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WHAT HAPPENS TO ANESTHESIOLOGISTS WHEN THEIR HOSPITAL CLOSES?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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America’s hospitals are in fiscal chaos. Anesthesiologists work in hospitals, and when a hospital closes, anesthesiologists lose their jobs. Sixty-seven percent of U.S. Hospitals are losing money, particularly when it comes to the treatment of Medicaid/Medicare patients.1  According to a recent study published in the journal Health Affairs, 55% of hospitals lost money on each patient they … Continue reading WHAT HAPPENS TO ANESTHESIOLOGISTS WHEN THEIR HOSPITAL CLOSES? →

THE MINI-COG: COGNITIVE IMPAIRMENT AND SURGICAL OUTCOME

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 Mini-Cog? Most anesthesia professionals have never heard of the Mini-Cog test, but recent evidence shows it can provide important prognostic information on our geriatric patients prior to surgery.     The Mini-Cog™ (© S. Borson, All rights reserved) is a 3-minute screening test for cognitive impairment. The test consists of three steps: … Continue reading THE MINI-COG: COGNITIVE IMPAIRMENT AND SURGICAL OUTCOME →

DROPPING SUBSPECIALTY ANESTHESIA SKILLS . . . LOSING YOUR RELIGION

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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In anesthesiology residency training we learn to perform every kind of anesthetic—cardiac, trauma, brain surgery, transplant surgery, abdominal surgery, chest surgery—on every type of patient—newborns, one-hundred-year-olds, or pregnant women. We learn those skills, and then we pass the American Board of Anesthesia written and oral exams on these skills. Then for the rest of our … Continue reading DROPPING SUBSPECIALTY ANESTHESIA SKILLS . . . LOSING YOUR RELIGION →

FRAILTY IN ANESTHESIA

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Recognizing frailty in anesthesia patients is critical. What if your patients, especially elderly patients, could enter their personal data and symptoms into an iPad app, and what if that information could help you determine if their risk for anesthesia was too great to risk having surgery? Can you imagine this? It will happen someday soon. … Continue reading FRAILTY IN ANESTHESIA →

THE CHILD WITH AN OPEN EYE INJURY AND A FULL STOMACH

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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A 3-year-old boy is eating a McDonalds Happy Meal on the lawn of the restaurant. A lawn mower approaches, and a rock is ejected from the mower, hitting the child in the eye. The boy suffers a penetrating open eye injury, and is taken to the nearest hospital. You are on call for the repair. … Continue reading THE CHILD WITH AN OPEN EYE INJURY AND A FULL STOMACH →

THEANESTHESIACONSULTANT HITS ONE MILLION VIEWS – MARCH 2, 2017

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 want to thank my readers, as theanesthesiaconsult.com reached 1,000,000 views this week. The website was born in 2010 when I posted multiple columns I originally wrote for the Stanford Anesthesia Department publication The Gas Pipeline. Over the following months I added a series of columns aimed at laypeople, answering frequently asked questions about anesthesia. … Continue reading THEANESTHESIACONSULTANT HITS ONE MILLION VIEWS – MARCH 2, 2017 →

THE ART OF ANESTHESIA—A NEW TEXTBOOK, HIGHLY RECOMMENDED

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 if Yoda and Obi-Wan Kenobi wrote a book called, “The Art of Jedi Practice.” In the anesthesia world that book is now available, and it’s called Practical Anesthetic Management—The Art of Anesthesiology,  authored by C. Philip Larson and Richard Jaffe. Drs. Larson and Jaffe are both professors who taught me in the Stanford University … Continue reading THE ART OF ANESTHESIA—A NEW TEXTBOOK, HIGHLY RECOMMENDED →

ANESTHESIOLOGISTS: BEFORE YOU ADVANCE THAT NEEDLE . . . A CAUTIONARY TALE

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Clinical Case for Discussion regarding postoperative anticoagulation: You’re scheduled to anesthetize a 58-year-old, 80 kg male for a left total knee replacement. You utilize the current multimodal strategies for operating room anesthesia and postoperative pain reduction, including an ultrasound-guided adductor canal block with 0.5% ropivicaine, a spinal anesthetic (using a pencil-tipped 25-gauge Quincke needle) of 1.5 … Continue reading ANESTHESIOLOGISTS: BEFORE YOU ADVANCE THAT NEEDLE . . . A CAUTIONARY TALE →

