An Anesthesia Resident’s Prayer

Now I lay me down to sleep

I pray this pager does not beep

Please no risky extubations

Please no lengthy explanations

Please no 4AM calls for c/section

Please no swallowed razors in corrections

In this county, please no riots

Keep all the guns locked up and quiet

Keep the drunks out of their cars

Keep rabble-rousers behind bars

Keep all jigsaws out of hands

Keep all the Nattys in their cans

Keep all the rusty knives in blocks

Let all the crack stay formed in rocks

Let all the brains stay mass effectless

Give all the semi-urgents breakfast

Let every epidural work

Let no vascular disasters lurk

Let nobody’s water break

Let nobody’s RLQ ache

Let me not hear that timeout bell

Let not one fetus have decels

Let no heart failure be end stage —

Beep beep beep...

“This is anesthesia, returning a page...”

Jody C. Leng, M.D., M.S.*

* Stanford Hospital, Stanford, California. cimbalo@stanfordalumni.org

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power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Falling from Height...The Prognostic factors

Falls from Height is Knwon to cause major morbidities and mortalities. There are several prognostic factors for survival that have been identified: Height Age Type of surface Body part that touches the ground first Two other factors are important, but do not have a significant effect on mortality: Circumstances of the fall (suicide, accident, escape) Initial impact with an object before impacting the ground Height . Overall, about half of victims die at the scene, and a total of 70% die before they reach the hospital . The median height leading to death is about 49 feet, or about 4 to 5 storeys. 100% of victims die after falling 85 feet, or about 8 storeys. Age . Mortality increases with age due to pre-existing medical conditions and decreased physiologic reserve. Type of surface . The type of surface struck (i.e. grass, water, construction debris) can also have an effect on secondary injuries and survival. Mortality after striking a hard surface is nearly doubl...

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

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