A Day in the Life of an Anesthesiologist
Check out @ASAGrassroots’s Tweet: https://twitter.com/ASAGrassroots/status/981951115062337536?s=09
#NewYork budget excluded provision that would have undermined physician-led anesthesia care, opposed by @ASALifeline & @NYSSApga. #THANKYOU to New York lawmakers for protecting patient safety. #SafeAnesthesia4NY
https://t.co/3M5wQm0TK8
I was shocked to see that the NHS could ban surgery for the obese and smokers. That’s socialized medicine. You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare. But in a way, it’s empowering patients to take responsibility for their own health. Smoking, for sure — I agree 100% that surgery should be banned for this population. Obesity is a bit trickier — there’s genetics and environmental factors at play in this one. I don’t think anyone chooses to be obese. But, people do have the power to change their eating and exercise habits. Despite these efforts, there are some people who are still obese…. and these people should not be faulted.
I think the NHS is on to something here. They’re opening doors to moving the liability and responsibility away from physicians and towards patients. This is a plus. Outsiders may see it as separatism and elitist to only provide care for people who are healthy. But look at the facts and the data…. obesity has a lot of co-morbidities associated. Smoking has a lot of co-morbidities associated as well. Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough? In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness. With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health. I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation. It’s not easy, but my health is 100% my responsibility. I refuse to pass the buck to my husband, my family, my physician, etc. I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.
Patients need to change their mindset re: health. It is not your spouse’s responsibility to track your meds. It is your responsibility to know your medical conditions and surgical history. The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery. This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care. Please do not forget recreational drugs, smoking habit, and drinking habit in this list. It is very important to know all of these things. Also, your emotional history is very important. Depression, anxiety, failure to cope, etc. This all helps tie in your current living situation with stressors and your medical history.
Responsibility for health: personal, social, and environmental
It seems like in today’s day and age, emergencies are occurring everywhere. From hurricanes to shooters to earthquakes and fires… I think it’s always important to know what to do. Here are some fabulous checklists I’ve found for getting through those emergencies. These are not substitutions for knowledge and training. Clinical judgement warranted.
Emergency Manual from Stanford — Printable PDF
Ariadne Labs OR Crisis Checklist
Ariadne Labs Safe Surgery Checklist Template
Ariadne Labs Ambulatory Safe Surgery Checklist Template
Newton-Wellesley’s L&D Checklists
Checklist for Trauma Anesthesia
ASRA checklist for Local Anesthetic Systemic Toxicity
Johns Hopkins Central Line Checklist
STS Adult Cardiac Surgery Checklist
Ariadne Labs Cardiac Surgery Checklist
STS General Thoracic Surgery Checklist
STS Congenital Heart Surgery Checklist
University of Kansas Daily ICU Quality Checklist
Enhanced recovery after surgery #ERAS #anesthesia #pain #recovery
Summary of Enhanced Recovery after Surgery Guideline Recommendations. Canada.
Regional Anesthesia for surgery and other comparative studies. Sweden.
ERAS: Role of Anesthesiologist. UTSW.
Stanford Anesthesia ERAS pathway website
The Role of Regional Anesthesia in ERAS pathways. Sept 2015. UCSF.
Anesthesia Practice and ERAS. Cooper University Hospital. 2017.
ERAS: Anesthesia Tutorial of the Week. Number 204. Nov 2010.
ERAS and Anesthesia. Anesthesia Business Consultants. May 2015.
I’d love to incorporate my findings and use of lidocaine infusions and ketamine infusions on intraoperative and postoperative pain as a multimodal pain management pathway.
BJA Educ, April 2016. Intravenous lidocaine for acute pain: an evidence-based clinical update
Lidocaine Infusion for Perioperative Pain Management – Vanderbilt
Perioperative Use of Intravenous Lidocaine. Anesthesiology 4 2017, Vol.126, 729-737.
Anesthesiology, April 2017. Perioperative use of IV lidocaine.
Here’s what I’m currently using:
I’m also currently working on ERAS protocols for my practice as well as the use of ketamine infusions for intraoperative and postoperative pain and recovery.
We had a journal club where we discussed this article: Anesthesiology, May 2017; Clinical effectiveness and safety of intraoperative methadone in patients undergoing posterior spinal fusion surgery: a randomized, double-blinded, controlled trial.
Questions:
Methadone Dose Conversion Guidelines
Intraop Lidocaine for postop pain
Intraop Ketamine for postop pain
Literature search:
AVR
Brief case summary
Literature Search
Antifibrinolytic Debate