PREANESTHESIA CLEARANCE: TWO QUESTIONS FOR PRIMARY CARE DOCTORS

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Many patients require preoperative clearance prior to surgery, especially patients with significant medical problems or at extremes of age. Preanesthesia evaluation reduces surgical and medical complications. What two questions for primary care doctors summarize the desired important information in preoperative surgical clearance? Some health care systems run preoperative anesthesia clinics, where anesthesia professionals evaluate these … Continue reading PREANESTHESIA CLEARANCE: TWO QUESTIONS FOR PRIMARY CARE DOCTORS →

11 THINGS YOU CAN DO TO MAKE YOUR ANESTHETIC SAFER

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 can you do to make your anesthetic safer? This is what the anesthesia experience is like for most patients: You show up for surgery, and some anesthesia professional you’ve never met or talked to appears 10 minutes before you are to be wheeled into the operating room. The anesthesia professional might be an … Continue reading 11 THINGS YOU CAN DO TO MAKE YOUR ANESTHETIC SAFER →

IS PRIVATE PRACTICE ANESTHESIA DOOMED?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 the future of private practice anesthesiology? First off, let’s define “private practice.” The Merriam-Webster online dictionary defines private practice as: “a professional business (such as that of a lawyer or doctor) that is not controlled or paid for by the government or a larger company (such as a hospital).” In my community the … Continue reading IS PRIVATE PRACTICE ANESTHESIA DOOMED? →

DENTAL ANESTHESIA DEATHS . . . GENERAL ANESTHESIA FOR PEDIATRIC PATIENTS IN DENTAL OFFICES

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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GENERAL ANESTHESIA FOR DENTAL OFFICES CASE PRESENTATION: A 5-year-old developmentally delayed autistic boy has multiple dental cavities. The dentist consults you, a physician anesthesiologist, to do sedation or anesthesia for dental restoration. What do you do? DISCUSSION:  Children periodically die in dental offices due to complications of general anesthesia or intravenous sedation. Links to recent … Continue reading DENTAL ANESTHESIA DEATHS . . . GENERAL ANESTHESIA FOR PEDIATRIC PATIENTS IN DENTAL OFFICES →

ADVICE FOR LAYPEOPLE: HOW TO MAKE YOUR ANESTHETIC SAFER

the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Patients, what can you do to assure you have safe anesthesia care? This is what the anesthesia experience is like for most patients: You show up for surgery, and some anesthesia professional you’ve never met or talked to appears 10 minutes before you are to be wheeled into the operating room. The anesthesia professional might … Continue reading ADVICE FOR LAYPEOPLE: HOW TO MAKE YOUR ANESTHETIC SAFER →

ARTIFICIAL INTELLIGENCE IN MEDICINE

the anesthesia consultant 4 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 fascinated by the topic of artificial intelligence in medicine. This is the third column in a series regarding robots in medicine. (See Robot Anesthesia and Robot Anesthesia II) AI already influences our daily life. Smartphones verbally direct us to our destination through mazes of highways and traffic. Computers analyze our shopping habits and populate our … Continue reading ARTIFICIAL INTELLIGENCE IN MEDICINE →

THE ANESTHESIOLOGIST AND THE NFL

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 National Football League (NFL) of American football is a multibillion-dollar industry which dominates the sports airwaves and press headlines from the first preseason game each August until the Super Bowl each February. Do you know the intersection between an anesthesiologist and the NFL? At each and every NFL game there must be … Continue reading THE ANESTHESIOLOGIST AND THE NFL →

LESSONS LEARNED REGARDING SUGAMMADEX

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Regarding sugammadex and residual neuromuscular blockade: I’m aware of two cases of residual neuromuscular blockade which occurred during the past year. Both cases involved obese patients who required emergency reintubation. Both cases were near misses for brain death. Both of these near misses would never have occurred if sugammadex had been used. The first case … Continue reading LESSONS LEARNED REGARDING SUGAMMADEX →

THE MOST IMPORTANT TECHNICAL SKILL FOR AN ANESTHESIOLOGIST?

