Hi all,

Just a random query. For those working in anaesthesia in the US (or elsewhere in the world), how many cases have you done at end of residency/just before starting your attending job?

From my side, UK based anaesthesia trainee (resident) - have done around 1400 cases with varying levels of supervision/support since starting. In my 5th year and still have 2 years to go before being a consultant (attending equivalent).

Thanks!

Hey everyone! I’ve been working on a lightweight, fast web tool to help streamline pediatric pre-op planning (airway equipment sizing, weight-based syringe prep, fluid rates, and LAST tracking).

It’s 100% free with no ads or login required: https://pediatric-anesthesia-8asd.bolt.host/

Would love any feedback from residents, CRNAs, or attendings on the dosing matrices or missing features!

Anyone care to share what it is like to work at Kaiser? Previous threads from few years ago seem to state the base salary is for only 40hrs/week for 1.0 FTE? Any hours over that can be saved as vacation, or extra pay? If so does not seem like a bad gig. Any advice appreciated, thanks.

Seems to be more GI complications, & lately not meeting the 6-hour post-op extubation for xyz reason (usually logical & clinically appropriate).

I have personally always insisted that they come out. I'm talking about the pts that say they sleep with them in. I have people in my group who say it is Ok. Talking elective case on healthy specimens.

Where does the community stand on this? Never? Sometimes? Frequently?

Hi I am a CA-1 resident! When encountering elevated peak pressures I have been told to hand ventilate the patient. I do not understand what I am actually supposed to feel for and what that implies in terms of the etiology of my elevated peak pressures. Thanks!

I understand the basic distinction:

• Increased airway resistance (e.g., bronchospasm, secretions, kinked ETT) increases the pressure needed to generate airflow.
• Decreased respiratory system compliance (e.g., atelectasis, pulmonary edema, pneumoperitoneum, obesity/chest-wall restriction) increases the pressure needed to deliver a given tidal volume.

1. When hand-ventilating, what does increased resistance typically feel like compared with decreased compliance? For example, does resistance tend to feel worse with a rapid squeeze but improve with a slow squeeze, whereas poor compliance feels stiff regardless of squeeze speed
2. What should I expect during expiration? Does prolonged or sluggish exhalation reliably suggest increased resistance, and is a quick but small bag refill more suggestive of poor compliance? Or are these observations too nonspecific to be useful?

It's been almost 36 days. If anyone has received any news regarding the same, kindly share. Thanks

Anyone willing to share their Anki decks for fellowship/boards? I’ve been piecing things together from different decks (Orthoking, Huntoon review, and some PM&R decks), but haven’t found one that’s comprehensive. Any advice?

Current CA-2 that's interested in pain and running out of time to make a decision on applying. I like GA but pretty indifferent to big cases/super sick patients; rotated through pain and had a great time but also was in an academic setting with lower volume/production pressure. My PD is having me second-guess pain because our last 5 pain fellows all went back to GA (in various parts of the country). I feel like the pain market is a bit of a black box so just wanted to see what recent anes pain fellows were doing.

What periop protocols are you using that actually improve patient outcomes? Anyone found EMR or AI beneficial? Ultrasound/POCUS? Cardiac Output monitors?

No info on how recently he had water and how much, but I wonder if we (anesthesia and surgery) are being too militant in the U.S. about "NPO after midnight" when this appears to be a normal-weight patient, the "acceptable" NPO length of time for clear liquids is 2 hours, and overseas protocols often seem more reasonable. Throughout my career, I've seen plenty of anesthesiologists want 4 hours or longer for clear liquids (on normal-weight patients not on GLP-1s) just to be on the even-safer side, and I'm curious if this is just the docs I've worked with in private practice (both hospital and ASC) in the U.S. or it's something many more of us are seeing elsewhere.

Edit: This is NOT to say this patient is in the right, as has been misunderstood already. The article only reminded me of what I've seen in practice, and my post is for general discussion, not "Let's hit people's cars with hammers because we deserve elective surgery no matter what."

No I don’t wanna throw it out for a Mac blade 😝

I’m trying to work on the paraglossal approach, but I keep ramming the epiglottis into the glottis and I can’t seem to easily flip it back into the correct orientation to pin it anterior again. I can still put the tube in but I think my technique could be better. I have the patient in sniffing, I usually go deep the pull back until I see the glottis. When it works well, it works really well and I get a nice grade 1v, but the issue I keep encountering is the one I described above.

