Hello all,

Anesthesia trainee here. I have a quick question regarding narcotic titration at the end of a case.

I’ve always heard to titrate narcotic to a RR 8-12 (looking at HR/BP as well) for adequate analgesia pre-extubation.

My question is does this strictly apply to spontaneous ventilation when they’re fully reversed or can you gauge off of PSV as well?

I’ve noticed my RR changes going from PSV to spontaneous. Does this mean when they’re triggering on PSV, it’s not a true reflection of pain status and shouldn’t be considered when working in narcs?

TIA

Peds fellow here struggling a bit with ultrasound guided IVs on infants/neonates. I feel like I’m okay once they’re above age 2 or so, but these small superficial ones are giving me issues.

Any tips or advice for improving stabilization and needle visualization? Recently I’ve tried using tape to help get the skin taut and the secure limb which I think has helped somewhat. I feel like I struggle the most with visualizing the needle tip once it enters the skin, and often I’m already too deep by the time I find it.

TLDR:

A 68-year-old woman fell at home and suffered a left femoral neck fracture. She had stage IV lung ca with bilateral upper lobectomies - on chemotherapy and dexamethasone. The pulmonology service cleared her, advising she may need stress steroids. Two other anesthesiologist had declined the case.

Case goes okay, some hypotension after induction. Patient is unresponsive in pacu. CT concerning for shower emboli. Patient goes comfort care, husband sues. "Expert" testimony blames it on not given stress dose steroids on induction. Per anesthetist, they were given just not documented. Hospital was dismissed because the anesthesia group was an outside contracted group.

I'm an emergency medicine resident and I recently attended a pediatric anesthesiology presentation. The main speaker (ped anesthesiology fellow) said there's a massive disconnect between evidence based guidelines and what actually happens in the hospital. He said 1hr fluid cut off doesn't bump up aspiration risk and some of the newer research proves it. In his opinion, the NPO after midnight doesn't help the children and more frustrating for the parents. He said hospitals should be moving away from that rule.

Other people at the presentation disagreed with him and there was a lot of Q&A.

How does one conduct a discreet job search without current employer finding out? Some places require letters of rec even before offering interview, and I don’t want anyone at current workplace to know I’m looking elsewhere. For context this is my first job after residency. To ask prior workplace would mean going back to residency attendings who may/may not still work there…

Anyone know anything about working here? I understand they’re probably in a state of transition with the new residency program. Any details would be great, thanks!

Does anyone have experience working at OSU Wexner, what’s it like? I’m from out of state but have in-laws, considering moving to Columbus in general for job after residency.