UTILITY of contrarian paradigm

[aghast1]

Pigeon holing is an unfortunate human tendency.

When one reads a book title Anesthesia in Cosmetic Surgery, the very human tendency is to react, 'well I don't do this kind of work, of what possible use could I have for the ideas contained in this book?

From Ch. 1 Table 1-3 Minimally invasive surgeries appropriate for BIS-monitored PK MAC, the MIA technique

1. All cosmetic procedures (including abdominoplasty)
2. Gyn: laparoscopy (tubal ligation, fulgeration endometriosis)
3. Ortho: arthroscopy
4. Urology: lithotripsy
5. Gen. surg.: herniorraphy, breast cancer surgery (bx., mastectomy)
6. Neuro: microdisscetomy, microlaminectomy, carpal tunnel release
7. Sedation for morbidly obese
8. Peripheral injuries in US military field hospitals in Iraq & Afghanistan

This list is by no means exclusive.

There are probably many other uses for this paradigm for those interested in improving their patients' safety & outcomes.

Happy trails,

aghast1

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[aghast1]

[FONT=Verdana, Helvetica, sans-serif] Raskolnikov .
[FONT=Verdana, Helvetica, sans-serif] unregistered


.

[FONT=Verdana, Helvetica, sans-serif] posted 19 September 2002 20:41 . [FONT=Verdana, Helvetica, sans-serif] Hi there: I came across aghast1 by chance a number of years back whilst surfing for information on mortality in office based practice using sedation vs GA's whilst quality based dental GA practice in this country was under threat-now demised : and now that GA's have gone there appears to be a puritanical flurry of (the same college) activity in the realisation that sedation can be another form of GA administered by the non-anaesthetist ie lethal.As Tom Leherer would say"...but I digress-".

Until then Ketamine had been portrayed to me as akin to top shelf magazinefest:the reality has been completely different- if its hallucinations you want to give patients- give them tramadol or morphine-some say neostigmine- you'll have a higher success rate:

For surface procedures, induce hypnosis with SLOW propofol infusion,then approx 50mg ketamine, then infiltrate/nerve block the area with local- this is the main analgesic platform for the surgery- continue the propofol infusion to comply with your contract with the patient.Give NSAID,s; avoid as best you can opioids.

I've also used it in minor gynae with good results: propofol hypnosis, bolus ketamine approx 50mg, then intermittent propofol till end. Airways usually well maintained, cough reflex certainly there,avoid apnoea by slow rates of propofol.

Low volume laparoscopies for gyne -same technique, no tubes etc.

For the gynae I have a 1% incidence of n/v (in hospital) without routine anti-emetics.

Although aghast1's scriptures have a certain Messianic feel about them, the thrust of what he writes and his experiences with the technique have broadly been may experience over the last 3 years:certainly you can almost guarantee that Mrs" always sick after an anaesthetic" becomes Mrs."usually sick after an anaesthetic" - and thats without anti-emetics.
The chap next door uses ketamine infusions plus other things for major colorectal surgery- I have no experience of its benefits in such situations..

 

[Tenesma]

dude

please STOP with the self-promotion - it is making me gag

 

[aghast1]

dude

please STOP with the self-promotion - it is making me gag

Please stop 'straining' to something worthwhile. It is not working.

Self-promotion implies a financial motivation of which I have none.

Promoting a different paradigm with better outcomes is what it is about.

Your gagging is beyond indifferent to me.

Take some of the anti-emetics you so readily give your pts.

Then, have a nice day🙂

aghast1

PS The posting from SIVAK UK was 5 yrs old. Where were you then? You are clearly nowhere now.

 

[Trisomy13]

spam

 

[treasurefull2]

Pigeon holing is an unfortunate human tendency.

When one reads a book title Anesthesia in Cosmetic Surgery, the very human tendency is to react, 'well I don't do this kind of work, of what possible use could I have for the ideas contained in this book?

aghast1

Dude, you're an f-ing douche bag...I read the first two lines and didn't bother reading the rest...