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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’s the most critical technical skill for an anesthesiologist? I ask this question when I’m teaching anesthesia residents and medical students. Their most frequent answer is . . . the ability to place an endotracheal tube. This is the wrong answer. The most critical technical skill for an anesthesiologist is . . . facemask ventilation. Why? … Continue reading THE MOST IMPORTANT TECHNICAL SKILL FOR AN ANESTHESIOLOGIST? →

12 THINGS TO KNOW AS YOU NEAR THE END OF YOUR ANESTHESIA TRAINING

the anesthesia consultant 47 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 difficult challenge for any anesthesiologist is the transition from the end of anesthesia residency into the beginning of your first job. You’re on your at the hospital, sometimes on weekend nights, and sometimes at 3 a.m. In “Subterranean Homesick Blues” Bob Dylan wrote, Twenty years of schoolin’ and they put you on the … Continue reading 12 THINGS TO KNOW AS YOU NEAR THE END OF YOUR ANESTHESIA TRAINING →

ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: WHAT IS MALIGNANT HYPERTHERMIA?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 Malignant Hyperthermia? Patients frequently have concerns and misunderstandings.  Patients wonder what the disease is, if it could possibly strike them during anesthesia, and how the disease would be treated. The word “malignant” in Malignant Hyperthermia has nothing to do with malignancy or cancer. Hyperthermia is the medical term for high temperature, and Malignant … Continue reading ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: WHAT IS MALIGNANT HYPERTHERMIA? →

WAS JUSTICE ANTONIN SCALIA’S DEATH FROM OBSTRUCTIVE SLEEP APNEA?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Justice Antonin Scalia’s death was unexpected. I’ve never examined Justice Scalia, never had access to his medical records, and have no information other than what has been published over the Internet regarding the events of the last 24 hours of his life. According to published news reports, APNewsBreak: Justice Scalia Suffered From Many Health Problems, … Continue reading WAS JUSTICE ANTONIN SCALIA’S DEATH FROM OBSTRUCTIVE SLEEP APNEA? →

HOW DO ANESTHETICS WORK?

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 commonly hear two questions from my patients: “How does anesthesia work?” and “How do the anesthetic drugs make me fall asleep?” The short answer to both questions is, “We’re not sure.” This column is designed as a brief tutorial for non-anesthesiologists who wish to better comprehend how anesthetic drugs work. General anesthesia is the … Continue reading HOW DO ANESTHETICS WORK? →

12 TIPS ON BECOMING AN OUTSTANDING ANESTHESIOLOGIST

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 qualities define an outstanding anesthesiologist? The bell-shaped normal curve describes the random distribution of many things. A bell-shaped curve exists for the abilities of anesthesia doctors as well.     I’ve been practicing anesthesia since the mid 1980s. I’ve met and worked alongside hundreds of anesthesia colleagues from all corners of the globe. Some were … Continue reading 12 TIPS ON BECOMING AN OUTSTANDING ANESTHESIOLOGIST →

11 MEDICAL INACCURACIES IN FAMOUS MOVIE SCENES . . . AN ANESTHESIOLOGIST’S ANALYSIS

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 love the movies, but it can be painful to watch scenes where the facts are distorted, sometimes so much that the storyline is implausible. Let’s take a look at medical inaccuracies in movie scenes from 11 famous Hollywood films: Million Dollar Baby (2004). This film is my Hollywood medical pet peeve, and the movie … Continue reading 11 MEDICAL INACCURACIES IN FAMOUS MOVIE SCENES . . . AN ANESTHESIOLOGIST’S ANALYSIS →

SMOOTH EMERGENCE FROM GENERAL ANESTHESIA

the anesthesia consultant 6 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Anesthesiologists prefer their patients to have a gentle transition from the anesthetized state into the awake state. The desired goal is “smooth emergence.” When the general anesthetic requires an endotracheal tube, an issue is how to awaken the patient with minimal patient coughing and bucking while the tube remains in the trachea. Coughing and bucking … Continue reading SMOOTH EMERGENCE FROM GENERAL ANESTHESIA →

13 MAJOR CHANGES IN ANESTHESIOLOGY IN THE LAST TEN YEARS

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 13 major changes in the last ten years of anesthesiology, and give a letter grade to mark the significance of each advance:   SUGAMMADEX – The long awaited reversal agent for neuromuscular paralysis reached the market in 2016, and by my review, the drug is wonderful. I’ve found sugammadex to reverse rocuronium … Continue reading 13 MAJOR CHANGES IN ANESTHESIOLOGY IN THE LAST TEN YEARS →

