The Anesthesia Consultant is written by Richard Novak, MD, an Adjunct Clinical Professor of Anesthesiology, Perioperative and Pain Medicine at Stanford University.
The Department of Anesthesiology, Perioperative and Pain Medicine at Stanford has administered Mock Oral Board Exams to its residents twice yearly since the 1980s. The Mock Oral is designed to mimic the conditions of the American Board of Anesthesiology (ABA) Standardized Oral Exam (SOE), which candidates must pass to become board-certified. In a previous column I advised examinees how to best prepare for the Standardized Oral Exam, and how to best perform on the exam. In this column I’ll outline how to set up a Mock Oral Exam program.
There are hundreds of anesthesia textbooks, but which current books are the gold standards for anesthesia knowledge? Should you buy these books, or should you advocate that your hospital purchase them for the medical library?
The Rescue required 13 underwater general anesthetics delivered by an anesthesiologist and maintained by non-medical cave divers during their 3-hour swim to the mouth of the cave. How did this once-in-history anesthetic tour de force come about?
The first episode of House of the Dragon contained a gory scene of an awake Cesarean section. Queen Aemma was in the process of giving birth to a male heir, the baby was presenting feet first (breech), and was stuck,and could not be delivered vaginally. Grand Maester Mellos (a medieval physician-equivalent) offered a potential solution to the king. He said, “During a difficult birth, it sometimes becomes necessary for the father to make an impossible choice. To sacrifice one, or to lose them both. There is a chance that we can save the child. A technique that is taught at the Citadel—which involves cutting directly into the womb to free the infant. We must either act now or leave it with the gods.” Soon after that conversation a knife descended as Mellos cut into the queen’s abdomen while she screamed and the king whispered into her ear that he loved her. The blood loss from the procedure left the queen dead from hemorrhagic shock.
You’re the anesthesiologist on call on a Saturday night. A patient arrives at the Emergency Room complaining that he ate piece of steak one hour ago, and the meat got stuck in his throat. He is six feet tall and weighs 350 pounds, for a BMI of 47. The attending general surgeon wants to do an upper GI endoscopy to extract the piece of meat from the patient’s esophagus or push it through into the stomach. He’s called on you to do the anesthetic. What do you do?
The American Society of Anesthesiologists (ASA) just published a 2022 update on their ASA Difficult Airway Algorithm Guidelines. The 2022 document is a revision of the 2013 publication “Practice guidelines for management of the difficult airway: A report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway.” The 2022 ASA Difficult Airway Algorithm Guidelines are 51 pages in total.
The most important changes are identified by examining the 2013 and the 2022 algorithms side by side.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Who is responsible for your safety before, during, and after your surgery? Will it be a nurse or will it be a physician? This is an important question. Perioperative mortality is the third leading cause of death in the United States after heart disease and cancer. This statement appeared in the July 2021 issue of Anesthesiology, our … Continue reading NURSE ANESTHESIOLOGY?→
The physician anesthesiologist job market looks excellent. Medical students, college pre-med students, and academically successful high school students, are you wondering if anesthesiology is a great career for you?
Do you want an algorithm, or a human, to be your doctor? In 2004 I began writing Doctor Vita, a novel describing the encroachment of Artificial Intelligence (AI) into medical care. Fifteen years later, in 2019, Doctor Vita was published. The story described Artificial Intelligence in medicine as a perceived panacea that descended into a chaotic dystopian reality. This month’s issue of Anesthesiology, our specialty’s leading journal, contains two studies on further incremental Artificial Intelligence in Medicine advances in the operating room.
This week I filmed a 26-minute question and answer video for the American Sleep Apnea Association regarding the topic of sleep apnea and surgery. The video provides answers to individuals who have obstructive sleep apnea and are contemplating surgery and anesthesia.
You’re in the middle of your medical school years, and wondering what specialty to pursue. There are two major forks in the road when trying to choose the career that suits your emotional make-up and work ethic. The sooner you understand these two forks in the road, the better off you’ll be.
