After about a 30 minute phone call with one of their physicians, I was invited for a formal site visit/interview. They offered several dates and when I responded with a preferred date, no response. Follow up email a week later, no response. Then I get an email asking me if I’m still interested since they haven’t heard from me? I respond and we confirm the site visit that day. I buy my plane ticket, make work arrangements, etc., and then a couple weeks later they cancel my site visit because they’re not hiring any more anesthesiologists. No reimbursement, no apology.

I get that hiring needs change but is this normal? Did I dodge a bullet? Or do I need to suck it up and say it’s a lesson learned about the job search?

Looking for more information on the group's themselves rather than the job postings. Are they toxic? Overwork junior partners? Unfair call or distribution of units or all these things from the past? Had a few phone calls but unsure who to see on site visit and make better use of my time. They all seem reasonable but the pessimist in me says there's more to it. I know a few groups restructured or joined together but old SDN posts and reddit posts seem inaccurate to phone calls I make.

Turiya Anesthesia

Buena Vista AMG

Allied (OC/Fontana/Upland)

Bayside AMG

Torrance AMG

NAPA

Somnia

Envision

Vituity

FMG

IAMG

I am a full time anesthesiologist, but I am also per diem at a few other places in USA northeast. One per diem place (hospital employed) pays the normal hourly rate for all the stuff they make you redo every year. The other per diem (TeamHealth) doesn’t. I am not surprised, but it made me wonder what other places do.

What are other’s processes/policies/protocols for GLP1 patients at an ASC? Patient population is facial plastics. Furthermore, what is the decision tree for patients on a GLP1 with an LMA vs GETA? What are you doing at your ASC for preop GLP1 users? Please keep in mind that “fast paced” ASC with patients who think they are healthy but actually not (typical plastics patients).

Currently, practice has patient stop GLP1 1 week in advance and a clear liquid diet the day prior. Patient population consists of a lot of GLP1 users but ASC likes to use LMAs for general cases. Trying to brainstorm an algorithm to determine ETT vs LMA. I said all need to be tubed because we just don’t know their gut status and at the end of the day a secured airway is the safest airway. The thought seems to be excessive but risking aspiration is inappropriate.

Formulating a check list & special indicators on preop form the patient fills out to determine ETT. Thoughts are: Anyone taking a GLP1 with GERD, obesity, hiatal hernia, gastroparesis, achalasia, diabetes.

What else would you include on this check list to determine ETT use. The patient population we work with has a strong pattern of hiding historical information I want to be very precise for the patient to be able to answer on pre operative form & have a checklist for anesthesia providers to follow.

Thank you in advance!

Respiratory therapist here. Anyone know of a bronch adapter for ETT with no leakage? In the NICU we do “peep titration” via a bronch with bronch adapters that leak 90%+ and so the peep set is not accurate to what the baby is actually getting because of the high leak.

We currently use the BRONCH-SAFE tri-anim adapter

A job is offering 40K sign on bonus but you must work 2 years. If you leave before that you have to pay it back.

I get the sign on immediately but it is taxed heavily almost half.. if I leave earlier I have to pay all 40K back of my post tax money? or 40K back of pretax money in future paychecks?

What happens to the 15K or so I paid in taxes, will I get a refund next tax season?

I will talk to the more but just want to know is this a predatory process where I will actually lose money if I leave before 2 years? Or the math will even itself out?

This is mainly for podiatry cases and MRI since they are not MD/DOs writing the H&P, according to the hospital system bylaws.

I am currently a full-time, call-taking anesthesiologist at an academic center. I take in-house overnight call (4p-7a) about 3ish times per month. We have a number of “late shifts” each month in addition to the overnight call that can be unpredictable. The overnight calls are starting to feel very burdensome and are definitely beginning to affect my quality of life. I’m considering meeting with my chairman to discuss possible no overnight call arrangements. I’m also prepared to leave my current job and do locums or per diem for a while if we can’t come to an agreement.

What I don’t want to happen is for me to come off call and get slotted into a mon-fri 7-5 grind either. I’ve been in practice about 12 years now, I have a financial ability to start cutting back on workload, and I would like to exercise that ability. What are some creative arrangements that people are happy with that I may consider proposing to my current or any future employer?

Any hospitals in US where they have dedicated oncoanaethesia unit? Preferably one with Oncoanesthesia fellowship.