AN ANESTHESIOLOGIST’S INCOME

the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 much money does an anesthesiologist make? Let me begin by offering two anecdotes: I was an invited visiting anesthesia professor at a major university this year, and following one of my lectures an anesthesiology resident approached me for a discussion. During our conversation he revealed that his student loan debt was $300,000. In 2014 … Continue reading AN ANESTHESIOLOGIST’S INCOME →

AN ANESTHESIOLOGIST’S SALARY

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 much money does an anesthesiologist earn? What is a physician anesthesiologist’s salary in today’s marketplace? Let me begin by offering two anecdotes: I was an invited visiting anesthesia professor at a major university this year, and following one of my lectures an anesthesiology resident approached me for a discussion. During our conversation he revealed … Continue reading AN ANESTHESIOLOGIST’S SALARY →

DOES GENERAL ANESTHESIA CAUSE DEMENTIA?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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  Does exposure to general anesthesia cause dementia? In a word, “No.” A landmark study published in Anesthesiology Dokkedal U et al, Cognitive Functioning after Surgery in Middle-aged and Elderly Danish Twins. Anesthesiology. 2016 Feb;124(2):312-21  answers this question. Dokkedal studied 8,503 middle-aged and elderly Danish twins. Results from cognitive tests were compared in twins in which … Continue reading DOES GENERAL ANESTHESIA CAUSE DEMENTIA? →

THE PERILS OF INTERNET MEDICINE

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 printing press was the most influential invention of the last millennium. Now individuals use computers to search for Internet medical knowledge. THE PRINTING PRESS AND THE REFORMATION . . . , THE INTERNET AND MEDICAL KNOWLEDGE The book 1000 years, 1000 People by Agnes and Henry Gottlieb identifies Johannes Gutenberg as the most influential … Continue reading THE PERILS OF INTERNET MEDICINE →

TRENDS FOR THE FUTURE OF ANESTHESIOLOGY

the anesthesia consultant 20 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 can we expect in the next 10 years of anesthesiology? What will be the trends for the future of anesthesiology? I’m writing this in January 2016. God willing, we’ll all be alive and well to reread this in 2026, and find out how many of these predictions about the future of anesthesiology came true. … Continue reading TRENDS FOR THE FUTURE OF ANESTHESIOLOGY →

LARGE-VOLUME LIPOSUCTION: IS IT SAFE?

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 work in a private practice setting in Palo Alto, California, and liposuction is one of the most common plastic surgery procedures performed. The accepted definition of a large-volume liposuction is a total aspirate of greater than 4 liters. Seventy percent of the total aspirate is fat, so if a total volume of 4 liters … Continue reading LARGE-VOLUME LIPOSUCTION: IS IT SAFE? →

ANESTHESIA ERRORS: MALPRACTICE OR NOT?

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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If a patient suffers a bad outcome after anesthesia, did the anesthesiologist commit malpractice? If there was an anesthesia error, was it anesthesia malpractice? Not necessarily. There are risks to every anesthetic and every surgery, and if a patient sustains a complication, it may or may not be secondary to substandard anesthesia care. Let’s look … Continue reading ANESTHESIA ERRORS: MALPRACTICE OR NOT? →

ANESTHESIA EMERGENCY GUIDEBOOK

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 anesthesia emergency occurs without warning. Your patient’s vital signs are dropping. As the anesthesiologist, it’s your job to make the correct diagnosis and act promptly to save your patient. You need the ultimate anesthesia emergency guidebook. That ultimate guidebook is the Stanford Emergency Manual of Cognitive Aids for Perioperative Critical EventsS, written by the … Continue reading ANESTHESIA EMERGENCY GUIDEBOOK →

ZDoggMD MUSIC VIDEO TRASHES ELECTRONIC MEDICAL RECORDS

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 not a fan of the current state of Electronic Health Records (EHR), also known as Electronic Medical Records (EMR). Particularly in acute care, the computer keyboard and screen have no place between an anesthesiologist and his patient, an emergency room physician and his patient, an ICU doctor and his patient, or an ICU nurse … Continue reading ZDoggMD MUSIC VIDEO TRASHES ELECTRONIC MEDICAL RECORDS →

WOULD YOU GIVE AN NFL QUARTERBACK A PERIPHERAL NERVE BLOCK?