One large subset of anesthesia work closely mimics the lifestyle of dermatology practice. Before you sign up for a lifetime as a dermatologist, consider the subspecialty of ambulatory anesthesiology.
How soon will we see robotic anesthesia in our hospitals and surgery centers? Are proposed anesthetic robots too expensive to design, test, and manufacture? Can they be brought to market to assist current anesthesia providers? Can they be brought to market to replace any anesthesia providers? Keep these economic questions in mind as we review the current science of robotic anesthesia.
TheAnesthesiaConsultant.com presents its 2022 ranking of The Top 10 Living Anesthesiologists. These individuals made significant original contributions to the practice and/or education of anesthesiologists throughout the world. As a physician anesthesiologist who has attended to patients in the 1980s, 1990s, 2000s, 2010s, and now the 2020s, in both university and community settings, I’m uniquely qualified to identify and honor the leaders in our field over this time. Here’s the list:
You’re a patient scheduled for elective surgery tomorrow. You’re nervous and you’d like to drink a glass of wine (or two) at dinner the night before the surgery. Is this OK? What’s the relationship between alcohol and anesthesia?
An audit trail lurks behind every Electronic Medical Record (EMR). Every time a healthcare provider clicks his or her mouse on an EMR, that click is recorded by the Big Brother of Medical Care, the audit trail.
“I don’t think that people can really comprehend how horrific this disease is, unless they’ve been personally touched by it. I mean, people are literately suffocating inside our hospitals, and they are dying alone. And truly, my heart breaks for everybody who has lost their jobs or their housing, and for kids that aren’t able to go to school, and for people that aren’t able to see their families. And they don’t get the luxury to complain about COVID fatigue, and their families don’t get the luxury to complain about it, because they’re living in, like, COVID hell.”
Temporary presidential power was turned over to Kamala Harris during the time of Biden’s colonoscopy anesthesia. Biden has the most difficult and most important job on Earth. When can he return to duty?
Anesthesia is a hands-on specialty. We use our manual skills daily to place breathing tubes, insert intravenous and intra-arterial catheters, and place needles for spinal punctures, epidural catheters, and regional nerve blocks. The Merriam-Webster dictionary defines the internet as “an electronic communications network that connects computer networks and organizational computer facilities around the world.” This definition seems to have has very little to do with inserting breathing tubes, catheters, or needles, yet the internet changed anesthesiology forever.
What’s the difference between a physician anesthesiologist and a nurse anesthetist? After the first 3 – 4 years in the workforce, either one can master the manual skills of anesthesia. That is, either one can display excellence in intubating the trachea, performing a spinal or an epidural anesthetic, performing a nerve block, inserting an arterial line, or inserting a central venous pressure catheter. There is no fork in the career path that makes a busy Certified Registered Nurse Anesthetist (CRNA) automatically inferior to a medical doctor anesthesiologist in hands-on skills. So what really is the difference between a physician anesthesiologist and a nurse anesthetist? The answer: internal medicine.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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“I’m going to have surgery to have my gall bladder out. How long will the anesthesia last?” The query “How long does general anesthesia last?” is a common question before surgery. Modern anesthetics wear off quickly after surgery, but the answer to your question is “It depends.” It depends on: (1) which drugs were administered, … Continue reading HOW LONG DOES GENERAL ANESTHESIA LAST?→
In July 2020 the Food and Drug Administration (FDA) approved the intravenous benzodiazepine remimazolam (Byfavo, Acacia Pharma) for use in sedation for procedures of 30 minutes or less. Will anyone utilize this new drug, or is it an expensive addition to our arsenal with few significant advantages over current agents?
