r/anesthesiology

Hello all, I am not a medical professional, but I am a librarian at a health sciences academic library. This issue was spotted and reported to the folks over at NLM about a month ago, but the site still appears to be live and I wanted to set out a warning to steer clear of a site/ai tool.

The site PubMed.ai is promoting itself as a quality ai research tool, and heavily borrows from PubMed's visual language and recognizable branding. It advertises itself as useful for medicals students, researchers, and clinicians.

However, it is in no way affiliated with PubMed, and it has additional red flags. It claims to have a "team" behind the tool, but has no information about who is working on it. When I went looking for who is actually affiliated with the site, I only found what looks like a network of bots.

The site is also now using the logos of multiple universities, claiming to be affiliated by way of beta testing. I plan on reaching out to those listed and confirming whether or not any partnerships took place and hopefully get some more eyes on this issue.

UPDATE: for anyone curious, a couple of the universities have already passed this along to their lawyers. I knew they'd work fast, but I didn't know it would be that fast. Here's hoping that they'll be able to put a dent in this site, and make it common knowledge for their people to steer clear of it.

Joy Barbera, 48, of North Carolina, died after undergoing more than 10 hours of cosmetic surgery at an outpatient surgical center in Houston, Texas, according to a lawsuit filed by her family.

Barbera reportedly underwent multiple procedures in a single operation, including a Brazilian Butt Lift (BBL), liposuction, and body contouring. While the surgery was underway, her husband, Peter Ginnegar, received a phone call from the medical team as he traveled through the Rocky Mountains, informing him that his wife had stopped breathing and was revived with CPR.

Doctors later declared Barbera brain dead. The lawsuit alleges she suffered massive blood loss, a sharp drop in blood pressure, and severe complications during the procedure. Her family is now suing the plastic surgeon, anesthesiologist, and surgical facility involved in the operation.

Just wondering how often people are mask inductions here for elective healthy cases, if at all

We had a near 18 year old patient today who refused an IV because he was scared of needles and wanted to do mask induction. Healthy guy but stubborn teen. Purely elective case. Decision was made by his providers that oral/nasal premed can be given for IV placement, with no guarantee of extent or effectiveness, but no gas mask induction. After 45 min of back and forth, he finally agreed to an IV and all was well.

I personally thought if he was old enough to curse and have an attitude, He was old enough for an IV.

Any thoughts or insights on gas induction for teens/adults on an elective basis? Just curious

Feel awful, I know it’s a known complication and it’s mentioned during our consent, but can’t help but feel like I messed up. Done hundreds of intubations without issue, but this is really bothering me. Has anyone else chipped a patients tooth?

Now that we’re in the age of sugammadex, do you ever still reverse with neo + glyco/atropine when using roc/vec?

Wondering what is the longest TIVA case people have ran? And at what point do you get concerned about propofol infusion syndrome?

Piggybacking (I know, tell me to go fuck myself) on the recent thread about neostigmine. What are your experiences/restrictions on sugammadex usage outside of the operating theater? Are you ever called to reverse paralysis in the ED? ICU?

Online it seems to be difficult to filter the signal from the noise with all the hype around anesthesia as a specialty. I doubt many who do regret it, would spend time here, but if you do, know someone who does, or if there is some downside you were surprised about, please do share why and what else you would have chosen in hindsight (or medicine at all)? As a med student, I am trying to get honest, no BS reality check, which is very difficult to get nowadays with all the hype in med school.

Not interested in people who don’t regret or have nothing to add. Not trying to dismiss you, but plenty of information on that front already available.

How do you ladies pump at work? Specifically what is your work flow in terms of when/where do you put on your pump, when/where to transfer the milk, and what to do with pump parts and milk if you are stuck in a case? Do you bring the whole set up plus a cooler into the OR?

This is my third time around pumping at work but I've always supervised in the past and used a regular wall pump while my partners covered my rooms for me. Now I work mostly solo cardiac so the cases are long (6-10 hrs) and breaks are hit-or-miss. My last resort is to leave while on pump to pump (heh) but I'd rather not have to do that if I can avoid it. I've tried the willow in the past and the experience was so terrible that I'm completely done with wearables. Now I have a Spectra S1 and pumpables genie advanced, and cups to go with them.

I would appreciate any tips or experience you can share. The more detailed the better! Thanks

How many of you work in jobs that are more bread and butter? Like I mean haven’t done things like fiberoptic intubation, a lines, central lines, epidurals in years.

