Of course there are things we have to do to avoid this complication - in some cases we will even put the patient on a heart-lung machine prior to anesthetic induction. 253 on step 1. compensation isn't important (everyone gets nearly the salary in the military +/- bonuses). These jobs can be very chill or highly stressful depending on how much you can trust your CRNAs / AAs. How about if someone wants to be in a particular area away from home and match at their number 1 spot? I do a mix of general and cardiac anesthesia. However, if you want recognition and gratitude from your patients, if you want to be able to diagnose and practice clinical medicine, you might not like anaesthesia. No paperwork. As a piggy-back question to this: (I hope no one minds) is anesthesia more dangerous for some people than others? If you can eliminate IM then do so. I know you haven't started your residency yet so you might not know about how much time you'll spend sitting, but do you think rads would be a no-go for me for that reason? Good answer. something about having the attention span of a squirrel. I am an introvert and I am very happy left alone. Many such things have been done. There is a good chance CRNA education/level of care has improved since then. I love my job. Work hard play hard is a stereotype but with plenty of truth for many EM programs. Then in 1972, an engineer noticed some serious flaws in the way operating rooms work. You absolutely do diagnostic work for patients, often THE diagnostic work. (crashing patient, etc..). However, they might prescribe you pain medication.. lol. No networking or trying to run my own practice. EM from what you wrote seems like less of a good fit. depends on the surgical procedure and on the type of anesthesia used. this is the anesthesiologists greatest concern, usually. I was afraid I would miss diagnosing and treating patients and be mistreated by surgeons. A patient with increased intracranial pressure due (for instance) to a tumor should not receive ketamine, which increases that pressure further (at least, this is the classical teaching). Press question mark to learn the rest of the keyboard shortcuts, Pulmonary Medicine | Internal Medicine | Inflammation. even post-op, when someone is on a lot of antibiotics, that can kill of most of the intestinal bacterial flora, which leaves a ripe bowel in which clostridium difficile can grow, leading to colitis and possibly toxic megacolon. But, it doesn't sound like you enjoy the day-to-day of IM. Most side effects of general anesthesia occur immediately after your operation and don’t last long. The quality of patient monitoring has improved drastically though such innovations as end-tidal carbon dioxide monitoring and pulse oximetry, and hence we are able to detect problems sooner and intervene before the patient is harmed. This is fairly simple (I guess) I think they use a barbituate while monitoring brain wave function (ECG) to see if you're perceiving much. You feel drained from EM now. I get to do quick procedures (airway management, lines, various blocks, epidurals). HPSP MS3 here. Perhaps on a scale of open heart or brain surgery to something like … This can take a few days to pass. This is not to say that you should not use these latter two methods. you won't get high off of the anesthesia. 3 years later, I am so, so glad I chose anaesthesia. I'm also curious how much the risk changes between people being put under for the first time, and people who have been through it previously without complications. If I recall they monitor heart function and issue antagonistic stimulants and suppressants to assure that your heart function is working between necessary limits (except for heart surgery duh) while a controlled rate of paralytic is administered. Nope. however, i will say that there is a condition that is called malignant hyperthermia, and results from really bad reactions to common drugs used during anesthesia. Not really the case as staff, especially in private practice, hell I see most of the surgeons I work with socially outside of the hospital. do you like the OR? I will be asking my doctor about this (and I am going to a general practitioner and a cardiologist for a check up as well) but I would like to get your thoughts. 5-year AA here. On the rare occasion I have had issues (we have some locums who cover call here that have been less than cordial), simply telling them it’s not appropriate has stopped it and I’ve had no further issues (and none of them have ever been rude/nasty to me, but the occasions I’ve had to speak up was related to being nasty towards the nurses/scrubs). See if you can meet with your anesthesiology team. I'm curious about comparing the isolated risks of each. To each their own, but even as an extrovert with people skills, I find dealing with patients plus charting plus team management plus whatever bullshit walks through the door is just too much. Another compound suppresses the formation of long term memory. Anesthesia did it. No dealing with multiple consultations and follow up. It's a muscle paralytic which prevents you from moving during surgery. Just to mix it up and keep things interesting? These deeper states certainly can speed things up, making the surgica… 0 comments. The depth of IM is nice. General is the anesthesia type we think of most during a surgery where the patient is completely asleep. Local and regional are the two that are often confused with one another. I love procedures and this is also great for that. (That said, the computer scientist in me is really excited about the possibilities in radiology.). I don't mean interacting with patients, I mean interacting