papapump

A colleague was approached and berated for giving a reversal after the patient had received Cis. They had 4 twitches back and it was end of the case. I know the metabolism of Cis and it seems to me that maybe it does not need to be reversed but we were also taught that for medical- legal reasons to always reverse if given a paralytic. What are the thoughts current standards for reversing Cis? Besides medical-legal reasons is there a reason to reverse Cis? To be honest- I don't have a whole lot of experience with it but just wanted to get some more opinions. Thanks

Thanks. I want her to do what she wants but I get the feeling- this is going to be done more by the protocol and not with the patient in mind. Thank you for the words of encouragement.

That is a good question. I know they do use NMBA with LMA's in Europe as well- heck I've heard they use LMA's with prone cases over there. I was taught the same thing- don't use relaxants with an LMA. If the surgeon needs relaxation- I would just intubate and get a more secure airway. Until the standard changes and people use LMA with relaxants routinely I wouldn't do it.

Hi all. I am a Student nurse Anesthestist. My wife is pregnant with our second child and I have a couple of questions. A little background- our first child was born via C-section after FTP . She only dilated to 6 cm after 26 hrs and started having decels so they decided to cut. Also our son was 9#12oz when born. Now that she is pregnant she was thinking about trying a TLAC/ VBAC but there are some downfalls. Our hospital is a large woman's hospital that is also a teaching hospital. This is the hospital that we must go to due to insurance. She would like to try to labor in water but after the water is broke she was informed that she would have to get an internal monitor and have to stay in bed. She does not like this option and feels pretty helpless with her choices. Based on her FTP and the fact that the first child was very big, she is already measuring at 33 weeks but is only 30 weeks, and her history of C-section- I tend to think that maybe a section is the best route. Now I know that a C/S is usually not the best thing but given her limited options to do things the way she wants I tend to lean that way (yes I am aware that I am the one who does not have to recover). Also with her first pregnancy- the epidural really hurt her bladder- she has a bad bladder. She was HTN but not spilling proteins, but after our child was born, went full blown preeclampsia and had to be readmitted and put on Mag which slowed down her healing and made for an overall awful expererience. Right now her BP is okay so we are hopeful. I am just looking for some opinions on maybe she should try the TLAC and get the internal monitors and have to stay in bed- it is this groups policy or should she schedule a C/S at 39 weeks and go that route. Thanks

I am an SRNA who graduates this Dec. I had a kid in Feb before starting in Aug and now we have another on the way. It definitely makes things tougher. We don't have any family where I go to school so that doesn't help. CRNA school takes up A LOT of time. Programs are different so your time committment may vary. My program is integrated- clinicals and didactic while some are just classes for a year. Either way- you will be very very busy. That being said- I am still in the program. It honestly depends on the support of the spouse. Luckily, my wife has been through grad school so she knows that it takes up a lot of time and to be honest when the load was heavier and I was busy we fought a little more. But we made it through and it is a little easier now. Depending on your load though- plan on committing about 50-60 hours some weeks to school and studying. Some weeks more, some weeks less. Also- since the children will be young- find a quiet place to study because home is impossible. Good luck to you.

I can honestly say that school is tough. I am currently a SRNA who is about to graduate this Dec. After I moved we found out we were going to have a child and now we have another one on the way. It is tough with children- I am just being real honest. Definitely do-able but it is tough. I do know of people who have a tougher time (i.e. don't make it because of their family situation). Private loans are a little bit tougher to get right now so he may want to check into that before fully committing if he is depending on loans. If planning on staying where you are at now- check into local hospitals/ groups because sometimes they offer low interest loans if you agree to work for them for a couple of years. It'll definitely help though if you have somebody to help take care of the kids though. Good luck to you two.

I am currently a SRNA who graduates this December. I would have done nothing differently. Your program is going to teach you what you need to learn (at least they should). You will have some baseline knowledge of drips, ventilators, etc but to be honest a patient presenting for surgery is a lot different than a patient who is in the ICU. I find that PAC and all this knowledge about drips is covered in detail in lecture so minimal experience is only needed. The only thing I would make sure to do is go on a nice vacation and blow off some steam before starting because school is tough.

Thank You so much for the information. This is exactly what I was looking for. There's a strong chance that we'll be going back to TX (currently in PA) and I just wanted some info from people who are actually working there so this helps. Do you mind if I ask what group you work for and if you like it? Do you know anything about Corpus or San Antonio? Thank you so much again.

Thank You very much for the info. Do you mind if I ask what the work climate is like there. I know TX uses a lot of CRNA's but for instance I have heard that Austin isn't too CRNA friendly so I am wondering if that is the case with Houston. I know Houston is huge and I'm sure it depends on where you work but any info is helpful. Thanks again.

That does help. Thank You. Like I said, I am just looking for some general info on the group since they are the big ones in houston. Thank

HI. I am currently a SRNA who graduates soon and am starting to think about jobs. We have a lot of family in TX and know the Houston area. I know that GHA is the big group in Houston, TX and there are many hospitals, whether in the med center or out in the suburbs. My question is what is the climate like there. I know there are plenty of jobs. Do CRNA's get to do regional, heads, hearts or do we just get the smaller stuff? I just want to know what it is like to work in Houston- I have heard about other places but not much about Houston. Thank You

Thanks for the info Scop. That is kind of what I heard ( and I am in Pittsburgh so their reputation reaches all the way up here). I know my wife and I both love Austin (we went to school there), but I have heard that the practice isn't that great. NOt a lot of autonomy and just not treated well. Thank You

Hi Y'all. :chuckle I am currently in CRNA school out of the state of TX but am going to go back to TX when I am done. I was wondering if any Austin, TX or San Antone CRNA's have any perspective on the market in that part of TX etc.. I have heard Austin is kind of a tight market and you don't have a whole lot of autonomy (this is just what I've heard). I haven't heard much about San Antonio- except they like to party and have fun. I was just wanted to get some perspective on what it's like to be a CRNA in those two areas. Thanks