the anesthesia consultant 4 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 scheduled to anesthetize an NFL quarterback for a shoulder arthroscopy and rotator cuff repair. The patient earns $20 million dollars per year for throwing footballs. Would you feel comfortable inserting a needle into his neck to do a regional anesthetic? Would you feel comfortable doing an interscalene block on an NFL quarterback as part … Continue reading WOULD YOU GIVE AN NFL QUARTERBACK A PERIPHERAL NERVE BLOCK? →

AN ANESTHESIA PATIENT QUESTION: “WHY DID IT TAKE ME SO LONG TO WAKE UP AFTER ANESTHESIA?”

the anesthesia consultant 66 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Patients sometimes say, “Why did it take me so long to wake up after anesthesia?” when they discussed their previous anesthetic history. They are fearful that something is wrong with them, and they will always have delayed awakenings.   Certain patients have consistent bad experiences from a past general anesthetic. A previous anesthetic left them somnolent … Continue reading AN ANESTHESIA PATIENT QUESTION: “WHY DID IT TAKE ME SO LONG TO WAKE UP AFTER ANESTHESIA?” →

ARE OLDER ANESTHESIOLOGISTS LESS SAFE? 

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 you want an older anesthesiologist only months from retirement? Do you want a young and inexperienced anesthesiologist? Is there any data to help answer these questions? You’re boarding a commercial aircraft. It’s raining hard outside, and visibility is limited. You catch a glimpse of the pilots in the cockpit. To your relief, both of them … Continue reading ARE OLDER ANESTHESIOLOGISTS LESS SAFE?  →

HOW COMMON ARE CARDIAC ARRESTS DURING SURGERY AND ANESTHESIA?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 common are cardiac arrests during surgery? Uncommon, but the incidence is not zero and the outcome is usually dire. In 2004 the Japanese Society of Anesthesiologists reported 2,443 cardiac arrests (6.34 per 10,000 anesthetics) and 2,638 deaths (6.85 per 10,000 anesthetics) among 3,855,384 anesthetics. The majority of deaths were due to preoperative health complications … Continue reading HOW COMMON ARE CARDIAC ARRESTS DURING SURGERY AND ANESTHESIA? →

ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: WHY DO I HAVE TO STOP EATING AND DRINKING AT MIDNIGHT BEFORE SURGERY?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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“Why do I have to stop eating and drinking prior to surgery?” This is a common question I hear from my patients—they’re puzzled by the connection between going to sleep and stopping eating prior to surgery.   It’s vital that your stomach is empty prior to elective surgery and anesthesia. Once you’re anesthetized, your cough … Continue reading ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: WHY DO I HAVE TO STOP EATING AND DRINKING AT MIDNIGHT BEFORE SURGERY? →

AVOIDING AIRWAY LAWSUITS

the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Every anesthesiologist wants to avoid a bad outcome for his or her patients, and every anesthesiologist wants to avoid a malpractice lawsuit. At weddings you’ll often hear a Bible verse that reads, “And now these three remain: faith, hope and love. But the greatest of these is love.” (1 Corinthians 13:13) A parallel verse in the … Continue reading AVOIDING AIRWAY LAWSUITS →

ON BECOMING AN ANESTHESIOLOGIST… WHAT PERSONAL CHARACTERISTICS ARE ESSENTIAL TO BECOME A SUCCESSFUL ANESTHESIOLOGIST?

the anesthesia consultant 44 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 personal characteristics of a successful anesthesiologist? You’ve found The Anesthesia Consultant website, so you have some interest in anesthesia. Perhaps you’ve heard that anesthesiologists earn a comfortable living. Per wikiprofessionals.org: “According to figures from the U.S. Department of Labor, the lowest 10% of anesthesiologists earn under $135,110 per year, whereas the top … Continue reading ON BECOMING AN ANESTHESIOLOGIST… WHAT PERSONAL CHARACTERISTICS ARE ESSENTIAL TO BECOME A SUCCESSFUL ANESTHESIOLOGIST? →

IS ANESTHESIA AN ART OR A SCIENCE?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 the practice of anesthesia an art or a science? Is the practice of medicine an art or a science?Over one hundred years ago the father of modern medicine, Dr. William Osler of Johns Hopkins Medical Center, made the following statements: “Medicine is a science of uncertainty and an art of probability,” and “The practice … Continue reading IS ANESTHESIA AN ART OR A SCIENCE? →

WHAT IS PUBMED?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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PubMed is most important medical website on the Internet. If you’re a layperson seeking practical and accurate medical knowledge, you need PubMed. If you’re a medical professional seeking state-of-the-art information from the medical literature, you need PubMed. PubMed is most important medical website on the Internet. If you’re a layperson seeking practical and accurate medical … Continue reading WHAT IS PUBMED? →

HOW DO YOU START A PEDIATRIC ANESTHETIC WITHOUT A SECOND ANESTHESIOLOGIST?

