anesthesia question/residency/fellowship?

[sinustarsi]

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1. Why don't they make lidocaine/marcaine mix bottle? Can I mix it myself and store it for few days or even week? Getting sick of mixing this everyday for the next 40 yrs.
2. There seems to be a lot of buzz about best residency programs but are there top notch fellowship program for podiatry?
3. Do most attendings tackle big cases such as triple with only one sx assistance? All extra hands in the OR seems to help but I have not seen a surgical central without residents. I wander how they tackle this issue?

 

[krabmas]

1. Why don't they make lidocaine/marcaine mix bottle? Can I mix it myself and store it for few days or even week? Getting sick of mixing this everyday for the next 40 yrs.
2. There seems to be a lot of buzz about best residency programs but are there top notch fellowship program for podiatry?
3. Do most attendings tackle big cases such as triple with only one sx assistance? All extra hands in the OR seems to help but I have not seen a surgical central without residents. I wander how they tackle this issue?

1. when you get out of residency, you will get to decide what local to use. Why use a mix? I use mostly marcaine. sometimes in the beginning of the case lidocaine, then marcaine at the end. If in a joint ropivacaine.

2. fellowships are for extra training and about what fits for you and what you want your future to look like. There is no best one.
Look for the one where you are not a slave.

3. some attendings do all their cases with a cirrculating nurse and scrub tech. rearfoot , frames and all. not even a PA.

 

[Feli]

I would agree with krabmas...

2 A lot of the "fellowships" in podiatry are just looking for a $40-50k associate for a year. If you do a good program, you should hardly need one, but if you want unique skills or CV padding, pick one with good teaching and attendings/procedures you think you will learn a lot from. Hyer's at OSU/Grant, DiDominico's in Ohio, and the UPMC one (now matched straight in as a 4yr from the get-go) are probably at or near the top of pod fellowship offerings. Those will teach ankle implants, complex trauma and recon, etc which most grad residents will have seen few or none of, depending where they did their residency. If Craig Camasta in Atalanta ever starts a fellowship, I will be one of the first in line to apply, but he seems content training residents and the occasional mini fellow for a week here or there.

3 A lot depends on the scrub tech. There are techs or PA/NP/etc first assists who do only ortho cases and know the instruments, procedures, etc pretty darn well. They know what step comes next, what drill for what screw, plates, etc. That makes a huge difference. You can do everything yourself if you have good skills, but you need at least one good assistant/scrub.

 

[PADPM]

I can't recall the exact article, but years ago there was actually literature stating that there was no advantage to mixing Xylocaine/Marcaine and that it was actually not recommended. If you perform a literature search, I'm sure you can find the article.

I won't comment on fellowships, because enough has already been said and I have no more to add.

Although I have been involved with residency training in the past, three of the four hospitals where I do the majority of my surgical cases no longer have residents and I perform my cases alone, with only the help of who I'm lucky enough or unlucky enough to get that day to assist.

Two of my partners schedule cases the same day and work together, but I'm the lone wolf and the way our schedule works out, I'm in the OR on two days a week in two different hospitals without my partners.

I'm also on staff at a surgical center where I rarely perform cases, and there are no residents there either.

It's great to have an extra pair of experienced hands, but you should be able to perform any and all procedures by yourself.....just in case.

 

[PADPM]

This is the abstract from just one article that states there is no advantage to the mixture:


[SIZE=-1]Journal of the American Podiatric Medical Association, Vol 86, Issue 10 487-491, Copyright © 1996 by American Podiatric Medical Association [/SIZE]
CLINICAL TRIAL

Local anesthetics. Is there an advantage to mixing solutions?


BM Ribotsky, KD Berkowitz and JR Montague
[SIZE=-1]American Board of Podiatric Surgery, Boca Raton, FL 33486, USA.[/SIZE] The advantages to using a 50/50 mixture of lidocaine and bupivacaine with respect to onset and duration of local anesthesia instead of using the solutions independently were evaluated. In a double-blind randomized experiment, 12 subjects, each volunteering both feet, were studied. One foot was injected with 1 ml of one of the following three solutions: 1% plain lidocaine, 0.25% plain bupivacaine (Marcaine), or a 50/50 mixture of 1% lidocaine and 0.25% bupivacaine; and in the other foot, a 1-ml injection of normal saline as a blinded control. A 5.07 (10 g) Semmes-Weinstein monofilament wire was used for testing for sensory blockade, and the onset and duration of anesthesia was recorded for each subject. It was determined that there was no significant difference in the mean onset times for the three solutions, and no significant difference between the durations of anesthesia of plain lidocaine and the 50/50 mixture. Additionally, it was determined that bupivacaine had a prolonged duration of anesthesia compared with the other two solutions. The results of this preliminary study suggest that there is no clinical advantage, with respect to onset and duration of local blockade, to using a 50/50 mixture of plain lidocaine and plain bupivacaine in place of their independent use.

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