A 12-year-old boy and his mother walk into a surgery center. The child is scheduled for a tonsillectomy, and is otherwise healthy. The anesthesiologist induces general anesthesia, and ten minutes later the patient has ventricular arrhythmias which descend into a cardiac arrest. Advanced Cardiac Life Support (ACLS) measures are applied, but the child cannot be resuscitated, and is declared dead.
The conclusion of most general anesthetics requires the removal of a breathing tube. The removal of this airway tube, an event called “extubation,” is a critical and sometimes dangerous event. Extubation is risky business.
Until prospective scientific evidence demonstrates that QUANTITATIVE neuromuscular monitoring improves outcomes, mandating the extra technology of QUANTITATIVE neuromuscular monitoring as a required standard is not the correct path for the ASA to take in 2022 or at any time in the future.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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What is a difficult anesthetic? Most people have no real idea what anesthesiologists do. Many imagine an anesthesiologist’s job is to give a patient some “gas” which to keep the patient asleep, while the surgeon (the real doctor) heals the patient. This image is oversimplified and wrong. Anesthesiologists are responsible for your medical care before, … Continue reading A DIFFICULT ANESTHETIC→
When you arrive at the PACU, a nurse reattaches your patient to the vital sign monitors, and discovers that the patient’s oxygen saturation has dropped from 100% in the OR to a severely low value of 80% in the PACU.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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JAMA Surgery published the study “Association of Anesthesiologist Staffing Ratio With Surgical Patient Morbidity and Mortality” on July 22, 2022. This was a landmark paper on the topic of anesthesiologist:CRNA staffing ratios, which documented that having physician anesthesiologists direct three or four operating rooms simultaneously for major noncardiac inpatient surgical procedures increased the 30-day risks of patient morbidity and mortality. The senior … Continue reading ANESTHESIOLOGISTS COVERING THREE OR FOUR OPERATING ROOMS AT ONCE CAN INCREASE RISKS →
There are Two Laws of Anesthesia, according to surgeon lore. They are: 1. The patient must not move.
2. The patient must wake up (when the surgery is over).
How do pandemics end? Now that COVID-19 vaccines have been approved, we’re all hoping this is the beginning of the end of this coronavirus pandemic. What about a history lesson—how did the last large respiratory viral pandemic end? The 1918 Spanish flu pandemic was the last large respiratory viral pandemic.
Terminal anesthesia refers to a situation when a patient has a terminal illness such as end-stage cancer and is suffering through their last days. They request to have a general anesthetic so they are unconscious throughout the process of dying.
Who is responsible for your anesthetic? A doctor or a nurse? On March 28, 2021 the anesthesia world in the United States was rocked by the headline: “Wisconsin Hospital Replaces All Anesthesiologists With CRNAs.“
Was Tiger Woods driving under the influence (DUI) on the morning of February 23rd, 2021 when he was injured in a single car accident? Perhaps his anesthesiologist knows.
A South Korean group led by Dr. Y.E. Jang published a study in this month’s issue of Anesthesiology describing the use of a head-mounted smart glasses display during radial arterial line placement in patients younger than 2 years. Placing a catheter into the tiny radial artery in a child’s wrist is one of the most difficult procedures in our specialty. The average internal diameter of the radial artery is 1.2 ± 0.3 millimeter in children aged less than 2 years. Wearing smart glasses improved the anesthesiologist’s first-attempt success rate, and reduced the procedure time and complication rates. This was an important study, and important information.
In Charles Darwin’s book On the Origin of Species he theorized that organisms best adjusted to the environment are the most successful in surviving and reproducing. In the Great Reopening after the COVID pandemic of 2020 we will see Darwinism in action.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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One of my readers asked me to describe a day in the life of an anesthesiologist, as he was considering a career in anesthesiology. To aid you in visualizing yourself in the hospital, I’m substituting the pronoun “you” instead of “I” in the narrative below. Your day is as follows, Doctor: 0530 hours – Your … Continue reading A DAY IN THE LIFE OF AN ANESTHESIOLOGIST→
One of my readers asked me to describe a day in the life of an anesthesiologist, as he was considering a career in anesthesiology. To aid you in visualizing yourself in the hospital, I’m substituting the pronoun “you” instead of “I” in the narrative.
