Interviews

[Etomidate]

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Definitely a little early but in talking with my advisor, he gave this advice.

Star applicant: 10 interviews
Average applicant: 10-15 interviews
Below average applicant: 15 interviews

This is not including TY/Prelim Med, Surg interviews - he recommended 4-5 of these regardless of how competitive you are.

Any thoughts?

 

[UTSouthwestern]

Definitely a little early but in talking with my advisor, he gave this advice.

Star applicant: 10 interviews
Average applicant: 10-15 interviews
Below average applicant: 15 interviews

This is not including TY/Prelim Med, Surg interviews - he recommended 4-5 of these regardless of how competitive you are.

Any thoughts?

Etomidate sucks. Propofol is the true milk of amnesia.



And the advice above is sound.

 

[VentdependenT]

Etomidate sucks. Propofol is the true milk of amnesia.



And the advice above is sound.

I'm a ketamine man myself.

 

[Skip Intro]

Etomidate and propofol burn too much. Supposedly there is a "water soluble Propofol" currently in development that will all but replace Propofol with its limitations (i.e., as an awesome growth medium for fungus and venous irritation), but apparently still has the cardiac issues.

Ketamine. Hmmm... 'special K'. I've actually not seen it used yet, but I've heard that, other than kids, it's not all that often used because some people really freak out on it. Guess this is why you do a residency.

-Skip

 

[Idiopathic]

And the advice above is sound.

Great.



Now the problem is just determining where you fit in on that scale 😉

 

[UTSouthwestern]

Etomidate and propofol burn too much. Supposedly there is a "water soluble Propofol" currently in development that will all but replace Propofol with its limitations (i.e., as an awesome growth medium for fungus and venous irritation), but apparently still has the cardiac issues.

Ketamine. Hmmm... 'special K'. I've actually not seen it used yet, but I've heard that, other than kids, it's not all that often used because some people really freak out on it. Guess this is why you do a residency.

-Skip

That would be Ampofol or what I like to call Propofol lite. Half the lipid content of propofol or less. We have had a study on it going for the past couple of years. Hated to fill out the paperwork during the cases on the study.

Ketamine's psychomimetic effects (hence Vent's use of it) can effectively be minimized or eliminated with a pre injection dose of Versed (2-5 mg). I would give another dose of Versed at the midpoint of the case (1-2 mg) if you are using the Ketamine as your primary anesthetic or analgesic and if the case is proceeding at an academic pace.

Always remember being the OB west chief and hearing patients in the PACU, who had to be given Ketamine intraoperatively because the C section was hitting it's 3rd hour, talk to their long dead relatives, or freak out because a giant pink gorilla was trying to push them out the door.

 

[VentdependenT]

That would be Ampofol or what I like to call Propofol lite. Half the lipid content of propofol or less. We have had a study on it going for the past couple of years. Hated to fill out the paperwork during the cases on the study.

Ketamine's psychomimetic effects (hence Vent's use of it) can effectively be minimized or eliminated with a pre injection dose of Versed (2-5 mg). I would give another dose of Versed at the midpoint of the case (1-2 mg) if you are using the Ketamine as your primary anesthetic or analgesic and if the case is proceeding at an academic pace.

Always remember being the OB west chief and hearing patients in the PACU, who had to be given Ketamine intraoperatively because the C section was hitting it's 3rd hour, talk to their long dead relatives, or freak out because a giant pink gorilla was trying to push them out the door.

Ohh man I thought that Missy (the Pink Gorilla) belonged only to me.

Anyways, I was told that Ketamine is also a good choice for heavy etoh users because it works on the NMDA receptor vs the GABA (which is heavily down regulated in this population).

As for the trippen out thing, why would you want to stop that UT? People pay extra money for that sort of effect on the streets. Just joking my friend. I wouldn't want to feel a giant pink gorilla throwing me off a ten story balcony on emergence....a bit overwhelming I suppose.

CA I was working with on my interview at virginia mason was using neuroleptanesthesia. Working with droperidol, versed, and nitrous...pretty cool. Said he just wanted to try it out. As will I one day. 🙂

 

[UTSouthwestern]

Ohh man I thought that Missy (the Pink Gorilla) belonged only to me.

Anyways, I was told that Ketamine is also a good choice for heavy etoh users because it works on the NMDA receptor vs the GABA (which is heavily down regulated in this population).

As for the trippen out thing, why would you want to stop that UT? People pay extra money for that sort of effect on the streets. Just joking my friend. I wouldn't want to feel a giant pink gorilla throwing me off a ten story balcony on emergence....a bit overwhelming I suppose.

CA I was working with on my interview at virginia mason was using neuroleptanesthesia. Working with droperidol, versed, and nitrous...pretty cool. Said he just wanted to try it out. As will I one day. 🙂

Don't need the versed for neuroleptanesthesia, do need some narcotic because the combo you have above will have the patient reaching up to choke you after the boob job/penile enlargement is done.

 

[VentdependenT]

Don't need the versed for neuroleptanesthesia, do need some narcotic because the combo you have above will have the patient reaching up to choke you after the boob job/penile enlargement is done.

LMAO. I guess producing analgesia would be smart vs just snowing the pt. My apologies for leaving out the fentanyl.

UT, Glad to see you have my future practice picked out for me. Throw in sex changes and BLAM just show me where to sign.

 

[toughlife]

Definitely a little early but in talking with my advisor, he gave this advice.

Star applicant: 10 interviews
Average applicant: 10-15 interviews
Below average applicant: 15 interviews

This is not including TY/Prelim Med, Surg interviews - he recommended 4-5 of these regardless of how competitive you are.

Any thoughts?

How did he define each of the above?

 

[IceDoc]

Ketamine's psychomimetic effects (hence Vent's use of it) can effectively be minimized or eliminated with a pre injection dose of Versed (2-5 mg). I would give another dose of Versed at the midpoint of the case (1-2 mg) if you are using the Ketamine as your primary anesthetic or analgesic and if the case is proceeding at an academic pace.

Always remember being the OB west chief and hearing patients in the PACU, who had to be given Ketamine intraoperatively because the C section was hitting it's 3rd hour, talk to their long dead relatives, or freak out because a giant pink gorilla was trying to push them out the door.

I saw a paper a year ago about using a combo of Ketamine and Morphine in a PCA. I thought that was pretty wacked out, but they reported pretty good results . Has anyone out there used this combo?????

 

[Skip Intro]

... and if the case is proceeding at an academic pace.

Unfortunately, I already know what you mean. I once saw a junior attending and an early-in-the-academic-year PGY-2 gen surg resident (who'd only maybe touched a trocar twice) take over 3 hours to do a lap chole.

Residency here I come...

-Skip

 

[UTSouthwestern]

I saw a paper a year ago about using a combo of Ketamine and Morphine in a PCA. I thought that was pretty wacked out, but they reported pretty good results . Has anyone out there used this combo?????

Would only use that for refractory pain and with the understanding that tachyphylaxis will develop and require increasing doses to maintain the same effect.