Gum Chewing May Speed Recovery From Postoperative Ileus:
Something to mention across the ether screen Monday....
[Via Medscape Headlines]
[via LifeHacker]
Just Google 'Olympic Medals' to see the top three countries in the medals race.
via [LifeHacker]
The anesthetist can have a significant impact on the operating conditions a neurosurgeon has to work with. One example is a situation where the surgeon (or anesthetist) notices the brain no longer appears relaxed but begins to get 'tight' within the craniotomy window. Rather that a knee-jerk response of further hyperventilating the patient and/or giving Mannitol, it is prudent to first consider possible causes as follows:
As taught to me by John Drummond, M.D. at UCSD
Aspect Medical is the company that sells the 'awareness' monitors for anesthesia. Their product is the one featured so prominently in photos accompanying every print story I've seen on intra-operative awareness. This Yahoo Finance headlines seems to indicate it's paying off:
Full disclosure: I still don't use a BIS monitor
[Via Yahoo Search: anesthesia]
I think this is noteworthy because, in terms of complications, we used to think that one would need to quit smoking for at least six weeks before surgery for there to be any benefit. Though that may still be true, this review seems to indicate that if someone were to quit around time of surgery, their chances of success are better.
[via Newswise]An organization called Doctor's Advocate is announcing it's first successful effort to stop a 'frivolous' lawsuit in Pennsylvania: Doctor's Advocate Terminates First Frivolous Medical Malpractice Lawsuit; Case Against OB-GYN Dropped in Seven Weeks:
Here's the background on the organization: "Doctor's Advocate works to reverse the medical malpractice crisis and keep doctors in Pennsylvania by raising public awareness, lobbying for legislation to produce tort reform, and combating frivolous lawsuits with an inexpensive legal service."
Looks like being a member costs $1200 per year.
My Google News section on 'epidurals' came up with an interesting hit: Lower-back tattoos are popular with women, but do they make having epidurals during childbirth more dangerous?. It's a very good question because, at least in my practice, lower back tattoos are extremely common in laboring women. So common, in fact, that Saturday Night Live has a commercial parody for a product called Turlington's Lower Back Tattoo Remover (quicktime | windows media).
I was taught to avoid putting an epidural needle through tattooed skin and have gone to great lengths to do so. For example, one patient had a very large tattoo of what appeared to be the face of the devil on her lower back. On closer inspection, I noticed that the devil's right nares (which was free of tattoo ink) was right over her L3-4 interspace. I wished I'd taken a picture of that epidural catheter snaking out of the devil's nose.
I can't seem to find much science on the subject save for one abstract which makes a very reasonable suggestion to avoid coring out tattooed skin by making a small incision, if necessary. This may sound like a lot of trouble, but all it takes is a 16 gauge (or similarly large) hypodermic needle inserted into the skin first, then the epidural needle through that 'incision'.
Also via A Chance To Cut is a Chance to Cure, a pointer to a new stethoscope: 3M Littmann Electronic Stethoscope Model 3000
Listening to a patient's heart and lungs before anesthesia is something I don't do nearly enough. This may just be the gadget that makes it fun again...
A Chance To Cut is a Chance to Cure points to a cartoon or music that may not be right for the operating room.
It reminded me of a post at my first blog (which I'm reposting below):
A colleague pointed out to me that there are certain songs one should probably not play, or at least not while the patient is awake. What follows is his list of songs not to play while the patient is awake (with iTunes Music Store links where possible):
It looks to me like this would solve the OR's music problems. Staff could pre-program their favorite station and just log in from an operating room computer...as long as that wouldn't interfere with online shopping...
Trasylol (Aprotinin) is a very expensive drug used during many kinds of cardiac surgery to reduce blood loss. In today's print edition of the NEJM (but not online yet) is a very important article by Dennis Mangano (very, very smart anesthesiologist) which shows an "association between aprotinin and serious end-organ damage" including doubling the risk of renal failure requiring dialysis, a 55% increase in the risk of MI or heart failure, and a near doubling of the risk of stroke or encephalopathy. The good news is that there are alternative drugs which cost one tenth as much and are also very good at reducing the need for blood transfusion. More soon....
