Reader response
Myron Yaster MD
From Lynne G. Maxwell MD on labor day song
I remember the ILGWU song “look for the union lable” so fondly from my childhood! For any of you who are interested, there was a recent National Public Radio Marketplace piece on this topic: https://www.marketplace.org/2024/08/12/how-song-makes-the-union-strong/
From Kylie Foster MD Pediatric Anesthesiologist at the University of New Mexico on methadone for tonsillectomy
This is a super interesting article. I used methadone in my training and I use it from time to time in my practice, usually for spines & pectus, although sometimes for big orthopedic injuries in which the surgeon will not allow for a nerve block or abdominal cases for patients who are not epidural candidates. I would definitely be open to trying methadone for tonsillectomies, especially in kids who are staying in the hospital post operatively. At my institution, we give pre op oxycodone which seems to help PACU length of stay & lessen pacu opioid requirements. I will sometimes alternatively use intra-op morphine for mild/moderate OSA only. Did this study comment on severity of OSA and dosing of methadone? Was it PO or IV? Thanks!
From Elliot Krane MD on Assessing Competence in Psychomotor Skills: Do We “Know it When we See it”? and cognitive bias in the operating room
From Ravpreet Gill
To me dexamethasone is like any other drug with risks/benefits. I use it liberally, especially in my pediatric population, which involves a lot of T&A cases. However, I am conservative in that if I don’t need to use it but want to add a second antiemetic agent (I give everyone ondansetron), I may use metoclopramide (Reglan). It’s an old and cheap, but very effective drug in my opinion. Those concerned about dyskinetic symptoms can rest assured that they are rare with a one time dose, and easily treated with a dose of Benadryl.
From Sally Rampersad, MB, FRCA, Attending Anesthesiologist and Professor Dept of Anesthesiology and Pain Medicine Seattle Children's Hospital and University of Washington School of Medicine, Seattle, WA
I trained in the UK in the late 80’s/early 90’s. I cannot confirm the “ether day” story that you quoted in the most recent edition of PAAD. I do remember, however, enjoying a cup of tea and a sandwich in the induction room, with the door propped open and monitor turned towards me, brought to me by my operating department assistant (ODA) or anesthesia tech as they are known in the US. ODA’s were essential to patient safety, their years of experience often filling in for some of the gaps in a new trainee’s knowledge. At the Royal United Hospital in Bath, the answer to the question, “what size ETT do I need?” was “which ever one Ken puts in your hand!” When we first got a pulse oximeter and ETCO2 we didn’t have enough monitors for every induction room and every OR. It was most usual to induce in the induction room, even if there weren’t a full set of monitors. The monitor was the floor RN who accompanied their patient and stayed for induction. I found that the more junior the RN, the better a monitor they were. The look of terror, when the BP fell on induction and the pulse got a bit thready, always alerted me to any potential issues in a very timely manner! We did eventually get a full set of monitors in all locations, the floor RN’s continued to accompany their patients to the OR and Ken continued to hand me exactly the equipment that I needed and he made a great cup of tea.