RIVANNA’s Post

Absolute and relative contraindications are central to procedural decision-making in neuraxial anesthesia. But here’s the question: Are they as fixed as they seem? 🛑 Absolute contraindications (e.g., coagulopathy, patient refusal, or localized infection) are traditionally non-negotiable and foundational to patient safety, yet advancing medical technologies and techniques are slowly redefining what’s possible. For instance, enhanced imaging tools and multidisciplinary planning could mitigate risks in once-deemed “absolute” cases. ⚠️ Relative contraindications (e.g., spinal deformities, prior surgeries, or hypovolemia) depend heavily on clinical judgment. This raises important considerations: How can tools and training further support clinicians in navigating these nuanced cases? How can we make relative contraindications safer to manage? It’s time to rethink the evolving understanding of contraindications and explore opportunities for innovation. Progress in this field won’t just push boundaries — it could change lives. #Anesthesia #Innovation #Anesthesiology What do you think? Are absolute contraindications immovable barriers, or is there room for advancement? 💬Comment with your ideas and 🔁repost to help us keep the conversation going.

One of the keys to performing #USGRA is to know how to stay out of trouble, how to avoid complications such as injuring a nerve or local anesthetic toxicity. I created this image a long time ago but always hesitated to post it because of its oversimplification of a nerve. But I want to use it to explain a great technique to be safe during an #ultrasound guided peripheral nerve block. Needle B has entered the epineurium and some local has been injected. This injection could occur without much trouble. Maybe the regionalist just doesn't see their needle. This injection may result in a prolonged block, possibly a slight nerve injury resolving fairly quickly. Poor technique overall is the most likely culprit. Needle C is where we have some real issues. Entering and injecting within the endoneurium and possible trauma to fascicles. This space does not expand, the pressure within this space would increase very quickly with a small injection. Severe nerve damage can result. Needle A has a trajectory that is tangential to the nerve. This means even as a new regionalist if you lose sight of your needle on ultrasound and continue to advance you will just slide past the nerve causing no harm. This is a great way to keep yourself out of trouble. Also I should mention, Needle B is the reason you should not over sedate and maintain meaningful communication with your block patient. An injection through Needle B would most likely cause severe pain and your slightly sedated patient would react to let you know. Your deeply anesthetized patient may not let you know they are having severe pain leading to greater damage. FUJIFILM Sonosite, Inc. PAJUNK® Safersonic #anesthesia #anesthesiology #surgery #hospital #nerveblock #ultrasound #medicine #medical #healthcare

My latest article on a fascinating topic, "No Joke: UCLA Health Team Proves It’s Possible to Perform High-Acuity Anesthesia Procedures Outside the OR," about conducting high-acuity procedures outside the surgical suite. In this case, UCLA Health is providing the Hepzato Kit procedure in an interventional radiology suite to deliver high doses of chemotherapy directly to the liver without exposing the rest of the body to the drugs. This targeted approach means fewer side effects, making the treatment safer and more effective for patients with metastatic uveal melanoma who have liver metastases that cannot be surgically removed. Thanks to Dane Saksa, MD, MBA, Denise Heady, MA, and #UCLAHealth for their input. #HepzatoKit #Uvealmelanoma #ASAMonitor #anesthesiology

Fluid administration patterns can vary widely in the absence of goal-directed therapy protocols which may contribute to variability in surgical outcomes. A retrospective analysis of abdominal surgeries at two academic medical centers without departmental fluid administration guidelines (such as goal directed therapy) showed wide variability in infusion patterns between clinicians and within individual clinicians. https://lnkd.in/gnBvssz2 #hemodynamics #fluidmanagement #anesthesiology #patientsafety #GDHT

📚✨ Attention all anesthesiologists! We invite submissions of original research articles and reviews for an upcoming issue focused on Perioperative Medicine. The aim of this issue is to enhance the understanding and implementation of evidence-based practices to improve the quality, safety, and outcomes of perioperative care. We welcome multidisciplinary perspectives and research that bridge gaps between anesthesia, surgery, and perioperative medicine to provide comprehensive care to patients. Submit your manuscript today to contribute to the advancement of perioperative medicine and to share your insights with the global anesthesia community. 📌 Instructions to authors: bjan-sba.org/instructions 📌 Submit on: https://lnkd.in/dDkVehNJ When submitting the manuscript, select “Perioperative Medicine” as Section/Category and indicate “Special Issue: Perioperative Medicine” in the Comments areas of the submission platform. #anesthesiologyresearch #joinBJAN #citeBJAN #anesthesiology #anesthetists #sba #anestesiologista #anesthesia #perioperativecare #perioperativemedicine