PLEASE SOMEBODY DELETE THIS LOSERS POSTS IN ORDER TO SAVE THE QUALITY OF THIS GREAT ANESTHESIA FORUM.
I mean, come on, aren't there any moderators out there???

 

[aghast1]

Dude, you're an f-ing douche bag...I read the first two lines and didn't bother reading the rest...

PLEASE SOMEBODY DELETE THIS LOSERS POSTS IN ORDER TO SAVE THE QUALITY OF THIS GREAT ANESTHESIA FORUM.
I mean, come on, aren't there any moderators out there???

Pointing the finger at 'loser' should remind you that three of your own fingers are pointing back to yourself.😱

What possible use could there be for anesthesiologists not involved in cosmetic surgery anesthesia?😕

No breast augs in the field hospitals in Iraq & Afghanistan. Just a neat way to give field anesthesia without anesthesia machines and large quantities of O2.

The list on the original post of this thread lists procedures commonly performed by non-cosmetic anesthesiologists. What's your beef, dude?

"...aren't there any moderators out there???"

There are but I have not heard from a single one. Just I have not heard about my $30 contribution last Tuesday to support this forum.👍

Now if you have something relevant to say about my technique, like how you tried it and it a) really works, b) it really sucked that might be of interest. But, sticks and stones...


"...didn't bother reading the rest..."

Too bad, you might have learned something. But wait, I forgot, you already know everything.🙄

In 15 years of listening to sour grapes, there has yet to be a negative comment I have not previously encountered and dealt with.
Go forth and conquer your own world

aghast1

 

[fakin' the funk]

Pigeon holing is an unfortunate human tendency.

Here's a hint: YOU'RE ANNOYING. Take the hint.

 

[aghast1]

spam

I guess this means you get the difference between promoting an idea and promoting oneself

Bravo. Go to the head of the class.

 

[aghast1]

Here's a hint: YOU'RE ANNOYING. Take the hint.

Thanks for the compliment.😍

Hopefully, you might be just annoyed enough to consider how you conduct anesthesia in your practice.

aghast1

 

[Trisomy13]

I guess this means you get the difference between promoting an idea and promoting oneself

Bravo. Go to the head of the class.

fresh like a summer's eve.

 

[amyl]

BIS for carpal tunnel release? please.

 

[aghast1]

fresh like a summer's eve.

 

[Tenesma]

dude there is nothing contrarian about your paradigm - variations on what you consider "your" technique occur every day around the country -

you obviously must be very busy in SoCal since you rarely have time to post on this forum.... yawn

 

[aghast1]

dude there is nothing contrarian about your paradigm - variations on what you consider "your" technique occur every day around the country -

you obviously must be very busy in SoCal since you rarely have time to post on this forum.... yawn

still straining, i see.

"... "your" technique"

sorry, never claimed to have primacy for mixing propofol & ketamine

even cited guit et al 1991 paper (a reference of which i am confident you are aware of) as evidence that i always knew there was nothing new about mixing the two agents.

ref #24 ch 1 propofol ketamine with bis monitoring in anesthesia in cosmetic surgery:

Although Guit was the first to publish the combination of propofol and ketamine, the technique was described as a total intravenous anesthetic (TIVA).(24) TIVA strongly implies that the local analgesia injected by the surgeon is not essential to the success of the TIVA technique. In contradistinction, the surgeon's local is essential for the success of PK MAC.

in 1992, my original work was substituting propofol for diazepam in adopting Vinnik's paradigm hypnosis first, then dissociation (pub 1981).

this concept appears nowhere i am aware of in the anesthesia literature.

i could find nothing to assure me that hypnosis from propofol would be no different from hypnosis from diazepam as far as preventing hallucinations.

no one in anesthesia knew this was the key to avoiding ketamine associated hallucinations😱 - at least i have never read of heard about any articles. if you have one, please post it or pass it on.

mia or 'goldilocks' anesthesia simply pairs pk mac with bis monitoring to define levels of hypnosis. see previous posts.

