How Do You Manage Unruly Colleagues/Partners?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: How Do You Manage Unruly Colleagues/Partners?

Exposed to unruly colleagues/partners . . . one would think as adults/physicians, awarded the highest level of diplomacy within our specialty that our childhood years of pranks would be far in the past . . . but, oh, no!  How do you manage these colleagues, as they may still be some of the best clinicians within your department?  Often we ask ourselves, "If we replace them . . . what problems/who next do we inherit?" and so complacency sets in.  http://boards.medscape.com/forums?128@610.qKdMaLVjgR4@.2a37656f!comment=1

Giving Thanks To Our Colleagues On This Thanksgiving Day

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Giving Thanks To Our Colleagues On This Thanksgiving Day

We as anesthesia providers work in stressful situations . . . often our nerves wear thin . . . .  On Thanksgiving Day to take a moment to remember and thank our colleagues . . . . We often forget a simple "Thank You" is called for and often overlooked . . . . We'd like to hear comments from the Anesthesia Sphere as to when  your staff came to your rescue and/or thanks was given.  Link: http://boards.medscape.com/forums?128@610.xt67ajtIcE5@.2a36fecf!comment=1

Are Specialists "Best Fit" For Your Private Practice

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Are Specialists "Best Fit" For Your Private Practice?

We would like to hear from the Anesthesia Sphere as to whether or not YOUR private practice (non-academic setting) has sub-specialist (i.e., fellowship trained in cardiac, pads, OB, etc.) anesthesia providers . . . ?  What are the pros/cons to having/not having these specialists in your practice?  Link: http://boards.medscape.com/forums?14@@.2a36c5d7!comment=1

Anesthesia Adventures: Mission Honduras

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Anesthesia Adventures: Mission Honduras

I'm always looking for missions (medical/humanitarian/anesthetic/veterinarian, etc.) outside the regular daily routine . . . recently had the opportunity to travel to Roatan, Honduras . . . and build the island's first veterinarian isoflorance general anesthetic machine . . . 
Link: http://boards.medscape.com/forums?128@@.2a35fb0c!comment=1

Emergent Esophageal Rupture Repair . . . What's Your Anesthetic Game Plan

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Emergent Esophageal Rupture Repair . . . What's Your Anesthetic Game Plan?

 . . . trauma surgeon calls . . . needs to emergently bring female to your OR . . . repair of ruptured esophagus . . . . We'd like to hear from Anesthesia Sphere . . . as to what your preoperative anesthetic game plan is . . . .  Link:  http://boards.medscape.com/forums?128@610.1lQjaW2pkJM@.2a353abd!comment=1

Anesthesia Burnout . . . What's Left In Your Tank

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Anesthesia Burnout . . . What's Left In Your Tank?

Anesthesia career burnout has been a hot button with the increasing stresses/demands . . . .  With new healthcare demands & global economic stresses . . . anesthesia providers are dealing with increased pressures to manage sicker cases . . . with a "do it quicker/faster/more efficiently"  . . . with less support/ backup/assistance . . . .  After 25+ years of education/training, most anesthesiologists plan on a long(er) career [20-30+ years after residency] . . . but with increased work environment stresses/demands AND changing health care . . . What's left in your tank?  Link: http://boards.medscape.com/forums?128@947.m1MSamDNiST@.2a34bb5e!comment=1

What Is Your INR Target For Regional Blocks (i.e., AXB, ISB, FNB)??

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: What Is Your INR Target For Regional Blocks (i.e., AXB, ISB, FNB)??

We often care for patients that require some sort of a regional block, OTHER than spinal/epidural, with an INR that is not "normal"/elevated . . . .  Would you proceed, as in this example, with AXB with an elevated INR of 1.3 . . . given that you can apply compression?  Link:http://boards.medscape.com/forums?128@@.2a342d57!comment=1

"Wet Tap" . . . Now What (Intrathecal VS. Epidural Catheter Placement)??

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: "Wet Tap" . . . Now What (Intrathecal VS. Epidural Catheter Placement)??

Recently . . . discussing what to do when you have a "wet tap", while placing a lumbar labor epidural.  Some colleagues would place the epidural catheter intrathecally . . . in contrast, other colleagues would simply start over and replace the epidural catheter . . . epidurally.  We'd like to hear from the Anesthesia Sphere as to your experiences.  Link:  http://boards.medscape.com/forums?14@@.2a33ae98!comment=1

Endovascular AAA Repair: Spinal vs. General Anesthesia

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Endovascular AAA Repair: Spinal vs. General Anesthesia


Today . . . we are primarily choosing to use a long acting spinal for our elective endovascular AAA repairs.  This is a change . . . we have had very good success and have avoided complications that may appear with general anesthesia.  We'd like to hear from the Anesthesia Sphere as to what is working best for you (spinal vs. general anesthesia).  Link: http://boards.medscape.com/forums?128@848.LVcwark3eGD@.2a3327e2!comment=1

Dexmedetomidine: When And Where Your Practice?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Dexmedetomidine: When And Where In Your Practice?