You’re a high school or college student with proficiency in science and math, and you’re wondering about your eventual career path. Two of the most ambitious career choices would be to go to medical school, or to go into some form of computer science/software/hardware engineering.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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You’re the anesthesiologist assigned to a freestanding ambulatory surgery center (ASC). Are you and the facility prepared for an emergency at a surgery center? You meet your first patient of the morning, a 75-year-old female scheduled for lateral epicondylitis release surgery on her right elbow.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Anesthetizing uncooperative patients is difficult. The combination of autism and anesthesia requires careful planning. Children or adults with psychological, developmental, or behavioral disorders such as autism may be combative or aggressive, and may require extra measures of preanesthetic sedation or restraint. The parents/guardians and the anesthesia team need to be actively involved with forming the … Continue reading AUTISM AND ANESTHESIA→
How did our specialty advance from prescribing patients two shots of whiskey to administering safe modern anesthesia? In chronologic order, my choices for the 20 most important doctors in the history of anesthesia are:
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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An important question for many Americans is, “Is it safe for me to have surgery during the COVID pandemic?” Is it safe to reopen surgery? It depends. In the San Francisco Bay Area where I work, the answer as of today, June 4th, 2020, is “yes.” This is a key point: Healthcare professionals are more … Continue reading A QUESTION ABOUT REOPENING SURGERY. IS IT SAFE FOR PATIENTS?→
The question isn’t how many people in the United States will contract the coronavirus COVID-19. The key question is how many of these coronavirus cases will become extremely ill and wind up in an ICU.
On May 2, 2022, residents and fellows (medical doctors in their first years of educational work after medical school) at Stanford University Health Care voted to unionize.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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The February 2020 edition of Anesthesiology, our specialty’s preeminent journal, published an article on robotic anesthesia.1 The accompanying editorial by Dr. Thomas Hemmerling was titled “Robots Will Perform Anesthesia in the Near Future.”2 The author wrote: “I have no doubt that closed-loop (i.e. robotic) anesthesia is at least as good as the best human anesthesia. And that, … Continue reading ROBOTIC ANESTHESIA REALLY IS COMING→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Want to know how to make a billion dollars in healthcare and change the world for the better at the same time? You can make a billion dollars in healthcare by inventing a better Electronic Medical Record (EMR) system. If you’re a rising software engineer looking for a Holy Grail, this is it. Round up … Continue reading HOW TO MAKE A BILLION DOLLARS IN HEALTHCARE→
Cannabinoid Hyperemesis Syndrome (CHS) presents as a triad of chronic cannabis use, cyclic episodes of nausea and vomiting, and frequent hot bathing. If the patient withholds the history of chronic cannabis use, it’s difficult to impossible to make the correct diagnosis.
The JAMA Pediatrics article by Qiu et al showed a 37% increased incidence of autism spectrum disorder (ASD) in children whose mothers received epidural anesthesia during labor. The article drew scant publicity.
The COVID-19 pandemic rears its head, and you can’t speak out regarding appropriate public health measures without crossing your President. Such is the plight of Dr. Jerome Adams, the 20th Surgeon General of the United States, stuck between supporting medical science or avoiding conflict the President he works for.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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The United States is in the midst of an opioid epidemic. The crisis consists of two separate threats. One is the increased presence of powerful illicit street drugs such as fentanyl. The second threat is the increasing use of oral prescription painkillers like Oxycontin, Percocet, and Vicodin. This column addresses fentanyl—its medical aspects and the … Continue reading FENTANYL AND THE OPIOID CRISIS: AN ANESTHESIOLOGIST’S PERSPECTIVE→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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New anesthesiology graduates know a great deal, and yet still have a lot to learn. What do you need to know before you start your first job following anesthesia residency? You already know the basic science facts, and you’ve done three years of cases with a faculty member next to your right elbow at every … Continue reading NEW ANESTHESIOLOGY GRADUATES NEED TO KNOW _______.→
The hospital’s Quality Assurance (QA) program, also known as a Quality Improvement (QI) program, is charged with investigating this adverse event. The analysis of complications is one of the most interesting aspects of medicine. Every complication has an opening event, a story line, and a conclusion.