"... you obviously must be very busy in SoCal since you rarely have time to post on this forum..."

actually, i am busy enough to suit my needs. still walking around in short sleeves and sandals while much of the rest of the country is shivering.
stay warm,

aghast1

 

[gasnewby]

why oh why do people keep responding to him? 🙁

 

[Noyac]

PLEASE SOMEBODY DELETE THIS LOSERS POSTS IN ORDER TO SAVE THE QUALITY OF THIS GREAT ANESTHESIA FORUM.
I mean, come on, aren't there any moderators out there???

There was a time when we had mods. That number has been diminished by administrators who for some reason didn't feel that the mods were doing a very good job or that some of us were too confrontational. This is obviously a big job unfortunately bestowed on 1 person, Venty. Jet and OMD no longer frequent this site. And the admin's are not here enough as well. this is what we are left with.

 

[aghast1]

why oh why do people keep responding to him? 🙁

maybe because they are tired of hearing the same old cr*p from their instructors?

maybe because no one has refuted better, published ponv outcomes?

maybe because they cannot believe i can remain civil and dispassionate despite the numerous, ludicrous provocations attacking me as a person while refusing to deal with the information i have set forth in my paradigm.

maybe because they share my sense of what's wrong in academia.

maybe because they know someday they will leave their training and have to become accountable for their outcomes.

maybe because they get some level of amusement.

aghast1😍

 

[aghast1]

Don't know why they come to the web site and keep coming.
After all, if there was nothing novel, they can get info anywhere.
Here is a list of nearly 2 yrs worth of visitors to my non-commercial web site.
No statistical significance is implied.

1. United States 8,650
2. Unknown Country 2,366
3. Japan 205
4. Australia 145
5. United Kingdom 139
6. Canada 117
7. India 52
8. Mexico 50
9. Netherlands 39
10. Germany 38
11. Italy 34
12. New Zealand 28
13. France 27
14. Brazil 24
15. Switzerland 20
16. Belgium 20
17. Israel 19
18. Czech Republic 18
19. Singapore 18
20. Philippines 18
21. South Africa 16
22. Saudi Arabia 16
23. Sweden 16
24. Turkey 16
25. Malaysia 16
26. Argentina 15
27. Indonesia 15
28. Romania 15
29. Thailand 14
30. Poland 14
31. Spain 13
32. Greece 13
33. Egypt 11
34. Portugal 10
35. Pakistan 9
36. Taiwan 9
37. Norway 9
38. Russian Federation 8
39. Bulgaria 8
40. Yugoslavia 8
41. Austria 7
42. Ireland 7
43. Denmark 6
44. United Arab Emirates 5
45. Hungary 5
46. Estonia 4
47. Peru 4
48. Dominican Republic 4
49. Trinidad and Tobago 3
50. Finland 3
51. Iran 3
52. Ukraine 3
53. China 3
54. Slovak Republic 3
55. Nepal 2
56. Jordan 2
57. Cuba 2
58. Myanmar 2
59. Antigua and Barbuda 2
60. Cyprus 2
61. Lithuania 2
62. Lebanon 2
63. Guatemala 2
64. Malta 2
65. Syria 1
66. Hong Kong 1
67. Venezuela 1
68. Bosnia-Herzegovina 1
69. Virgin Islands (USA) 1
70. Ivory Coast (Cote D`Ivoire) 1
71. Moldavia 1
72. Albania 1
73. Fiji 1
74. Cambodia (Kingdom of) 1
75. Brunei Darussalam 1
76. Tuvalu 1
77. Luxembourg 1
78. Croatia 1
79. Sri Lanka 1
80. Vietnam 1
81. Polynesia (French) 1
82. Qatar 1
83. Chile 1

It just feels good.🙂

aghast1

 

[Mman]

11,000 visitors in 2 years?