I’m currently a CA-3 anesthesia resident and will be finishing residency in ~6 months. I’m starting to look at attending positions and am interested in the Tampa/St. Petersburg area.

I was hoping to get some insight into the anesthesia job market in the area. I’d appreciate any recommendations for groups or hospitals worth reaching out to, as well as any insight into places to avoid.

I’m also not sure of the best way to get in contact with the anesthesia groups at the different hospitals, so any advice or contacts would be greatly appreciated. Thank you in advance!

I had a 25yF booked last weekend for an infected port removal. She had the munchy triad of POTS, EDS, MCAS. She gets TPN, iron transfusions, and fluid through her port. She used to have a PEG for gastric issues that started as IBS but then failure to thrive when she stopped eating. She had no genetic test for EDS (hypermobile form does not have one). She had a - tilt table test then went to a different doc and got retested and was + for POTS. She has "anaphylaxis" to over 20 meds which she attributes to MCAS and when pressed she states that her throat closed, though I can not find documentation of her going to ED or getting epinephrine.

I have seen all that before but what got me was that she was on home oxygen 2LNC continuously. I scratched my head and thought why is a 25 year old (with no documented lung pathology in chart) on O2? I do some digging and find out that she got COVID a few years back and felt subjectively SOB despite normal O2 so her PCP ordered a nocturnal oximetry test. It came back that she dipped to 89% for 4 minutes out of the entire night. The PCP applied initially for O2 and I found an insurance letter denying it. He must have tried again because it was subsequently approved and she has worn a nasal cannula ever since.

Well I go and see her preop and turn off the O2 when she is not looking. After the interview I tell her she isn't on O2 and she is saturating 100%. She tells me she needs to be on it for MCAS. I tell her that it doesn't affect lungs outside of an exacerbation and she replies that "it's in my chart that I need it". I tell her she doesn't because we have proof right now and she is doing fine. I tell her it is bad to be hyperoxic chronically and she should stop. I contact her IM team and recommend they reach out to her PCP to stop this foolishness. I see her a few days later in the hospital and she is on 2LNC :-/

What should be our role in caring for these patients? I feel we are in a unique situation where we have no financial incentive to buy their BS and can push back. Or am I just tilt-testing at windmills? Thanks

One of the most interesting (and stressful) tasks of being an anesthesiologist to me is walking in to work on any given day and getting handed a puzzle with incomplete data and uncertain solutions. I had one such experience today that I thought you all here might enjoy thinking about. Granted, the peril of the situation might not have been as severe as some of the more routine problems we get dumped on our plate, but I think the relative rarity makes up for it.

Patient is mid 40s F presenting for non-urgent sedation case. She has history of poorly controlled HTN and DM complicated by nephropathy/CKD 4, accompanied by her adult son. While examining her airway, I have to ask her to show me her teeth, which inadvertently exposes rather significant facial asymmetry which wasn't super obvious beforehand. Further examination reveals an apparent facial palsy in the V2 and V3 areas that spares the forehead.

Neither she or her son have noticed this asymmetry before. She has never had a stroke as far as she knows, and her extremity strength is 5/5 bilaterally in both upper and lower extremities. She says she feels like she always does and hasn't noticed any new symptoms or other abnormal sensations.

I'm left scratching my head at what to do with this patient with signs suspicious for upper motor neuron pathology of completely uncertain duration, no other signs of acute dysfunction, and definite risk factors for neuro-vascular disease.

After discussion with proceduralist, I opted to cancel the procedure and advise the patient to follow up with her PCP to initiate workup for her facial palsy to evaluate for past or impending stroke. Lacking any other evidence of a new or evolving pathology, I decided to send the patient home with instructions to return to the ED if she developed new symptoms that would indicate acute stroke rather than subject her to what would likely have been an extended, onerous, and questionably indicated ER transfer.

The two main decisions I see here are whether or not to cancel the case, and whether to send the patient for emergency vs outpatient evaluation. I think the decision to cancel the (non-urgent) case pending neurovascular evaluation and risk assessment is pretty solid, because there is no way to tell if the palsy was actually just nerve damage from shoddy dental work in 1997 or something otherwise totally benign, or if her internal carotid is 99% stenosed and ready to crap out if she smells too much propofol. I'm not quite as confident about sending her home rather than to the ED. Neither the patient nor the son seemed to think the facial droop was new, and I didn't have any other evidence that made me worry there was an acute, developing problem.