with that one patient who is obviously seeking painkillers, or the diabetic that is angry and doesn't understand why you can't just surgically reattach his gangrenous toe as he sips his 7/11 big gulp slurpy (real patient for me), or perhaps the worst, the patient interaction with the patient who wants to get better but the social system has failed via insurance, poor support, or poor socioeconomic factors. Thoracic high‐resolution computed tomographic (T‐HRCT) findings for Canine idiopathic pulmonary fibrosis acquired under general anesthesia have been described previously. When you go in for surgery, you have to sign various waivers and consent forms related to the anesthesia. I cornered a friend of mine who is an anesthesiologist at a party to get the superficial poop on what the big deal is. However, the use of general anesthesia may be contraindicated for some affected dogs. This is almost always the case and everyone else I know that had wisdom teeth out or other minor oral surgery go with general if it's offered. There are many disease states that make anesthesia much more dangerous than for a healthy patient, and many of them are much more common than MH. While general anesthesia is sometimes necessary, ask about other approaches -- like a local or spinal anesthetic. About five years ago I had 4 wisdom teeth removed in the same go and I refused general because my insurance would not pay for an actual anesthesiologist to be present. Although newer anesthesia drugs have greatly reduced side effects, operations can still produce stress on your dog’s body and they may be nauseous or vomit after the surgery. Plus when things go wrong, I know what to do and how to save lives. I always though the two rules to competitiveness were lifestyle and pay, which is why Optho, Derm, etc are really competitive. Malignant hyperthermia is also known in the veterinary realm; I know of one dog that was saved from malignant hyperthermia by being taken from neuter surgery and put into a snowdrift when they went into uncontrollable overheating. All the facts in this are pulled directly from the notes I took during that lecture. It offers a good procedural and clinical mix. It was my second option as I missed out on my first choice. I agree that the complications attributable to major surgery are more common overall and harder to prevent. Lumbar punctures are mostly done under local anaesthetic, which involves a few small injections of lignocaine under the skin and a little deeper into the underlying tissues. Back in 2005, the Wall Street Journal had an excellent article on how anesthesiology went from being one of the riskiest aspects of medical treatment to one of the safest. I don't know how someone can do this for 35 years and not resent it. Speaking of procedures, they're for the most part quick, innovative, and often curative. If you're a people person you will still get plenty of people time interacting with patients during their procedures (which there are a lot of) and you will interact with other doctors, PAs, techs, and students quite a bit if you like. A patient with aortic stenosis may not tolerate drops in blood pressure on anesthetic induction the way a healthy patient will. In general, the sicker you are, the higher your risk. Cookies help us deliver our Services. Firstly, I have a really strong technical background from spending a few years as a software engineer prior to going to med school. You should be able to look at your job and say "Yea, I can be happy doing this for the next 35 years". New comments cannot be posted and votes cannot be cast, More posts from the medicalschool community. Good mix of pharm, path and physio. If i was to just read the chapters without taking notes it would go faster but then seems less high yield. there was historically a much larger problem with anesthesia being dangerous, as the the signs of things going really poorly (such as poor oxygenation) were the patient showing physical signs (blue or gray skin discoloration). Much of this change was brought about by frank recognition of the hazards, and a constructive addressing of the risks. No rounds. The site may not work properly if you don't, If you do not update your browser, we suggest you visit, Press J to jump to the feed. Some of the bad stuff that you will dodge includes a lot of paperwork and typing, complicated call schedules (most hospitals work a night float or night hawk system), and the dreaded patient interaction. Whatever you can sense or observe doesn't get written to long term memory (rohypnol or something similar) so you can't remember whatever sensations get through. You don't need to love what you do, but you should like it. I have to do the military match in addition to the civilian match and have to stress way earlier than everyone which means I need to know what I want to do before too. The case I would build for going into radiology is that you get a lot of the good of medicine and side step the bad. Devlin B. Lv 6. I can give a different perspective here as I wasn't happy with anaesthesia when I began. Im seriously considering the above 4 things but am open. Never had anything more than a local for it. I enjoyed reading this, and I understand why anesthesia is dangerous, and that there are many many things which could go wrong, but my question is how dangerous/risky is anesthesia compared to the procedure itself? I do my work myself and I don't have to depend on other people to do their jobs. If burnout is the same as EM, the training time is ~twice as long as ophtho/gas/em, and the salaries aren't substantially different, I'm concerned it would be prohibitive to lose 2-3 years of