Jeez, my lame sports blog pulls in an average of 10-20,000 hits a month (depends on the sports season, CFB is a biggie) and I don't even know how to write well. Hell, I don't even generate that much original content. I haven't posted on it in 2 weeks and I've still had 1000 unique visitors in the last 7 days.

Am I now considered an expert in my blogging field?

 

[aghast1]

11,000 visitors in 2 years?

Jeez, my lame sports blog pulls in an average of 10-20,000 hits a month (depends on the sports season, CFB is a biggie) and I don't even know how to write well. Hell, I don't even generate that much original content. I haven't posted on it in 2 weeks and I've still had 1000 unique visitors in the last 7 days.

Am I now considered an expert in my blogging field?

These are visits, not hits.🙂

Most anesthesiologists are not involved with cosmetic surgery anesthesia and give in to pigeonholing.

I am thrilled with the response.

FWIW, the web site will be 7 years old this August 1.👍

Happy holidays!

aghast1

blogging or flogging, be an expert

 

[dhb]

Terms of Service:

"Posting Advertisements

This is a forum of ideas, so advertisements are not allowed in the main forums. Advertisements may only be posted in the Free Classifieds section of the forums. A member may answer another member's question about their occupation or business, however, blatant advertising or solicitations of or for business is prohibited. This includes, but not limited to, links to products or services with which the poster is affiliated, whether or not a fee is charged for the product or service. Spamming, in which a user posts the same message repeatedly, is also prohibited. Pyramid schemes -- chain letters that involve money -- are not only prohibited by the Student Doctor Network standards, but they're also illegal. It is permissible for members to mention services or products that are provided by them or the companies with which they are affiliated, as long as the information is germane to the topic, is not a blatant advertisement, and the members mention their affiliation with the company in the content of the message."

 

[VentdependenT]

Terms of Service:

"Posting Advertisements

This is a forum of ideas, so advertisements are not allowed in the main forums. Advertisements may only be posted in the Free Classifieds section of the forums. A member may answer another member's question about their occupation or business, however, blatant advertising or solicitations of or for business is prohibited. This includes, but not limited to, links to products or services with which the poster is affiliated, whether or not a fee is charged for the product or service. Spamming, in which a user posts the same message repeatedly, is also prohibited. Pyramid schemes -- chain letters that involve money -- are not only prohibited by the Student Doctor Network standards, but they're also illegal. It is permissible for members to mention services or products that are provided by them or the companies with which they are affiliated, as long as the information is germane to the topic, is not a blatant advertisement, and the members mention their affiliation with the company in the content of the message."

Yup.

 

[aghast1]

Yup.

relevance?

web site is not explicitly given or stated

is it spamming for list members to repeatedly ask the same question?

interest by international visitors list speaks to the utility of the paradigm, the topic of the thread

aghast1

 

[chocomorsel]

Thank you, Thank you, Thank you so much moderators. I was wondering what the heck was taking soo damn long. What a jerk. Adios!!!!!

 

[Gern Blansten]

Freedom for my people! Thanks Venty! What a piece of work that guy was.

 

[coprolalia]

Just like to add, for no other reason than to gloat, that my initial assessment of this person was spot on. In other words, it was worth the official warning I got from the moderators.

-copro

 

[Gern Blansten]

Just like to add, for no other reason than to gloat, that my initial assessment of this person was spot on. In other words, it was worth the official warning I got from the moderators.

-copro

Actually, I was the first to recognize his "douchebagginess" and I trademarked the term specifically for him. If you need to use the term, feel free to do so with my blessing.

 

[coprolalia]

Actually, I was the first to recognize his "douchebagginess" and I trademarked the term specifically for him. If you need to use the term, feel free to do so with my blessing.

Duly noted. 👍 😀 😎

-copro