"Taking care when you are not aware”Doctor . Regional anesthesia enthusiast,aspiring to be better Dadda bear to Arya, #HeforShe. Cricket: India &Delhi Capitals.
Abu Dhabi, United Arab Emirates
Joined November 2012
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Awesome #ESRA2026 at Lisbon
@ESRA_Society does one better each year, great memories getting my hard earned ESRA-DRA and rubbing shoulders literally with @amit_pawa and @jeffgadsden who hav influenced several people like me around the world. @BlockIt_Hot_Pod
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Always blocked supraclavicular . And works all the time . The anatomy , the US ergonomics and the “ nomenclature “ like podium sign and corner pocket …it’s like seeing CSF in a good spinal .
SleepDoctor retweeted
I like to “scrape the paint” off the artery using hydro-dissection and then go for the 6 o’clock mark…youtu.be/Uk-2pdFQ75A?is=t7RQ…
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Indeed! Our goal is to keep up the reputation of the book. We are confident it will be a great resource for anyone taking care of patients for Neurosurgery or neurological disease. The 6th edition has come out after a long gap & covers all contemporary topics & advances.
SleepDoctor retweeted
Congratulations, Dr. @deepak_neuro , on editing the 6th edition of Cottrell’s Neuroanesthesia—considered by many the bible of neuroanesthesia! A wonderful achievement and an invaluable contribution to our specialty. Looking forward to reading it
@SNACCNeuro
@ISNACCINDIA
Congratulations
Even for a non neuro anesthesiologist, I know how significant Cottrell’s text book is
🙏🏻
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
💯
RSI is an option only for Emergency!
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 ..."
SleepDoctor retweeted
Gastric US & discussions, will guide the level of sedation. If solids or gd2, I’d cancel (unless patient willing to be fully awake, & surgery not expected to be complex), empty or gd1, proceed. My threshold to cancel is high (understand this differs between colleagues)
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DBCA, getting under artery and the spread to radial, ulnar then draw back to flatten angle get median, many times the MCN becomes oblique OOP.
SleepDoctor retweeted
I sent this video to Jeff for a competition on the first ever blocktober
The ulnar (I checked with the nv stim) is sitting doggedly to the axillary artery for some reason know only unto itself! The median gives it a good shove, gives up and pops over it
The scan starts distal
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Ooooh I love an axillary for so many reasons
My top tips
1. Focus on Artery and conj. tendon view
2. Always dynamic scan the Ulnar ..it’s a capricious wee fella
3. If you can’t find the MCN it’s probably sticking with the median for a little longer
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GA also carries a risk of n injury, particularly the common peroneal nerve, which is vulnerable to compression & positioning. SA does not automatically establish causation. Key is preop neurological assessment, documentation and informed consent, regardless of the technique
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Surely the clinician would have to explain this to the patient when discussing SAB vs GA. My concern here is that should the patient perceive a change in their symptoms postoperatively they may attribute it to the anaesthetic choice. GA avoids that dilemma.
SleepDoctor retweeted
Love an axillary block. The nerves aren’t always where you expect them…With residents, I’ll add a PNS to check who’s who. Probably more fun than anyone should have in an armpit. youtu.be/vBpWpL0al9s?is=WIzs…
SleepDoctor retweeted
I love teaching axillary brachial plexus blocks. So much cool anatomy to go over. And fun physiology too -- seeing how the hand does a different dance when stimming each nerve separately is (yes, nerd alert) an eye-opener for the trainees. When YOU do this block, what order do you go in?
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I’m not sure what the issue is here with spinal anaesthesia?
Surely it’s the analgesic RA that is the theoretical problem??
SleepDoctor retweeted
That would be a shared decision with the patient. Hips aren’t super sore and yes RA is better but not absolutely necessary. “If we made that worse, no matter how small the risk, is it a deal breaker for you?”