attending salary, you know? Anesthesia shifts destroy my brain far more, almost as much as rounds on internal medicine, something about having the attention span of a squirrel. Why don't you consider ophthalmology. But anesthesiology, despite meeting both those criteria (high pay and infamous for being a "you just sit around for 90% of the time" job), isn't as hard to get into. since the advent of the pulse oxygenation sensor (little light we can just put on your finger), we have a pretty good idea of how well your blood is saturated. Don't do EM if you dont like working extremely hard for a shift. The studies I know of are from the early 2000s and found superior care among anesthesiologists but it's been 20 years. Local anesthetic is the "mildest" form of anesthesia used to just numb the area. One compound suppresses the sensation of pain. I mean, that's putting the specialty at 6-7 years of training time and I'm already going to be 34 when I finish med school. By the 1970s, we managed to get it down to 1 in 10,000. Supervisory positions are probably considered the norm. these can cause strictures and small bowel obstruction, which often means another abdominal surgery. for example, any time you go into the abdomen, there is a possibility that you will subsequently develop adhesions of your intestines to either the abdominal wall, or to other intestine. Coronavirus disease‐19 (COVID‐19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), remains a public health emergency of international concern with high levels of community transmission and a high mortality rate in high‐risk groups [].The care of patients with COVID‐19 has put a significant strain on intensive care unit (ICU) resources worldwide. It is true that there have been some mandated changes in the engineering of anesthesia equipment that prevent dangerous errors. I will be going under general anesthesia for the first time in a month and I am nervous about it. I'm personally skeptical about whether this correlation means causation. Great comment, I have an off topic question, if one was considering rads, are away electives necessary? Seems like an easy high impact/massively read study possiblity. Rads vs anesthesia - do you like dark rooms? Introduction. When you go in for surgery, you have to sign various waivers and consent forms related to the anesthesia. The danger for such a patient is that positive-pressure ventilation (such as through a mask or endotracheal tube after a patient becomes apneic secondary to anesthetic induction) can cause the mass to obstruct the trachea or large bronchi, leading to inability to ventilate and subsequent death. Much like smoking cigarettes, abstaining from marijuana in the weeks before surgery can decrease the likelihood of complications during and after surgery. ... help Reddit App Reddit coins Reddit premium Reddit gifts. By using our Services or clicking I agree, you agree to our use of cookies. Here are the different types of anesthesia: Local—Numbs only the area treated. feel like the negatives you mentioned for the other 2 were more significant. One patient who smoked marijuana 4 hours prior to surgery was the topic of another case study, after experiencing an airway obstruction during the proc… Anesthesiologists work to ensure the safety and comfort of patients during surgical procedures by administering medications for pain reduction or sedation. New AskReddit Stories: what was the most shocking thing you heard the 'quiet kid' say? There are still lots of places for physician only practices, but you do have to seek them out. Yes. The anesthesia costs related to (the) anesthesiologist's fee is substantially more than the colonoscopist's fee, yet the value of the procedure is the colonoscopy and polypectomy not the sedation, so this has become a contentious matter." Things I used to find stressful and challenging now I don’t really think twice about, and I imagine I will feel that way about a lot more things after 20 more years of doing this. From the makers of our beloved OpenAnesthesia and in conjunction with IARS [International Anesthesia Research Society – they produce the journal, Anesthesia & Analgesia] there is a new study tool called Self Study Plus. Cross posting from r/anesthesiology. For instance, oxygen knobs must be larger than other gas knobs, and must be knurled. Some dials rotated clockwise, others counterclockwise. It is what my professor told me, so take it as you will. Epidemiological studies are done where the cause of each perioperative death or injury is attributed to a specific cause. Like nicotine, marijuana can complicate surgery and should be avoided in the weeks and even months prior to your procedure. Additionally, I noticed the burnout rate is quite high (about the same as EM, which is frankly terrifying). IM - I love the depth of this. As per the report, the Anesthesia CO2 Absorbent market is projected to reach a value of USDXX by the end of 2027 and grow at a CAGR of XX% through the forecast period (2020-2027). You feel drained from EM now. General anesthesia is a combination of medications that put you in a sleep-like state before a surgery or other medical procedure. