Category: Procedures

Suprascapular blocks

Trends are evolving in decreasing intraoperative and postoperative opioid use.  Therefore, anesthesiologists are constantly learning new regional techniques to help with postoperative pain.  For shoulder surgeries, I’ve moved away from interscalene blocks toward supraclavicular blocks.  I think the interscalene block provides a better block of a total shoulder surgery, however, certain patient comorbidities often make

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Emergency Checklists

It seems like in today’s day and age, emergencies are occurring everywhere.  From hurricanes to shooters to earthquakes and fires… I think it’s always important to know what to do.  Here are some fabulous checklists I’ve found for getting through those emergencies.  These are not substitutions for knowledge and training.  Clinical judgement warranted. Emergency Manual

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Walking labor epidurals

What is an epidural? American Pregnancy Association: Epidural Anesthesia N Engl J Med 2010;362:1503-10. Epidural analgesia for labor and delivery. What is a “walking” epidural? Brigham and Women’s Anesthesiology 2 2000, Vol.92, 387. Walking with Labor Epidural Analgesia: The Impact of Bupivacaine Concentration and a Lidocaine–Epinephrine Test Dose. MJAFI, Vol. 63, No. 1, 2007. Walking Epidural :

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Mitraclip and TEE for MR

  European Heart Journal – Cardiovascular Imaging (2013) 14, 935–949.  Peri-interventional echo assessment for the MitraClip procedure.  Everest Clinical Trial results PPT Open Heart 2014;1:e000056. Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome. ASE Echo 2016: Percutaneous approaches to MR. UofMichigan PPT. 2015: The role

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Ventricular Assist Devices: Impella

“There’s an emergent case coming for impella placement.” Impella?  I’ve read about these devices and I’m familiar with managing patients on LVADs as well as providing anesthesia for LVAD placement.  But, I’ve never done an Impella on a critically unstable patient. YouTube video describing the purpose and placement of the Impella Cath Lab Digest: Overview

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PEC 1 & 2 Blocks, Serratus Anterior Block

I’ve been hearing more and more about PEC 2 block for mastectomy.  What’s wonderful about this block is that it seems that the risk of pneumothorax is lower than for a paravertebral block. Egyptian Journal of Anaesthesia; April 2014. Thoracic Paravertebral Block vs. Pectoral Nerve Block for Analgesia after Breast Surgery SlideShare powerpoint: PEC 1

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Left atrial occlusion devices

Our hospital is starting to do more left atrial occlusion devices for people who have afib and aren’t able to tolerate blood thinners. Currently, two types are offered by our cardiologists: Watchman procedure (endocardial) vs Lariat procedure (epicardial).  Lariat It look and acts similar to a lariat or lasso.  An external guide wire with a

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Minimally invasive mitral valve surgery from an anesthesiologist’s perspective. #cardiac #mitral #tee #minimallyinvasive #robot #anesthesia #meded

Surgically, more and more cases are performed through tiny incisions for minimal scarring.  Don’t let that underestimate the size of the procedure.  For example, mitral valve surgery is still a common procedure that involves a sternotomy (“cracking the chest”) and stopping the heart — it’s a big procedure.  However, surgeons have become adept at making

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