and research, I’ve changed my…

Dexmedetomidine, A Perfect Drug for Aortogram Run-off

Hi everyone, I hope you are all doing well. I can’t believe it is almost Christmas. Time flew by. I have been absent for a little while as I mentioned that I started my new job at an academic center. Starting this August, I took on research projects. I have submitted two prospective clinical research…

Synergistic Effect of Cisatricurium and Rocuronium

This topic has been on my mind for about a year. But I wasn’t able to find a satisfactory answer until recently. Here is my story with the use of cisatricurium and the rocuronium for a patient who has ESRD. About a year ago, I was doing an abdominal wound closure. Patient had wound vac…

No Narcotic Induction

As some of you remembered, I have recently changed my job to a university academic center where I have picked up a few new tricks and some new understandings of the effects of common drugs we use. I would love to share one of my favorites with you.  I am in love with no narcotics induction because…

Use of Sugammadex on Patients who have ESRD

This is a follow-up post on the Use of Sugammadex on Patient Who Has Myaesthenia Gravis. Last week, I had a patient who has ESRD and on HD and patient was scheduled for a laparoscopic hernia repair case. Patient has active acid reflux and obese with BMI=40. We all know cisatricurium takes forever to take effect. Now that we…