A 68-year-old female patient is admitted to the Intensive Care Unit (ICU) following cardiac surgery. 👉 MEDICAL HISTORY AND CONDITION: She has a history of multimorbidity, including hypertension and diabetes. Additionally, the patient has prior cognitive impairment, which has been noted in her medical records. Currently, she is experiencing a hypoactive form of delirium, characterized by lethargy and sedation, slow responses to questioning, and minimal spontaneous movement. 👉QUESTION: What is not a suitable pharmacological treatment for managing the patient's hypoactive delirium in the ICU postoperatively? A. IV paracetamol B. IV dexmedetomidine C. IV benzodiazepines D. IV haloperidol Write your answer in the comments below! Enhance your anesthesiology skills with "Anesthesiology Review: A Comprehensive Q&A Guide" by NYSORA. Gain practical insights and boost your expertise. Get your copy now: https://lnkd.in/dZpwPung

One of the BEST things about the practice of anesthesia is that there are many ways to run an anesthetic and have a great outcome. After 25 years of practice I still constantly wonder if there is a better way for me to take care of patients. I am always adjusting and questioning everything I do. This short video is a good example. Most Total Knee Replacement patients get a spinal and 1 or 2 ultrasound guided peripheral nerve blocks. What if the patient can’t have a spinal? I actually prefer General Anesthesia for our total joint replacements in our practice. It suits our staffing and workflow. How do we do it well…? Long story short I added an ultra short acting Femoral Block to the usual Adductor Canal (Femoral Triangle) and IPACK blocks. Pain relief from a Femoral Boock is superior to the Adductor Canal Block. With NESACAINE, a short acting local anesthetic, the femoral block (a motor and sensory) wears off by the time the patient is ready to walk. The pain relief from the femoral block covers the tourniquet pain for the surgery. The general anesthetic can be opiate free or sparing. The single shot Adductor Canal Block (Femoral Triangle) will continue to work for at least 24 hours. My hope is that more practitioners would share their “go to” techniques. Everyone has something to offer. FUJIFILM Sonosite, Inc. PAJUNK® Safersonic #ultrasound #nerveblock #anesthesia #anesthesiology #hospital #surgery #healthcare

Total spinal anesthesia (TSA) is often classified as a rare complication, but even “rare” occurrences can cause catastrophic patient outcomes. TSA can lead to immediate respiratory depression, cardiovascular collapse, and extensive neurological impairment. Prevention is the best cure. Minimizing risk is essential. While ultrasound-guided neuraxial anesthesia may not fully eliminate the risk of TSA — which will always depend on the appropriate dose and procedural technique — it brings an added layer of precision and insight to neuraxial procedures. And that gives clinicians more insight for procedural decision-making, which means more control over patient outcomes. #Anesthesiology #PatientSafety #Ultrasound 🔁 Repost if you agree.

Let’s delve into this complex relationship and explore how it impacts both patients and providers alike. #ClearSurvey #patientsatisfaction #radiology #anesthesiology #MIPS #survey #MSNHealthcareSolutions #MedicalBilling #PracticeManagement #MIPSSolutions #medicalbillingandcoding #patientcare #healthcareprovider #patientfeedback #healthtech https://loom.ly/dy-lbS4

🌟 Want to boost patient engagement? ClearSurvey shows how feedback surveys can encourage patients to actively participate in their care. Learn more in our latest blog: https://loom.ly/UGtcavA #ClearSurvey #patientsatisfaction #radiology #anesthesiology #MIPS #survey #MSNHealthcareSolutions #MedicalBilling #PracticeManagement #MIPSSolutions #medicalbillingandcoding #patientcare #healthcareprovider #patientfeedback #healthtech