Every anesthesia provider must learn to free-solo early in his or her career. The 2018 movie Free Solo showcases Alex Honnold as he became the first person to free solo climb the 3000-feet high El Capitan wall of granite in Yosemite National Park without ropes or safety gear
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Anoxic brain injury. These three words make any anesthesiologist cringe. In layman’s terms, anoxic brain injury, or anoxic encephalopathy, means “the brain is deprived of oxygen.” In an anesthetic disaster the brain can be deprived of oxygen. Without oxygen, brain cells die, and once they die they do not regenerate. If something dire goes wrong … Continue reading FIVE MINUTES . . . TO AVOID ANOXIC BRAIN INJURY→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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I’m forwarding these excellent notes from the University of California San Francisco (UCSF) Medical Center on COVID-19. The most sobering data: 40-70% of the US population will be infected over the next 12-18 months. After that level you can start to get herd immunity. Unlike flu this is entirely novel to humans, so there is … Continue reading INFORMATION FROM THE BIOHUB PANEL on COVID-19, UCSF→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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What do the electric chair and anesthesiology have in common? The pertinent Venn diagram includes capital punishment, death by lethal injection, electrocution, and anesthesiology ethics. Anesthesiologists inject intravenous drugs to keep people alive during surgery. No anesthesiologist would be involved in lethal injection procedures or in recommending methods for killing another human being. Lethal injection requires someone … Continue reading THE ELECTRIC CHAIR AND ANESTHESIOLOGY→
Dr. Frédéric Péchier is apparently suspected of injecting lethal doses of potassium chloride or anesthetics into intravenous bags either prior to or during simple surgeries.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Do doctors ever ride in ambulances? Ambulances are a territory usually staffed by Emergency Medical Technician (EMT) personnel, but yes, in certain emergencies doctors do ride in ambulances. In the process of doing 30,000 anesthetics, I’ve taken several rides in the back of an ambulance with my patients. Why? Sixty-six percent of surgeries in the … Continue reading DO DOCTORS EVER RIDE IN AMBULANCES?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Greetings. My name is Dr. Richard Novak, the author of About The Anesthesia Consultant. The Anesthesia Consultant exists to increase your knowledge about anesthesia and the practice of medicine before, during, and after surgery. The Anesthesia Consultant is designed to inform and entertain both laypeople and medical specialists, and provides answers not found in traditional textbooks. I’m a … Continue reading ABOUT THE ANESTHESIA CONSULTANT→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Last week Lawton Burns PhD and Mark Pauly PhD of the Wharton School of Business at the University of Pennsylvania published a landmark economic article entitled, “Detecting BS in Health Care.” Yes, you did not read that wrong—the academic paper used the abbreviation “BS” to describe the bull—- in the healthcare industry. As a … Continue reading DOCTOR VITA AND THE BS IN HEALTHCARE→
Data exists that intravenous caffeine may be effective in assisting the awakening of patients following general anesthesia. Will future anesthesiologists routinely use caffeine to wake patients after surgery?
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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My name is Dr. Richard Novak, and this website’s mission is to increase your knowledge about anesthesia and the practice of medicine before, during, and after surgery. The Anesthesia Consultant is designed to inform and entertain both laypeople and medical specialists, and provides answers not found in traditional textbooks. I’m a Stanford-trained physician, double-boarded in internal … Continue reading ABOUT THE ANESTHESIA CONSULTANT→
anesthesiologists need to lose their reluctance to cut a surgical airway into a patient’s neck in a “can’t intubate, can’t oxygenate” airway emergency. A surgical airway is an invasive airway via the front of the patient’s neck into their trachea.