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Clinical Case: In your first week in community practice post-residency and fellowship, you’re scheduled to anesthetize a 4-year-old for a tonsillectomy. You’ll start the anesthetic without an attending or a second anesthesiologist. How do you start a pediatric anesthetic alone?   Discussion: During residency it’s standard to initiate pediatric cases with an attending at your … Continue reading HOW DO YOU START A PEDIATRIC ANESTHETIC WITHOUT A SECOND ANESTHESIOLOGIST? →

THE ACHILLES’ HEEL OF ANESTHESIOLOGY… WHAT IS THE GREATEST THREAT TO OUR SPECIALTY?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Anesthesiology is a wonderful profession, as I have described in many previous posts on theanesthesiaconsultant.com. But nothing is perfect, and anesthesia has one threat which could in time undermine the entire specialty. What is this threat? What is anesthesiology’s Achilles’ heel? No, it’s not the nurse anesthetists, nor the stress of covering surgeries in the … Continue reading THE ACHILLES’ HEEL OF ANESTHESIOLOGY… WHAT IS THE GREATEST THREAT TO OUR SPECIALTY? →

WILL YOU HAVE A BREATHING TUBE DOWN YOUR THROAT DURING YOUR SURGERY?

the anesthesia consultant 45 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 the most common questions I hear from patients immediately prior to their surgical anesthetic is, “Will I have a breathing tube down my throat during anesthesia?” The answer is: “It depends.” Let’s answer this question for some common surgeries: KNEE ARTHROSCOPY: Common knee arthroscopy procedures are meniscectomies and anterior cruciate ligament reconstructions. Anesthetic … Continue reading WILL YOU HAVE A BREATHING TUBE DOWN YOUR THROAT DURING YOUR SURGERY? →

CALIFORNIA SOCIETY OF ANESTHESIOLOGISTS ONLINE FIRST: BOOK REVIEW OF THE DOCTOR AND MR. DYLAN AND INTERVIEW WITH THE AUTHOR

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 post is a link to an article originally published in the California Society of Anesthesiologists Online First Blog, Authored by Dr. Michael Champeau (current Treasurer of the American Society of Anesthesiologists, as of October 2017): Book Review of THE DOCTOR AND MR. DYLAN Mar 02, 2015 by Michael Champeau, M.D. tags: book review, Rick … Continue reading CALIFORNIA SOCIETY OF ANESTHESIOLOGISTS ONLINE FIRST: BOOK REVIEW OF THE DOCTOR AND MR. DYLAN AND INTERVIEW WITH THE AUTHOR →

INEXPERIENCED DOCTORS, OVERCONFIDENT DOCTORS, AND YOU

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 JULY EFFECT AND THE NOVEMBER EFFECT: In American teaching hospitals, newly minted doctors begin internships each July. The term “July Effect” was coined to describe this shift change in academic hospitals each July, when the arrival of inexperienced doctors may increase the risks of medical care. In the United Kingdom, newly minted doctors begin their … Continue reading INEXPERIENCED DOCTORS, OVERCONFIDENT DOCTORS, AND YOU →

AIRWAY LAWSUITS

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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At weddings you’ll often hear a Bible verse that reads, “And now these three remain: faith, hope and love. But the greatest of these is love.” (1 Corinthians 13:13) A parallel verse in the bible of acute care medicine would read, “Emergencies are managed by airway, breathing, and circulation. But the greatest of these is … Continue reading AIRWAY LAWSUITS →

