Wednesday, April 5, 2006
Air Force Anesthesia: Ether and Pentothal?
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The U.S. Air Force physician recruitment web site has a web page for anesthesiologists which claims I can "administer such anesthetics as ether, sodium pentathol and nitrous oxide while maintaining life support of patients under your care."
Since ether hasn't been used in decades and few practicing anesthesiologists know how to administer it, that would explain why I'd have to "maintain life support of patients under [my] care." Seriously, doesn't anybody read this stuff before they post it on their site? There's not a single fact on that page to help me decide whether I'd like to learn more or 'contact an Air Force Advisor today.'
Tuesday, March 14, 2006
Wisconsin Limits Noneconomic Damages In Malpractice Suits
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Wisconsin Senate Approves Limits On Noneconomic Damages In Malpractice Suits:
"The Wisconsin state Senate on Wednesday voted 25-8 to approve a bill that would place a $750,000 limit on noneconomic damage awards in medical malpractice cases, the Milwaukee Journal Sentinel reports. Six Democrats joined all 19 Republicans in voting for the bill."
[Via UK Medical News Today]
Sunday, March 5, 2006
Vaccines, Mercury, and Autism--New Data
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My smart wife tells me that this article is really big news: Early Downward Trends in Neurodevelopmental Disorders Following Removal of Thimerosal-Containing Vaccines (pdf). I've quoted the entire abstract below:
"Contemporaneously with the epidemic rise in neurodevelopmental disorders (NDs), first observed in the United States during the 1990s, the childhood immunization schedule was expanded by the U.S. Centers for Disease Control and Prevention (CDC) to include several additional thimerosal-containing vaccines (TCVs). On July 7, 1999, a joint recommendation was made by the American Academy of Pediatrics (AAP) and the U.S. Public Health Service (PHS) to remove thimerosal from vaccines. A two-phase study was undertaken to evaluate trends in diagnosis of new NDs entered into the Vaccine Adverse Event Reporting System (VAERS) and the California Department of Developmental Services (CDDS) databases on a reporting quarter basis, from 1994 through 2005. Significant increasing trends in newly diagnosed NDs were observed in both databases 1994 through mid-2002. Significant decreasing trends in newly diagnosed NDs were observed in both databases from mid-2002 through 2005. The results indicate that the trends in newly diagnosed NDs correspond directly to the expansion and subsequent contraction of the cumulative mercury dose to which children were exposed from TCVs through the U.S. immunization schedule."
The big news is the last sentence: trends in newly diagnosed ND's [ed: autistic spectrum disorders] correspond directly to the expansion and subsequent contraction of the cumulative mercury dose to which children were exposed from TCVs through the U.S. immunization schedule.
There were suspicions during the time that vaccines contained Thimerisol that it was responsible for an associated increase is the so-called autistic spectrum disorders. The suspicion was based on reports of increases in autism in the community. These were explained away by the observation that diagnosis had become much better during the same time period and the fact that scientific data supporting such a link were of very poor quality. Nonetheless, many parents chose to forgo immunization of their children out of concern that vaccination would increase their risk of autism or related disorders. Skipping immunization did not increase their risk of infectious disease because of herd immunity, up until enough members of a population are unprotected and disease can once again propagate among the non-immunized.
There are ongoing flame wars among blogs about this issue, but his article should cause many of those involved to rethink their position.
Tuesday, February 28, 2006
Is this what Constant Gardener Was About?
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Desperate for Dollars - The Nation of Guinea Pigs:
"How India became the global hot spot for drug trials. Big pharmas have a billion people vying to be part of clinical trials of untested drugs. Areas known only for snakes and heat now have good hospitals after the government passed a law allowing the drug testing and advertised its "treatment naive" patients."
[Via digg]
Bird Flu Now Cat Flu....in Germany
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Bird Flu Found in Cat in Germany after eating infected bird.
MAC: Maximum Anesthesia Care?