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. save. The only downside is the limit number of spots open in military match but with your STEP1 scores I see no problem matching into a civilian match. The depth of IM is nice. Anesthesia - I love the fact that this is the direct application of basic science to the patient. It'll be even worse on Christmas day or a Saturday at 3am. --- LIKE AND I WILL UPLOAD MORE REDDIT STORIES! If you don’t mind me asking, how do you feel about CRNAs? However, I feel many patients too quickly defer to their peers suggestions and surgeons recommendations. Of course, it's a hypothetical. Hello! Another thing is: one radiologist I know told me practically 90% of DRs do a fellowship. Looks like you're using new Reddit on an old browser. There is a big jump when you go from M4 to PGY-1 and that mostly comes in the form of expectations. I wish you luck, certainly a good spot to be in (having many choices as opposed to none or few), feel free to PM me if you have any other specific questions. There are a time and place for these methods. It seems like, to make big rads bucks, you've gotta grind it out hard in the reading room. I'm shocked at the number of people who think this way. In addition it's one of the few specialties that is still mostly still dominated by private clinics. We mostly manage chronic conditions. share. I think the biggest downside is whether you want to supervise. Hi there, I’m 1.5 years into Anesthesia practice at medium size community shop. It'll be even worse on Christmas day or a Saturday at 3am. In the 1940s, the going rate was around 1 in 2,500. even in well controlled environments, the way the body reacts to having any invasion is really dependent on the individual. Ask a science question, get a science answer. Some radically different medicines were stored in nearly identical containers. I work hard hours 10 months of the year and take off 2 … Do you think eventually it will just become such an awful, disgusting grind that you'll just hate it? Most of the time, within an hour or 2 after the surgery, there are no effects at all from the anesthesia. I love my job and recently took the next step by working on a "locum tenens" contract basis (1099) instead of full-time (W-2). I'm assuming you aren't doing IR. I’ve had a few fellow students try to dissuade me from it because of CNRAs taking the available positions. You will feel this way for life. As for that standing around, now I know how many things are going on that I have to monitor and take care of. Overall, general anesthesia is very safe, and most patients undergo anesthesia with no serious issues. No dealing with irate family members. Non-oxygen wall gas tubing cannot connect into the machine's oxygen input anymore. If you inject lignocaine into a vein you can cause strange heart rhythms, but just before you push the plunger of the syringe to inject some you pull it back to make sure you're not in a blood vessel. I guess it matters how you define "danger". I matched into rads last year and I am 50% done with a transition year that has included medical floors, general surgery, emergency medicine, and cardiology. Kittens receive anesthesia when they are spayed or neutered, and most pets receive anesthesia at least once more during their lifetimes.. General anesthesia is achieved by administering drugs that suppress your cat’s nerve response. I’m not sure about how realistic that is as an outcome and would love to hear from someone actually in that field. You listed no negatives for radiology, that's a start. Does that put them at a higher risk for complications in the surgery? 31 lumbar puncture survivor here. Perhaps on a scale of open heart or brain surgery to something like wisdom teeth or cosmetic surgery. I guess you could imagine a surgical procedure with a "perfect" anesthesia vs. what is typically used today. administer several compounds which suppress or stimulate various functions. Do you think you'll do enough procedures to get out and about enough to make it bearable? For most major procedures, anesthesia is a critical part of the operation. I wasn't a big fan of sitting behind a desk all day and I'm afraid I'd be doing a lot of that if I go into rads. There is plenty of depth in rads and anesthesia. 1 decade ago. Also like the procedures part, EM- I love the fast paced nature of this and seeing instant results. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Anesthesia is more dangerous to people with chronic heart disease and chronic respiratory disease. Under general anesthesia, you don't feel pain because you're completely unconscious. really, with all of the sensors and monitors now, i would say that anesthesia is not very risky, and i would trust my anesthesiologist. Hey I really appreciate this writeup. Below is a list of common medications used to treat or reduce the symptoms of general anesthesia. Acute conditions are rare and often in emergencies. New AskReddit Stories: Doctors, nurses, and hospital staff of Reddit - what are your experiences (funny, sad, horrible) with people waking from anesthesia? See if you might have a choice. None have had a trained anesthesiologist present. When I tell people this many think I'm nuts. I don't think he meant it that way. Patient coded after the surgeon lacerated the inferior vena cava and failed to control the bleeding? how often do you see the proverbial poop hit the fan (or surgical lights)? Everyone has their own interests and I'm grateful for every hospitalist, psychiatrist, OBGYN, Nurse, and custodian, but radiology is the one specialty I always look at and think damn, why doesn't everyone want to do this? Similarly you are a specialist, but you require a broad range of knowledge because patients with every conceivable disease will present for surgery. Not to hijack the thread but I'm also considering rads and maybe my questions will be useful to OP. The local anaesthetic given for a lumbar puncture is very safe compared to the risks of the actual lumbar puncture which include central nervous system infection, bleeding and neurological injury. 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