ROBOT ANESTHESIA II

the anesthesia consultant 3 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 anesthesiologists on the verge of being replaced by a new robot? In a word, “No.” The new device being discussed is the iControl-RP anesthesia robot. THE iCONTROL-RP ANESTHESIA ROBOT On May 15, 2015, the Washington Post published a story titled, “We Are Convinced the Machine Can Do Better Than Human Anesthesiologists.” In recent years … Continue reading ROBOT ANESTHESIA II →

BLOOD PRESSURE DROPS TO 85/45 FOLLOWING THE INDUCTION OF ANESTHESIA: WHAT DO YOU DO?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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CLINICAL CASE: You’re scheduled to anesthetize a healthy 55-year-old female for an appendectomy. Her blood pressure is 150/90 on admission. In the operating room, you induce anesthesia with your standard recipe of 2 mg of midazolam, 100 mcg of fentanyl, 200 mg of propofol, and 40 mg of rocuronium, and intubate the trachea. Five minutes … Continue reading BLOOD PRESSURE DROPS TO 85/45 FOLLOWING THE INDUCTION OF ANESTHESIA: WHAT DO YOU DO? →

HOW TO PREPARE TO SAFELY INDUCE GENERAL ANESTHESIA IN TWO MINUTES

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 prepare to induce general anesthesia in two minutes? You’re called to induce anesthesia for a patient being rushed to the operating room for emergency surgery. You arrive at the operating room only minutes before the patient is scheduled to arrive. I recommend you use the mnemonic M-A-I-D-S as a checklist to prepare … Continue reading HOW TO PREPARE TO SAFELY INDUCE GENERAL ANESTHESIA IN TWO MINUTES →

IS ANESTHESIA A CUSHY SPECIALTY?

the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Samuel Shem’s classic novel/satire of medicine, The House of God (published in 1978, more than two million copies sold), follows protagonist Dr. Roy Basch as he struggles through his year as an internal medicine intern. A second physician recommends Basch switch careers to one of six no-patient-contact specialties: Rays, Gas, Path, Derm, Eyes, or Psych. … Continue reading IS ANESTHESIA A CUSHY SPECIALTY? →

IS ANESTHESIA A CUSHY SPECIALTY?

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 anesthesia worthy of the House of God‘s assessment that it’s a cushy medical specialty? My answer, after thirty years of anesthesia practice, is … it depends. Samuel Shem’s classic novel/satire of medicine, The House of God (published in 1978, more than two million copies sold), follows protagonist Dr. Roy Basch as he struggles through … Continue reading IS ANESTHESIA A CUSHY SPECIALTY? →

THE TOP 10 MOST STRESSFUL JOBS IN AMERICA versus THE TOP 10 MOST STRESSFUL SITUATIONS IN ANESTHESIOLOGY PRACTICE

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Anesthesia has been described as 99% boredom and 1% panic. Is anesthesiology one of America’s most stressful jobs? Not according to prominent Internet media sources. Careercast.com listed the Top 10 Most Stressful Jobs in America in 2015, and those jobs were: Firefighter Enlisted Military Personnel Military General Airline Pilot Police Officer Actor Broadcaster Event Coordinator … Continue reading THE TOP 10 MOST STRESSFUL JOBS IN AMERICA versus THE TOP 10 MOST STRESSFUL SITUATIONS IN ANESTHESIOLOGY PRACTICE →

HOW LONG WILL IT TAKE ME TO WAKE UP FROM GENERAL ANESTHESIA?

the anesthesia consultant 128 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 the most frequent questions I hear from patients before surgery is, “How long will it take me to wake up from general anesthesia?”   The answer is, “It depends.” Your wake up from general anesthesia depends on: What drugs the anesthesia provider uses How long your surgery lasts How healthy, how old, and … Continue reading HOW LONG WILL IT TAKE ME TO WAKE UP FROM GENERAL ANESTHESIA? →

ADVICE FOR PASSING THE ORAL BOARD EXAMS IN ANESTHESIOLOGY

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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As a faculty member on the Stanford Department of Anesthesiology, Perioperative and Pain Medicine, I enjoy the opportunity to give mock oral exams to the Stanford residents. First-year residents struggle mightily, while third-year residents are experienced and savvy. Taking six mock oral exams during a three-year anesthesia residency is valuable preparation for the real American … Continue reading ADVICE FOR PASSING THE ORAL BOARD EXAMS IN ANESTHESIOLOGY →

WHAT ONE QUESTION SHOULD YOU ASK TO DETERMINE IF A PATIENT IS ACUTELY ILL?