Almost every anesthesiologist in America has experience with surgery using the da Vinci robot system. Is robot surgery a miraculous futuristic device that advances surgery to a higher plain? Or is it an expensive gadget for hospitals and surgeons to market and attract potential patients?
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Today theanesthesiaconsultant.com was named the #7 anesthesia blog in the world by Feedspot. I’m grateful to Feedspot for this honor, and to my readers for making this possible. See the link here to view the complete list of the world’s top anesthesia blogs. Theanesthesiaconsultant.com was ranked #7, behind such high-powered professional websites such as Anesthesiology … Continue reading THE #7 ANESTHESIA BLOG IN THE WORLD→
Medicare for All would decimate the specialty of physician anesthesiologists in America. Medicare for All would cause an exodus from the specialty of anesthesiology. The current national Medicare conversion factor for anesthesia is $22.18, or only 29% of the 2018 overall mean commercial conversion factor.
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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How do you imagine the future of medical care? Cherubic young doctors holding your hand as you tell them what ails you? Genetic advances or nanotechnology gobbling up cancerous cells and banishing heart disease? Rick Novak describes a flawed future Eden where the only doctor you’ll ever need is Doctor Vita, the world’s first artificial … Continue reading Coming in 2019, from All Things That Matter Press: DOCTOR VITA, Rick Novak’s second novel→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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8-year-old Matadi Sela Petit, who journeyed from the Democratic Republic of Congo to Los Angeles for surgery, died at Cedars-Sinai Hospital on December 16, 2018, from what has been described as “a rare genetic reaction to the anesthesia.” Matadi was born with a cleft lip and a tumor on the left side of his face/cheek … Continue reading 8-YEAR-OLD CONGOESE BOY DIES FROM ANESTHESIA. WHAT HAPPENED?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Is sublingual sufentanil dangerous? The United States Food and Drug Administration (FDA) voted to approve the narcotic sufentanil for sublingual use in November of 2018. Sublingual sufentanil is 5-10 times more potent than fentanyl, and dissolves under the tongue in seconds. In an era of opioid overdose crisis, we now have a new, even more … Continue reading IS SUBLINGUAL SUFENTANIL DANGEROUS?→
How many anesthesia residents choose further subspecialty fellowship education at the end of their residency, and which subspecialties are those graduates choosing?The grid below, published in the California Society of Anesthesiologists Vital Times 2018, lists the fellowship choices from the last five years of Stanford anesthesia resident graduates:
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Lethal injection using fentanyl occurred for the first time in the death penalty execution of Carey Dean Moore in Nebraska August 14th, 2018. Per CBS News, “The Nebraska drug protocol called for an initial IV dose of diazepam, commonly known as Valium, to render the inmate unconscious, followed by the powerful synthetic opioid fentanyl, then … Continue reading LETHAL EXECUTION USING FENTANYL . . . AN ANESTHESIOLOGIST’S OPINION→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Dr. Richard Novak, an Adjunct Clinical Professor of Anesthesiology at Stanford University Medical Center, is available for anesthesia expert witness consultation. Dr. Novak is a clinician who administers anesthesia and directs perioperative medical care at Stanford University Hospital and multiple outpatient surgery centers in and around Palo Alto, California. Dr. Novak has personally performed more … Continue reading ANESTHESIA EXPERT WITNESS→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Imagine . . . rare unrepaired surgical cases in foreign lands, coupled with surgeons in America who rarely have the opportunity to operate on such cases. A win-win situation would be to fly American medical teams overseas to help these patients. This model for plastic and reconstructive surgery was born at Stanford University Medical Center … Continue reading SURGICAL CASES IN FOREIGN LANDS—INTERPLAST→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Dr. Atul Gawande was named CEO of the new Amazon-Berkshire-JPMorgan Chase healthcare partnership. Dr. Robert Pearl wrote an original article in Forbes (June 25, 2018) titled, “Why Atul Gawande Will Soon Be the Most Feared CEO in Healthcare.” Dr. Gawande is a Professor of Surgery at Harvard/ Brigham and Women’s Hospital, and is the bestselling … Continue reading WILL ATUL GAWANDE CHANGE THE FUTURE FOR ANESTHESIOLOGISTS?