Any other general miller tips?

Hello guys,

i passed EDRA part 1 and i am looking to finish this an take part 2a and 2b.

Has anyone of you taken those exams and tell us how they orepared for it?

Are there anywhere question catalogs from old exams just like for the ESAIC exam?

Thank youn

Anesthesia resident very interested in a general anesthesiologist position at an academic institution. How do you go about reaching out to these places if you don’t see a posting on GasWorks? And when you do reach out/apply, how long should you expect to wait before having any sort of communication?

Interested in the Midwest (OSU, Chicago academics, IU health, Michigan etc)

Thanks!

https://laws.com/news/injury-law/court-reverses-dismissal-in-wrongful-death-case-against-tenet-11040473

I’m a CA2 who is planning on applying for fellowship in a few weeks. I’m looking at the programs and many seem to have their own residents. My anesthesia department doesn’t have a cardiac fellowship.
With the SFA match it seems like programs are allowed to select their residents as an exception.

Is there a way to know which programs will be doing this ahead of sending applications? I am trying not to waste my signals.

Attending private practice/locums anesthesiologist here. In the GI procedure room I am currently in, the sharps container is completely full of empty propofol bottles. Seems like improper use to me and since now there is no room to toss needles. I usually throw my glass bottles into regular trash cans. Ideally glass vials specific container whenever it is available. What do you guys do in your practice?

I’m not necessarily looking for the data although I would take it. My understanding is that Sullivan Cotter tends to be lower because it is a higher concentration of academic sampling. Does anyone know that to be true? We are pseudo academic, but really just community, and our admin use Sullivan Cotter as a reference for salary, which I’m thinking is doing us (worker bees) a disservice. I know using any database is fraught—and likely underestimates—but we’ve got to start somewhere and admin like that.

Today I had an 83 yo patient with a history of spinal stenosis that over the years had received 30 something lumbar ESI. Over the years he states that the pain doc has had to continually lower the level of injections due to calcifications. Now injections are at L5-S1. Scheduled for THA under spinal.

I haven’t really used US for neuraxial much. Mostly just for determining midline on very obese patients with poor landmarks. This is for various reasons including need to have a curvilinear US available, not having people freak out about people doing anything different, and timing (ironically because this could actually save time if utilized on patients like this one,
but people don’t get it).

I found it quite helpful for finding a window in the sagital oblique interlaminar view. Actually found a window at L4-5 and L5-S1. No windows above L4-5. Went with L4-5. Hit OS with midline and so I went right paramedian,the side I scanned, and got clear CSF. I went midline initially because I still find it helps me build a mental image by probing with the needle, but I can imagine forgoing this step eventually.

I did the scan out in pre op and marked his back with a surgical marker. Spinal performed in the OR.

For those of you that utilize US for neuraxial, how do you employ this in your practice? It doesn’t save time on the average spinal, only the difficult ones. Also, ideally it would be done before struggling and wasting time on blind approaches.

Had an attending say I could have it if I could get it fixed. Looks like the button was ripped off. It charges but won’t turn on. Not sure if a small computer person could solder a new button on, I’m thinking it’s a contact issue? GE said they do not do repairs only replacements or battery replacements. What are your thoughts?

Alright folks - I got a 70+ BMI patient tomorrow and it got me thinking…

How frequently are you seeing BMI 60+? What region do you practice in?

Competition round - what’s your HIGHEST BMI in your career so far? Winner gets street cred of course 😎

On the L&D floor for the competent senior residents that are proficient at neuraxial procedures, are you always physically present during labor epidural placement?

During my training obviously while still learning the attendings were hands on but after I was comfortable they were typically readily available. Now when I supervise I am available as needed for the seniors but some of my colleagues think that is inappropriate/inadequate supervision.

Just wanted to see how it is at other training institutions.

CA3 here,

Most DLT I’ve placed via DL and it’s been pretty easy. The few times I’ve used a glidescope have been more challenging in terms of tube delivery and getting past the cords. We primarily use the hyperangulated glidescope blades at our institution and I’ve tried bending the DLT stylet to mimic the rigid stylet usually used with the glide. I’m usually able to get the tube to the cords but then am having difficultly advancing much past.

Any advice on how you place DLT with a video laryngoscope?