April 26th, 2011 by Bongi in Humor, True Stories
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Yes, I have an alter ego. Yes, I dress in funny clothes with a cap covering my head and a mask covering my face. And yes, dressed as such I try to fight the powers of evil (mainly sepsis and bleeding and cancer and the like). I am … a superhero. But there is often little understanding for what goes on under the paper thin masks and baggy gowns we wear. certain …um…occurrences, well, occur with us just as much as with other people.
A common cold behind a theatre mask is no small thing. Remember you can’t blow your nose. Sniffing loudly only works for a while and attracts all sorts of strange stares. Just leaving it is really the only option. The positive side of this is you suffer less from the mild dehydration that accompanies massive loss of …mucus. There is, after all, fluid replacement (it is a very short trip from your nostrils to your mouth over your upper lip). ‘Nuf sed. Somehow this never appealed to me though. So, for all you budding surgeons out there, when you have a cold, plug your nostrils with tissue before scrubbing up. once you’re scrubbed, it is too late. The side effects are only a slight change in voice which is a small price to pay to avoid the constant lip licking and salty taste throughout the operation. Read more »
*This blog post was originally published at other things amanzi*
March 13th, 2011 by Medgadget in Better Health Network, Research
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A team of French anesthesiologists has developed an automatic delivery system of propofol and remifentanil, which they recently tested in a multi-center trial involving 196 surgical patients. The researchers reported in Anesthesia & Analgesia that the system, which uses a Bispectral Index (BIS) monitor as a guide, performed better than manual administration:
We have developed a proportional-integral-derivative controller allowing the closed-loop coadministration of propofol and remifentanil, guided by a Bispectral Index (BIS) monitor, during induction and maintenance of general anesthesia. The controller was compared with manual target-controlled infusion.
The controller allows the automated delivery of propofol and remifentanil and maintains BIS values in predetermined boundaries during general anesthesia better than manual administration.
Abstract in Anesthesia & Analgesia: Closed-Loop Coadministration of Propofol and Remifentanil Guided by Bispectral Index: A Randomized Multicenter Study
*This blog post was originally published at Medgadget*
March 2nd, 2011 by Bongi in Book Reviews, Opinion
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This post is a bit of a diversion from my usual posts, but I think it may still be worthwhile. You see, I want to promote a book.
I’ve just read the book, “Steeped in Blood: The Life and Times of a Forensic Scientist“ by David Klatzow. What a stunning book. It really gives insight into the South Africa of old and possibly what South Africa of future may end up being like. I suggest that everyone get ahold of it and read it.
However, David, I do feel I must challenge you on one point. Towards the end of your book, you say one of your surgeon friends told you a story of one of our Cuban import surgeons who tried to do a tonsillectomy through the neck rather than through the mouth, the normal way of doing it. I know this story and have heard it often myself in the corridors in Pretoria. Unfortunately it’s urban legend and nothing more.
I have worked with the Cubans, and they aren’t too shabby. Don’t get me wrong — they aren’t a scratch on a South African specialist (although the standards are dropping as you rightly point out, and quite soon they may be far better than homegrown specialists), but the point is that they wouldn’t do something so bizarrely stupid. I even suspect I know who your surgeon friend might be, especially if he presently finds himself in Pretoria rather than Johannesburg, where you no doubt got to know him.
Anyway, still an absolutely brilliant read for anyone who wants to get a peek into the workings of the apartheid government of old. Go and buy it now.
*This blog post was originally published at other things amanzi*
January 28th, 2011 by DrWes in Better Health Network, Opinion
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You know it’s bad when the attending surgeon has to write this at the beginning of his operative note:
“I certify that the services for which payment is claimed were medically necessary and that no qualified resident was available to perform the services.”
So there you have it.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
January 10th, 2011 by KevinMD in Better Health Network, Opinion
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In a recent New England Journal of Medicine, a perspective piece on what to do with fatigued surgeons is generating debate. The issue of work-hour restrictions has been a controversial issue when it comes to doctors in training, something that I wrote about earlier in the year in USA Today. But once doctors graduate and practice in the real world, there are no rules.
As summarized in the WSJ’s Health Blog, the perspective piece argues for more regulation for tired surgeons:
… self-regulation is not sufficient. Instead, “we recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived,” they write. For example, elective procedures wouldn’t be scheduled for the day after a physician is due to be on all-night call.
And the authors suggest that patients be “empowered to inquire about the amount of sleep their clinicians have had the night before such procedures.”
It’s a noble goal, and indeed, data does show that fatigued surgeons tend to make more errors. Patients, once confronted with a choice of being operated on by a tired surgeon, may choose to postpone surgery. Read more »
*This blog post was originally published at KevinMD.com*