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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You’re interested in medicine, but you’re not sure what specialty to pursue. Why become an anesthesiologist? Let Dr. Novak convince you to choose an anesthesiology career. As Dr. Novak states on TheAnesthesiaConsultant.com homepage, “The profession of medicine offers a lifetime of fascination, and no specialty is more fascinating than anesthesiology.” Listen to Dr. … Continue reading WHY BECOME AN ANESTHESIOLOGIST?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Can you perform an emergency surgical cricothyroidotomy? In the dreaded Can’t Intubate, Can’t Oxygenate (CICO) scenario, if your patient has no airway, you must immediately establish a front of neck access (FONA) to save your patient’s life. This week I attended an outstanding Stanford Anesthesia Grand Rounds delivered by Drs. Jeremy Collins, Susan Galgay, and … Continue reading FRONT OF NECK ACCESS→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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For years I’ve extolled the intellectual and emotional virtues of a career in anesthesiology. This week U.S. News and World Report credited anesthesiologist with another honor: the highest paying job in their 2018 Best Paying Jobs survey. Regarding the #1 job, physician anesthesiologist, the article states, “the breadth of the profession has dramatically expanded in … Continue reading PHYSICIAN ANESTHESIOLOGIST LISTED AS THE #1 BEST PAYING JOB BY U.S. NEWS AND WORLD REPORT→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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The year was 1999, the technology stock market was exploding, and businessmen in Silicon Valley were getting richer by the hour. Meanwhile, back at the metaphor, anesthesiologists practiced their essential healing profession, and hoped HMOs and hospital administrators would not decrease their anesthesia quantum wage any further. The cartoon won an Honorable Mention award at … Continue reading CARTOON FROM THE 1999 AMERICAN SOCIETY OF ANESTHESIOLOGISTS ART CONTEST→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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THIS ORIGINAL ANESTHESIA CARTOON WAS PUBLISHED IN THE CALIFORNIA SOCIETY OF ANESTHESIOLOGISTS BULLETIN, VOLUME 52, NUMBER 2, APRIL-JUNE 2003. IS ANESTHESIA AN ART OR A SCIENCE? WAS NIETZSCHE CORRECT THAT ‘WHAT DOES NOT KILL ME MAKES ME STRONGER?” In 2018, anesthesiologists consider surgeons our colleagues, and we seek and expect collegial relationships with them. I’ve … Continue reading CARTOON — IS ANESTHESIA AN ART?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Let’s discuss an elephant in the room of operating room anesthesia–the association between peripheral nerve blocks and nerve injury. The use of peripheral nerve blocks has crescendoed in anesthesia practice, stimulated by the use of ultrasound-guided visualization of nerves. There are growing economic industries in ultrasound machines, ultrasound block needles, and in anesthesia personnel who … Continue reading NERVE BLOCKS AND NERVE INJURY→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Some people have difficulty seeing the outstanding merits of physician anesthesiology. I understand where these opinions come from, but the phenomenon still bothers me. Today I read a thoughtful and well-written essay in Anesthesiology News titled, Anesthesiologists-The Utility Players of the Medical Field written by anesthesiologist David Stinson MD from my native state of Minnesota. His … Continue reading MERITS OF PHYSICIAN ANESTHESIOLOGY→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Point/Counterpoint: How new is modern anesthesia? Are modern anesthesia techniques radically different from the methods of twenty years ago? True or false? POINT: False. Twenty-first century general anesthetics are nearly identical to the anesthetic techniques of the late 1990s. Consider this list of the most commonly administered anesthetic drugs in the United States in … Continue reading HOW NEW IS “MODERN ANESTHESIA?”