Anesthesia Sphere (Discussion) - Dexmedetomidine is becoming an anesthetic drug with a wide range of uses . . . sedation in ICU/MRI/CT . . . sedation for awake fiberoptic intubations . . . and as a component to general anesthesia.  We would like to hear when and where you are using dexmedetomidine in your practice.  Whate are your experiences with dexmedetomidine?  Link: http://boards.medscape.com/forums?128@871.HbeeaDAdetK@.2a32ccc2!comment=1

Anesthetic Drug Shortages: How Is This Affecting Your Practice?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Anesthesia Drug Shortages: How Is This Affecting Your Practice?

Anesthesia Sphere (Discussion) - in the US, we have experienced an increased incidence of anesthetic drug shortages.  For example, . . . fentanyl, propofol, etomidate, succinylcholine and lately atropine . . . how the drug shortages have impacted your practice and how are you managing.  Link: http://boards.medscape.com/forums?128@259.FPaqapWGccG@.2a3237a0!comment=1

"The Perfect Storm": OB Alert (Emergent GETA for C-section) - Unable to iintubate . . . now what???

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: "The Perfect Storm": OB Alert (Emergent GETA for C-section) - Unable to iintubate . . . now what???

Anesthesia Sphere (discussion) . . . anesthesia team prepares for and induces RSI GETA . . . vocal cords VERY anterior . . . unable to intubate . . . patient starts to VOMIT! . . . what are your airway management options? Link:  http://boards.medscape.com/forums?128@282.BzO5a36sbBf@.2a3165ec!comment=1

"Best" Time For Zofran: After Induction or Before Emergence?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: "Best" Time For Zofran: After Induction or Before Emergence?


Anesthesia Sphere (discussion) . . . amongst anesthesia providers there are always topics of debate/discussion . . . BEST time to give Zofran . . . . PONV is not only a miserable experience . . . costly issue . . . which dosage time have you seen work best?  Link: http://boards.medscape.com/forums?128@@.2a3103bf!comment=1

Platelet Count: Routine Assessment Prior to Placement of Labor Epidural?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Platelet Count: Routine Assessment Prior to Placement of Labor Epidural?


Anesthesia Sphere (discussion) . . . should we, as anesthesia providers, be routinely checking platelet counts prior to labor epidural placement (LEP) . . . .  Link:  http://boards.medscape.com/forums?128@@.2a30ac39!comment=1

Special Request: Asked To Provide Anesthesia For Colleagues, Friends & Special Cases

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Special Request: Asked To Provide Anesthesia for Colleagues, Friends & Special Cases


Anesthesia Sphere (discussion) . . . .  On occasion you may be asked (special request)  . . . to provide/attend anesthesia for a special case . . . request may seem flattering, daunting and considered an honor; however, should these cases . . . .  Link:  http://boards.medscape.com/forums?128@610.JanTaRcfgkz@.2a306074!comment=1

Surgery is a Go: Yes, No, Maybe So?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Surgery is a Go: Yes, No, Maybe So?


Hypothetical case for Anesthesia Sphere:  . . .  as patient transfers to the OR table . . . they exclaim "I don't want surgery . . . I'm scared" . . .   Link: http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a3017f3!comment=1

Combating Postoperative Shivering: Past, Present and Future

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Combating Postoperative Shivering: Past, Present and Future


Anesthesia Sphere (discussion) . . . . Over the years many medications have been . . .   Link: http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2fab9f!comment=1

AIRWAY BOWL 2012: Glidescope vs. Fiberoptic Bronchoscopy

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: AIRWAY BOWL 2012: Glidescope vs. Fiberoptic Bronchoscopy


Anesthesia Sphere (discussion):  Is the Glidescope becoming the new airway device "SUPERCHAMP", in the OR/periphery for those challenging airway . . .   Link: http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2f1f33!comment=1

Follow-up blog: Location, location, location . . . where do YOU place the PAC/central line???

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Follow-up blog: Location, location, location . . . where do YOU place the PAC/central line???


Many thanks to the Anesthesia Sphere poll takers [180+] and commentators.  Definitely an election/debate year with twists and turns on the  . . .   Link: http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2e948f!comment=1

Location, location, location . . . where do YOU place the PAC/central line???

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Location, location, location . . . where do YOU place the PAC/central line???


Case discussion (Anesthesia Sphere):  71 y/o male is being airlifted to your hospital for emergent heart (CABG x 5) surgery & . . .   Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2e1f49!comment=1

Mission reflections: Remembering the children of the world . . . on Xmas day

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Mission Reflections: Remembering the children of the world . . . on Xmas day


. . . I'm reflecting, today, on the many hardships that the children of the world endure.  I'm disheartened as to how defenseless the . . .   Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2d4bc0!comment=1

Follow-up to blog: ST changes after induction . . .

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Follow-up to blog: ST changes after induction . . .


Transpired events:  After much discussion (anesthesia & multiple cardiologists) it was felt that the most likely cause for the patient's ST changes . . .   Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2cfbc8!comment=1

ST changes after induction (w/ negative cardiac catheterization). Why???

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  ST changes after induction (w/ negative cardiac catheterizaton).  Why???


