About a two years ago an ENT surgeon I have never worked with requested that I use a TIVA for her patient who was having an endoscopic sinus surgery.   I thought this an odd request.  I did an initial literature search and indeed found a few studies supporting this concept.  However, there were other […]

 I recently changed jobs and joined a hospital based anesthesia group at a busy downtown facility in my area.  There were many adjustments needed to accommodate a different cultural practice.  For example, on my first day of work I was assigned to do my own case for a IM nail in an elderly gentlemen who […]

 Today I was assigned to take care of 40 year old female who had had a previous breast augmentation 14 years ago and then subsequently developed a multitude of problems including difficulty eating with severe weight loss requiring placement of a gastro jejunostomy feeding tube.  Today she weighed 47 kg and had developed a sacral […]

 Since I last updated my blog related to perioperative surgical site infections and oxygen tension, several articles have appeared related to this topic. I would like to update my blog with the latest information to provide context to the highly charged debated related to intraoperative FiO2.Just this year, an editorial review was published [1], going […]

 This morning my patient was a 62 year old female who uses marijuana daily.  She also reported to me that after a recent general anesthetic she experienced a two week period of amnesia immediately following her anesthetic. She stated that she performed all of her normal activities and that friend and family told her she […]

 Recently, there have been more articles published on post operative delirium (POD) in the anesthesia literature.  The ASA has added additional training related to this topic as we become more aware of the significant consequences of post operative delirium in our aging population.  We have learned that those who experience POD will likely see an […]

 I recently started a new position at a facility that performs a fair number of DIEP flaps after breast cancer surgery.  The surgeries are very adamant that the anesthesia provider avoid all vasopressors and give at minimum 4 to 5 liters of fluid regardless, and also use additional repaid fluid infusion to treat and prevent […]

 a 59 year old male presented with a complex VHR via robot laparoscopy.  He had a prior history of drug abuse, hepatitis C and a long smoking history resulting in mild undiagnosed and untreated COPD.  The patient was given a GETA anesthetic with sevoflurane, rocuronium, dilaudid, and low dose ketamine. During the anesthetic, his minute […]

 59 year old female for D&C and hysteroscopy with a history of pituitary adenoma, empty sella syndrome, Adrenal insufficiency, HTN, OSA, and BMI of 31. The patient was taking cabergoline to inhibit the secretion of prolactin via agonism of dopamine receptors. The patient also had a history of PONV and was very concerned with this […]

 A 28 year G3P2 carrying twins vertex vertex, presents the day before induction for consultation with anesthesia.  She states that she was diagnosed with thrombocytopenia by MFM, and started on 10 mg of prednisone for a platelet count of 71K.  She has had two prior deliveries without epidural analgesia.  She plans on vaginal delivery this […]