→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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You’re a board-certified anesthesiologist. You’ve graduated from a residency program in which you learned the nuances of preoperative, intraoperative, and postoperative anesthesia practice. Yet at times, surgeons or patients will ask you to do something counter to your medical judgment. Individuals would never board a Boeing 787 aircraft and tell the pilot what to do, … Continue reading WHEN SURGEONS, OR PATIENTS, TRY TO TELL THE ANESTHESIOLOGIST WHAT TO DO — 14 EXAMPLES→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Is your grandfather too frail for surgery? There are iPad apps to help you answer the question regarding frailty and anesthesia. Webster’s Dictionary defines frailty as “the condition of being weak and delicate.” Frailty is also a medical term with an accepted definition of “a multisystem loss of physiologic reserve that makes a person more vulnerable … Continue reading IS YOUR GRANDFATHER TOO FRAIL FOR ANESTHESIA?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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You’re an anesthesiologist nearing completion of your residency or fellowship. You’ve passed the written exam from the American Board of Anesthesiology, and are preparing for the anesthesia oral board exam. You’ve heard that 20% of examinees fail the oral exam, and you’re worried. What should you do? I’m not an American Board of Anesthesiology (ABA) … Continue reading ADVICE FOR PASSING ANESTHESIA ORAL BOARD EXAMS→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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My greatest joy of being a doctor comes immediately after the conclusion of a pediatric anesthetic. I stay with the child until the anesthetic depth has dissipated, the breathing tube is removed, and the child is awake and safe with the recovery room nurse in the Post Anesthesia Care Unit. At that point I walk … Continue reading THE JOY OF BEING A DOCTOR→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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The most significant anesthesiologist of the 20th century died just weeks ago, on December 21, 2017. His name was William New, MD, PhD. Many of you have never heard of Dr. New, and don’t know what he was famous for, but in my opinion he was the Most Valuable Player of the anesthesia ranks in … Continue reading THE MOST SIGNIFICANT ANESTHESIOLOGIST OF THE 20TH CENTURY→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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What are the risks of pediatric anesthesia? What should you do if your 2-year-old son or daughter requires surgery and anesthesia? Is the anesthetic risky? Should you consent to proceed? Should you wait until he or she is 3 years old? The answer to all these questions is: “It depends.” Let’s look at recommendations as … Continue reading ANESTHETIC RISKS IN CHILDREN→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
Latest posts by the anesthesia consultant (see all)
What are the anesthetic risks for children? What should you do if your 2-year-old son or daughter requires surgery and anesthesia? Should you consent to proceed? Should you wait until he or she is 3 years old? The answer to all these questions is: “It depends.” Let’s look at recommendations as they exist in 2018. … Continue reading ANESTHETIC RISKS IN CHILDREN→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Are surgery centers safe? This column is in response the Kaiser Health News story “How a push to cut costs and boost profits at surgery centers led to a trail of deaths” published on USAToday.com this week. The article set off a firestorm of controversy in the surgery center industry. The Kaiser article cites anecdotal … Continue reading ARE SURGERY CENTERS SAFE?→
Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. email rjnov@yahoo.com phone 650-465-5997
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Let’s look at a case study which highlights a specific risk of general anesthesia at a freestanding surgery center or a surgeon’s office operating room, when the anesthesiologist departs soon after the case is finished. The patient is a 66-year-old woman admitted for a facelift, neck lift, and blepharoplasties. The surgery is scheduled for 8 … Continue reading CODE BLUE – WHEN AN ANESTHESIOLOGIST PREMATURELY DEPARTS A FREESTANDING SURGERY CENTER→
