Gotosleepy

like said above.... the catheter issues are old... In fact, microcatheters are BIG in Europe now and are on their way through the FDA process - some of the microcatheters are 32 Gauge!!!! In fact most major OB insitutions (>10,000 deliveries/year)...

georgia ... agreed... i like adding vioxx 25mg po prior to induction... in my practice, i feel it has made a nice improvement on limiting narcotic use...

interesting note: we used to do and interpret our own EEGs for SSEPs/MEPs and carotids while doing those cases.... now the neuro depts have a political stranglehold... the incidence of awareness used to be more common in cardiac cases during the 60s/...

there is nothing wrong with high-dose narcotic techniques - especially in neonates or in cardiac or even in neuro patients.... but to use high dose fentanyl for other cases that are short (ie: tonsillectomy) is kinda pointless... you could get the sa...

while i like the idea of high-dose narcotics - giving a patient 700mcg of fentanyl for a 20 minute case? give me a break.... while i agree the less volatile you use, the better the wake up, I find that using such high doses of fentanyl unnecessary......

10 to 15 ug/kg??? isn't that a bit high? unless the case is going to last 4 hours or more...

i like the old definition of MAC... if there is a fire during a MAC, the patient should be able to get up off the OR table and run with you to the nearest exit... 3% DES??? masking them... with a propofol infusion.... you gotta be kidding...

i don't think giving NDMB prior to establishing an airway is very smart at all... However, I frequently give NDMB prior to establishing an airway if I know that the patient has a recent history of intubations and was easy mask/easy intubation, or i...

nobody can defend giving a paralytic without ventilating... however we do it all the time for RSI.... are all RSI patients easier to intubate? and what do you do for a patient that is MH-susceptible who is going to need RSI??? and is 3 years old and ...

so if you can ventilate .... does that mean that you can always intubate? and if you aren't 100% positive that you can intubate, why not do all of your inubations awake?.... food for thought

okay.... so now you can't ventilate, patient is desaturating.... are you going to try to intubate? if so, what drugs will you give and why?

gaspassah.... i see your point, and I have become far more selective in which patients i use LMAs... And no, i don't advocate the use of LMAs for c/s as they do in England.... not because i don't believe their literature (which shows it is safe), but...

athomas... what is the incidence of aspiration with general anesthesia, what is the incidence of aspiration for LMAs and for ETT.... you'd be surprised by what you find...

the reason i still use lmas despite my 2 silent aspirations is based on scientific grounds (ie: literature based).... just because i have 2 adverse reactions with a device doesn't mean i shouldn't use it anymore (imagine if you had 2 carotid sticks ...

i agree with you jwk... they should definitely not be used indisciminately... in fact, i had two silent aspirations in no-risk factor young patients (both were okay after all), but still LMA isn't perfect. I just want point out that it is an alternat...

jwk.... show me the literature that shows that there is an increased incidence of documented aspiration in mechanically ventilated patients by LMA vs ETT.... in fact, if you look at the literature (if you eliminate ICU patients, pre-existing pulmonar...

actually the lethal part of the injection is a bolus of Potassium Chloride - the paralytic is just to make the patient look at peace for the witnesses...

some places offer extra months of focused clinical exposure - i know of 2 centers that provide 6 months of peds exposure.... if you want to be at the level of a fellowship trained MDA i can only suggest the following: 1) med school 2) anesthesia resi...

there are no pain fellowships for CRNAs.... the aana is still trying to get that whole mess approved...

deepzzzzz.... what a pompously annoying post... but since this is a CRNA board, i guess posts like these are allowed.... if i can presume to paraphrase your long tedious post: MDAs are balding, bottom of the med school class people who have no under...

like i said earlier paralytics in an unintubated patient should only be provided by an anesthesiologist/CRNA.... and definitely should not be used as a means to manage confusion/restlessness in the ICU. the gold standard for airway protection is an a...

oh the list goes on and on... recent tracheal resection and reconstruction for dilation... suspension microlaryngoscopy... TURP w/ obturator nerve stimulation (and you don't want the patient to kick the urologist) and the beauty of an LMA is that yo...

i said that you can paralyze a patient just as long pt is sedated (and won't be aware of paralysis) and just as long as there is an anesthesia provider at the bedside to maintain/secure the airway.... whether this is with an ETT/LMA or just a mask ai...

actually you can use paralytics in somebody who isn't intubated... but they need to be sedated as well, and you need an anesthesia provider there

Tubal ligations can absolutely be done under spinal.... the gynecologist just has to insufflate less CO2 and have good fiberoptics to provide good lighting, and then aspirate all the CO2 out of the abdome at the end of the procedure... a tiny bit of...