On rare occasion an a line has been required but I have not had a case like this in years. Central lines are rarely done in OR and if needed are done by the surgeon. And well fiberoptic is so rare with video nowadays anyway. I love my job currently but always wonder about what if I had to make a change? Or what if i was put in a situation and couldn’t do certain things from just purely being out of practice.

How has it been for anyone who has gone from a place like where I work to something more?

I don't mind OB, and I don't absolutely hate the 24s when I'm scheduled for one monthly. Recently though with my family growing, I've wondered about finding a job that offers only OB 24 hour shifts. Something about just working two long days and taking a quick nap or two the next day to reset seems appealing at the moment to maximize time with the family. Particularly since my wife is a stay at home with the children and I could have access to them everyday that I'm off.

I'm only 31 so I feel like as of right now, I am able to be a bit sleep deprived here and there but I haven't consistently done long overnight shifts since CRNA school a few years back.

For those of you that have been doing only OB shifts or maybe only 24hr shifts, how is it down the line? Any regrets? Am I imagining brighter pastures with rose colored glasses here?

Or is it just the same BS everywhere?

How do you guys do your percutaneous mitral valve repair? General/ mac? What is the cocktail of choice?

Hi all,

Current CA-1. We had a GSW to the abdomen in the OR, resuscitated with blood products as surgery stopped bleeds with quick damage control resection of small and large intestines. They applied wound vac, pt is normotensive with no pressors, satting well at 100% on 50% FiO2. Sedation with boluses of ketamine and fentanyl throughout surgery.

I gave report to ICU over the phone with circulating nurse, but then later I’m told ICU is not going to accept the pt by OR staff who go up to check. At this point pt is on the stretcher with mobile monitor and still connected to our OR vent with capnography. ICU says PACU should take the pt. My thoughts are that it’s feasible if not ideal. Our one PACU nurse on this weekend day has ICU experience, and we have mobile ventilators. I can also stay in PACU but I’m the only anesthesia resident and another trauma may come up. My attending is very authoritative and gets mad if we speak up so while this is happening, I’m following his lead, asking his view on whether we should extubate etc.

Finally we’re told ICU will accept the pt again. Before transport, we give 100 mcg fent, 50 mg ket, 2 mg midaz. Pt is 100kg+ large male.

We get to ICU ventilating with ambubag and give verbal report. After a few minutes, pt begins to emerge and there’s not currently drips set up in the room. We (attending and I) have only emergency presses with us. That’s a mistake I regret. Many times I’ve been told always have a stick of propofol. So that is clear to me. My attending tells me to run down the three floors to the OR, I get etomidate and roc, run back up, pt has pulled out arterial line, one 18 g IV, one 18 g IV remaining. I push the etomidate and roc, pt deepens, drips are set up, lines are established, the pt is safe and stable.

But obviously this isn’t acceptable, I know we should have had emergency drugs. I went through Morgan and Mikhail looking for guidance regarding sedation during transport. Should we have ideally set up sedative drips for this pt we planned to keep intubated? Obviously the boluses pre-transport weren’t enough, the pt was young and healthy + heavy. Pt did meet extubation criteria with good spontaneous ventilation tidal volume. My attending said yes that’s true but leaned towards and ultimately decided to keep intubated, given pt had open abdomen with wound vac and the potential for further or missed bleeding.

What are your thoughts? In addition to carrying sedative/paralytic drugs with us, should we have extubated, started drips, anything else?

Good morning all,

Anesthesiologist in my 50s here. My kids will both soon be in college and my parter and I are contemplating our next steps. I've done some locums work during vacation weeks in the past and I'm seriously considering quitting my full time job and slowing down, selling our house and working 2 90ish day contracts a year and spending the other 2 quarters slow traveling to find our ideal retirement location where we will buy a new home. Then would continue working as much as I need to until pulling the trigger on retirement. Ideally I would like to find contracts where I could do solo anesthesia if possible. Anyone have any guidance on the feasibility or potential problems with this plan? The only concern I can think of is the 90 day periods where I won't be working and if this will cause any problems with credentialing. Seems like a perfect way to check out new places and providing flexibility income wise.

For everyone that does OB, how many people do CSE if patient is in severe pain and to help get them comfier faster while epidural sets up? If you do what do you dose?
Who all utilizes a DPE for confirmation of epidural (especially on a difficult one)?
Does anyone utilize DPE to help with the local anesthetic translocation intrathecally in very small amount?
If you do not do either for any reason, is it you don’t think it is necessary and just increases risk? Facility policy? Or what is your reason?