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Injury and Liability Associated with Monitored Anesthesia Care: A Closed Claims Analysis.:
"Analysis of closed malpractice claims associated with monitored anesthesia care showed a high severity of patient injuries, comparable to claims associated with general anesthesia. Severe respiratory depression from an absolute or relative overdose of medications used for sedation was the most common damaging mechanism. Burn injuries due to fires from the use of electrocautery in the presence of supplemental oxygen represented a surprisingly high proportion of all monitored anesthesia care claims (17%)."
[Via Anesthesiology]
Our Time Is Up
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Would you treat patients any different if you knew you only had six weeks to live? The iTunes Music Store has an Oscar-nominated short film titled Our Time Is Up (requires iTunes). If you're a therapist or psychiatrist, it's worth the $1.99 price ten times over.
Sunday, February 26, 2006
Gum, one stick, p.o. times 1 hour, TID prn ileus
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Gum Chewing May Speed Recovery From Postoperative Ileus:
"In a randomized study, gum chewing was associated with faster recovery after elective open sigmoid resection by stimulating bowel motility. (CME,CE)
"
Something to mention across the ether screen Monday....
[Via Medscape Headlines]
Sunday, February 19, 2006
More LifeHacker Google School Tips
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- Access websites from behind a proxy
- Find toll-free numbers
- Subtract words from your search
- Search web page titles
- Filter adult content with safesearch
- Lookup phone numbers
- Compare prices near you
- Map area codes
[via LifeHacker]
Google That Medal Count
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Just Google 'Olympic Medals' to see the top three countries in the medals race.
via [LifeHacker]
Saturday, February 18, 2006
Inside the Brain
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"What happens in the brain of a person with Alzheimerâs disease? This tour explains how the brain works and how Alzheimer's affects it."
Saturday, February 11, 2006
Tight Brain Checklist
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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:
- Are the pressures controlled?
- Is the metabolic rate controlled?
- Are vasodilators in use?
- Are there any unexpected mass lesions?
Are the pressures controlled?
- Arterial Pressure
- pCO2
- pO2 (remember that hypoxemia is a potent stimulus for cerebral vasodilation
- Intrathoracic pressure
- Airway pressure
- Jugular venous pressure (includes external venous compression by C-spine collar or twill used to secure endotracheal tube)
Is the metabolic rate controlled?
- Pain
- Light anesthesia
- Awareness
- Seizures
Are vasodilators in use?
- Potent agents (Isoflurane, Desflurane, Sevoflurane, Enflurane)
- Nitroprusside
- Nitroglycerine
Are there any unexpected mass lesions?
- Pre-existing pneumocephalus exacerbated by nitrous oxide
- Cerebral hemorrhage remote to the site of surgery
As taught to me by John Drummond, M.D. at UCSD
Wednesday, February 8, 2006
Aspect Medical Fearmongering Pays Off
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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:
"Aspect Medical posts revenue, profit gains in 2005 (bizjournals.com via Yahoo! Finance):
Aspect Medical Systems Inc. ended 2005 with a large jump in both revenue and net income, as demand for its anesthesia monitoring systems expanded at a healthy clip."
Full disclosure: I still don't use a BIS monitor
[Via Yahoo Search: anesthesia]
Tuesday, February 7, 2006
Smoking Cessation Before Surgery Encouraged
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"According to a new comprehensive review of existing studies in the February issue of Anesthesiology, surgical patients who are nonsmokers, or who stop smoking prior to surgery, tend to fare better in the recovery period than smokers. This is in addition to the benefit seen during the actual surgery, when anesthesia is safer and more predictable in nonsmokers due to better functioning of the heart, blood vessels, lungs and nervous system.
Add to all of this another bonus: smokers who have quit around the time of surgery may have fewer problems with nicotine withdrawal after the operation than they would have if they had tried to quit at other times. This may be due to medications and therapies commonly used during surgery and recovery, which may suppress nicotine withdrawal symptoms. Even if patients do have problems with nicotine withdrawal after surgery, they can safely receive help such as nicotine patches."
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]
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