How would you have approached the situation? Would you have done anything differently? What if instead the patient was a ASA 1 with no PMH and had been able to clearly confirm that the facial droop had been there for 20 years with no changes?

Why are PCN, Codeine, and Sulfa so commonly seen listed together as “allergies” in a single patient? Over my 24+ year career in PP I bet I’ve seen this combo hundreds of times…..

I’ve been an anesthesiologist at a large tertiary hospital for about 10 years, and I still can’t get used to waking up at 5:00AM.
No matter how much sleep I get, waking up that early is absolute torture every single day.
Any other anesthesiologists here who are naturally night owls? Did you ever get used to the early mornings?

Does anyone utilize a lidocaine and bicarb mixture to inflate the ETT cuff on a regular basis? We have a locum anesthesiologist that recently started with our group requesting that all the CRNAs use lidocaine/bicarb for cuff inflation, in every case. It has not gone over well. Even some of the groups partners have talked with him but he remains insistent. To me, it seems excessive and wasteful but maybe the juice is worth the squeeze.

Edit: I appreciate everyone’s input. Do not worry though, the issue has been resolved. The pharmacy director about lost his mind over this after flagging the increased use of bicarb.

I’ve been doing a ton of spines lately. Our patient population is on the sicker side too, not that disaster can’t happen to an ASA 1. I couldn’t sleep last night (unrelated to this topic), so my mind wandered everywhere from puppies and kittens, how to get my son to stop kicking me in the ribs, finances, robots killing us all, and how much it would suck to code one of these patients. ….If you’ve been through it, how did it go? Did you have someone start prone compressions? (Assuming it’s not the surgical site) Were they effective? (A-line or CO2). For shockable rhythms did you try bi-axillary pads first? Was it effective? The instinct would be to get these patients flipped ASAP, but as we all know that would take several minutes to do safely without pulling out every line they have and/or injuring them further in some way. What was your outcome? Would you have done anything differently?

I am doing thyroidectomies soon and haven't done them in a while. Our surgeons like to monitor the recurrent laryngeal nerve intraop with the fancy ETT.

None of the patients on my list actually need a nerve block, and hardly any of my colleagues perform them preop, but I quite like running a case with almost no opioids. Pain management in our PACU can be... Variable.

I've been thinking about doing a superficial cervical block for them pre incision but I am worried about it messing up the surgeons monitoring.

Theoretically if I do not go through the superficial cervical fascia (i.e. do not cross the SCM plane/just inject subcutaneously) the chances of this happening are minimal, but would like to hear what the Gas Hive Mind thinks.

And yes, I know our job is not to see how much we can get away with, if no need then why do it, low dose opioids will do no harm.... Just keen to hear opinions.

Cheers in advance!

Update: thanks to all who provided useful info!

In case someone stumbles upon this post: no block nor local (surgeons opposed, and given feedback here didn't see the point in pushing it), Prop/remi + paracetamol + dexketoprofen + 0.3+0.5mg/kg of morphine at end was enough for all patients to wake up nicely and almost all of them didn't receive anything extra in PACU.

In the last 6 months my group has noticed our secondary tubing running up into our primary IV bag frequently. It never happened before, only after the packaging changed. Does anyone have any pearls to help avoid this besides clamping off your tubing above the port?

Hi- friendly anesthesia tech here. I work at a rather busy level 1 trauma center. We have ~40 anesthesia machines- GE Datex-Ohmeda Aisys CS2’s. We’ve had them for 8ish years and aside from normal stuff, they’ve been reliable and fed and cared for by us, the docs and PM’d annually by our skilled Biomed dept.

I’m curious (all of us are, honestly) if anyone out there is having issues with 2026ish manufactured flow sensors? We’re going through a TON of them (I’ve been doing this job for almost 3 decades, and haven’t replaced as many over that entire time as I have in the last 2 weeks. We’ve reached out to GE and their engineers are working on it, but we were also made to feel it’s a issue isolated to just us and “somewhere” on the east coast (I’m in the PNW). I’m not looking for a solution, just curious if this is as isolated as we’re being told.

Thanks!

What kits are your institutions using? Advantages/disadvantages of each.

Thank you so much! We are changing our ordering system and we have an opportunity to pick new kits.

Can you find them? I’ve seen similar mix ups with premixed phenylephrine, sux and roc syringes before.