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February 4, 2023

BehindTheMedspeak: When in doubt, do nothing

Screenshot 2023-01-21 at 11.01.35 AM

Excellent advice from Dr. Garfield re: what to do if you're giving anesthesia and something unexpected (not unanticipated: the art of giving anesthesia safely lies in having enough experience to have anticipated anything that could possibly happen โ€” though every once in a while, perhaps once a year after you've been passing gas for, say, a decade, something unanticipated does occur) happens.

Prime example: during anesthesia induction, premature ventricular contractions (PVCs) are common.

The novice immediately reaches for the pre-filled lidocaine 100mg syringe; in contrast, I would simply increase hand bag-and-mask ventilation volume and rate, which acutely lowers CO2: the resulting hypocarbia usually did the trick.

I used to tell residents that simply holding the syringe in their hand solved the problem.

February 4, 2023 at 04:01 PM | Permalink


Years ago, I suffered a break to my tibia and fibula that required surgery to put back together. My anesthesiologist agreed to a spinal block rather than a general, and I was conscious during the procedure. Not bad at all. Could not see anything below my waist because the table was articulated and designed to immobilize my legs. But I could see the instruments that reported vital signs -- pulse, blood pressure. I decided to have some fun.

In one college course, I trained in biofeedback. I have some conscious control over my pulse and blood pressure. Since all I had to see was the report of those two vital signs, I decided to see how low I could go.

I dropped my pulse to 50 and my BP to 90/60. (I may be mistaken about that number. Years have passed, and I do not recall the numbers precisely. But the systolic was less than 100.) Immediately my gas passer came and checked me over. I raised my numbers back to 72 and 110/80. Satisfied that I was not going to die on the table, my gas passer went back to his other duties. So I dropped my numbers again. Back he came. Numbers raised. Back he went. Dropped again. Back he came. Numbers raised. This time, he stayed.

Well, it was fun while it lasted.

Posted by: antares | Feb 4, 2023 5:00:14 PM

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