SleepDoctor

Deepak Sharma @deepak_neuro · Oct 18

The 6th edition of Newfield and Cottrell’s Neuroanesthesia is now published! Honored to be an editor for this prestigious book! What surprise to see it being launched at #ANES26 @ASALifeline.
@Wolters_Kluwer @wkhealth

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Jeff Gadsden Verified account @jeffgadsden · Oct 18

Thanks @AirwayMxAcademy , I do appreciate there's no evidence that gastric US changes outcomes. That said, there are lots of things we use every day that provide useful information while lacking evidence. Pulse oximetry has not been shown to reduce periop mortality, but I sure ain't gonna stop using it while I await some dude to do a meta-analysis on it.

Here's the real value: In the above example, if I scan and find stomach is empty, that means I can proceed confidently with my plan of spinal plus propofol sedation (aka unconsciousness/loss of airway reflexes). If I were just to reflexively intubate the tracheas of every joint replacement on a GLP1 (about 15-20% now), I would now be exposing those patients -- as you point out -- to a new set of risks (airway trauma, bronchospasm, blah blah blah).

If I DO find a full stomach, then we have some decisions to make. Spinal with the patient awake through the procedure is one option. Postpone is another. Re-scan an hour or two later is a third. GA with RSI is an option I suppose BUT....RSI is hardly a guarantee of safety. Most operative aspiration events occur during RSI/full stomach.

Here's a question for everyone out there (and I'm genuinely curious). If you have a known full stomach and you proceed with GA/ETT for an elective case and the patient has a serious aspiration event, is that defensible? I reaaaallllyyy hate questions that start with "Dr. Gadsden, please explain to the jury ..."

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mchong Verified account @michyaries888 · Oct 17

@jeffgadsden @amit_pawa @EMARIANOMD @elboghdadly @RegionalAnaesUK @docmorne @DrJeniMD @EngySaid_MD @ajrmacfarlane @galusweegie @Nadia_Hdz_MD @pritanand @BlockIt_Hot_Pod @deepak_neuro @rosie_hogg @DrNavSidhu @NavBahal @PeterMerjavy @DrRobbieErskine @DrTuhinM I routinely do gastric US for all on GLP, even if they’ve done 24 h of clears. Block, Spinal +/- sedation

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Jeff Gadsden Verified account @jeffgadsden · Oct 15

You've got a patient for hip replacement. She reports that she's had some tingling/numbness in her peroneal/fibular distribution for over a year, on and off (in the operative limb). Has had some electrodiagnostic testing which shows increased latency and decreased amplitude indicative of a mononeuropathy, no evidence of nerve root compression in spine. No motor issues. #Blocktober26

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