. . . presents for repeat lumbar surgery [L2-S1] with removal and replacement of hardware.  Case is scheduled for 5-6 hours.  Patient has received . . .   Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a2cbb25!comment=1

OFIRMEV (acetaminophen): When And Where . . . In Your Practice?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  OFIRMEV (acetaminophen): When And Where . . . In Your Practice?


We would like to get input from our Anesthesia Sphere colleagues as to when, where, how frequently and how much OFIRMEV (injectable acetaminophen) . . .    Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a0f4422!comment=1&cat=All

Follow-up blog: Why is the patient so tremulous ("don't lose sight of the forest for the trees")

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Follow-up blog: Why is the patient so tremulous ("don't lose sight of the forest for the trees")


. . . severe acute alcohol withdrawal [delerium tremens].  There was no mention of his quantity of alcohol use/abuse in the H & P, so we were curious as . . .    Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a0f0448!comment=1

Why Is The Patient So Tremulous?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Why Is The Patient So Tremulous?


. . . specifics altered for HIPPA . . . . Case discussion for the Anesthesia Sphere, although this case discussion is focused more for residents/students, we'd like to hear input from . . .   Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a0e12a9!comment=1

4+ hour spinal . . . what's your recipe?

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  4+ hour spinal . . . what's your recipe?


4+ hour spinal . . . what's your recipe?  Case discussion for the Anesthesia Sphere.  Lets say, for discussion,  that you are asked to give a single . . .    Link:  http://boards.medscape.com/forums?128@610.TCXPa1NNffW@.2a0e7126!comment=1

Medical & Humanitarian Mission: Tanzania

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Medical & Humanitarian Mission: Tanzania


. . . to Tanzania, Africa.  My mission took me through the locales of Dar es Salaam, Kilimanjaro, rural areas of Arusha and Zanzibar.  The . . .   Link:  http://boards.medscape.com/forums?128@610.XCLsaUHufwm@.2a0de045!comment=1

Follow-up To Blog: TRAUMA CALL . . .

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Follow-up To Blog: TRAUMA CALL . . . 


. . . Air & blood "bubbles" noted from laceration site of neck [into trachea].  Next, patient underwent bedside emergent . . .   Link:  http://boards.medscape.com/forums?128@610.XCLsaUHufwm@.2a0d0eb9!comment=1

Follow-up to blog: "To Block . . . Or Not To Block" . . . That Is The Question

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Follow-up to blog: "To Block . . . Or Not To Block" . . . That Is The Question 


As promised to the "Anesthesia Sphere", here is the anesthetic game plan that was implemented . . .   Link: http://boards.medscape.com/forums?128@610.XCLsaUHufwm@.2a0d6a2d!comment=1

TRAUMA CALL . . . your early morning "WAKE UP" call

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: TRAUMA CALL . . . your early morning "WAKE UP" call


Your fast asleep (0200) when your Trauma Call pager . . . reads . . . "ER needs you here STAT" . . .
Link:  http://boards.medscape.com/forums?128@610.XCLsaUHufwm@.2a0cabae!comment=1

"To Block . . . Or Not To Block" . . . That Is The Question

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  "To Block . . . Or Not To Block" . . . That Is The Question 


An interesting case I thought I'd post to the "Anesthesia Sphere" . . . . I knew of a colleague headed into the hospital . . . .  Link:  http://boards.medscape.com/forums?128@610.XCLsaUHufwm@.2a0ce0b9!comment=1

When to paralyze . . . that is the conundrum

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: When to paralyze . . . that is the conundrum


We, as anesthesia providers, are frequently confronted with the following (non-RSI) clinical scenario of a GETA induction, mask ventilation, paralysis (+/-) before or after attempted mask ventilation . . .  
Link:  http://boards.medscape.com/forums?128@610.FCXGaRprfyK@.2a0bc8c5!comment=1

The Lost Art of the Awake Blind Nasal Intubation (ABNI)

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  The Lost Art of the Awake Blind Nasal Intubation (ABNI)

The ABNI technique is becoming a lost art and rarely used/considered in today's age of . . .  Link: http://boards.medscape.com/forums?128@610.NhQCakJZflr@.2a0a5e4d!comment=1

Mission Nicaragua

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title:  Mission Nicaragua

The following is a brief chronological synopsis of our mission to Nicaragua.  Goals of mission:  1) meet leaders of USNS Comfort hospital ship . . .   Link:  http://boards.medscape.com/forums?128@610.FCXGaRprfyK@.2a0b17fe!comment=1

Medical Mission Possible (101)

Medscape & WebMD blog posted by anesthesiologist (Chief Medical Officer/President of World-Docs, Inc.) blogger Michael D. Sornson MD (drmike); Blog: Chronicles of Anesthesia; Anesthesia Sphere; Title: Medical Mission Possible (101)

As I plan for an upcoming medical mission to Nicaragua, I'm reminded of lessons learned (some easy/some hard) from my past medical missions.  Should you decide to accept your next medical mission assignment . . . read on.  Link:  http://boards.medscape.com/forums?128@610.XCLsaUHufwm@.2a09e48b!comment=1