the anesthesia consultant 3 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 one question should you ask to determine whether a patient has a serious medical problem? What one question must you ask to determine whether urgent intervention is required? Imagine this scenario: You’re an anesthesiologist giving anesthesia care in the operating room to your second patient of the day. The Post Anesthesia Care Unit (PACU) … Continue reading WHAT ONE QUESTION SHOULD YOU ASK TO DETERMINE IF A PATIENT IS ACUTELY ILL? →

TEN REASONS NURSE ANESTHETISTS (CRNAs) WILL BE A MAJOR FACTOR IN ANESTHESIA CARE IN THE 21ST CENTURY

the anesthesia consultant 5 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

  My debut novel, The Doctor and Mr. Dylan features a nurse anesthetist in the starring role of Mr. Dylan. Nurse anesthetists have provided anesthesia care in the United States for nearly 150 years, and CRNs will be a major factor in the future. In the beginning, anesthesia care for surgical patients was often provided … Continue reading TEN REASONS NURSE ANESTHETISTS (CRNAs) WILL BE A MAJOR FACTOR IN ANESTHESIA CARE IN THE 21ST CENTURY →

THE EBOLA VIRUS, ANESTHESIA, AND SURGERY

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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A patient infected with the Ebola virus is admitted to your hospital’s intensive care unit. You are called to intubate the Ebola patient for respiratory failure. What do you do? Discussion: The first patients infected with Ebola virus entered the United States in 2014. American physicians are inexperienced with caring for patients with this disease. … Continue reading THE EBOLA VIRUS, ANESTHESIA, AND SURGERY →

THE PERIOPERATIVE SURGICAL HOME HAS EXISTED FOR YEARS

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 American Society of Anesthesiologists is supporting an expansion of the role of anesthesiologists in the delivery of perioperative care in hospitals. This proposed model is called the Perioperative Surgical Home. The American Society of Anesthesiologists defines the Perioperative Surgical Home as “a patient centered, innovative model of delivering health care during the entire patient … Continue reading THE PERIOPERATIVE SURGICAL HOME HAS EXISTED FOR YEARS →

DO YOU NEED AN ANESTHESIOLOGIST FOR ENDOSCOPY OF YOUR ESOPHAGUS, STOMACH, AND UPPER GASTROENTEROLOGIC TRACT?

the anesthesia consultant 9 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 you need an anesthesiologist for upper gastrointestinal endoscopy? In the aftermath of Joan Rivers’ tragic death following an upper endoscopy procedure at a New York outpatient surgery center, every news bureau is discussing this topic. Because I have no inside information on Joan Rivers’ medical care during her procedure, I will not judge her … Continue reading DO YOU NEED AN ANESTHESIOLOGIST FOR ENDOSCOPY OF YOUR ESOPHAGUS, STOMACH, AND UPPER GASTROENTEROLOGIC TRACT? →

THE DOCTOR AND MR. DYLAN HITS #1 BESTSELLING ANESTHESIA BOOK IN THE WORLD AT AMAZON.COM

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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On October 2, 2014, my debut novel The Doctor and Mr. Dylan was the number one bestselling Anesthesiology book in the world on Amazon.com Kindle. Click on this image of the book to reach the Amazon webpage:       REVIEWS: 5.0 out of 5 stars The Doctor and Mr Dylan, March 3, 2015 By prabha … Continue reading THE DOCTOR AND MR. DYLAN HITS #1 BESTSELLING ANESTHESIA BOOK IN THE WORLD AT AMAZON.COM →

SHOULD PHYSICIANS BE TESTED FOR DRUGS AND ALCOHOL?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 60-year-old man has a heart attack in the middle of an emergency abdominal surgery at 11:00 pm and dies two hours later. Should the anesthesiologist submit to a drug test to seek out alcohol or drug ingestion that could have made her performance impaired? Discussion: In the 2012 movie Flight, Denzel Washington stars as … Continue reading SHOULD PHYSICIANS BE TESTED FOR DRUGS AND ALCOHOL? →

SUCCINYLCHOLINE: VITAL DRUG OR OBSOLETE DINOSAUR?

the anesthesia consultant 6 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Succinylcholine: vital drug or dinosaur? Succinylcholine (sux) has the wonderful advantage of rendering a patient paralyzed in less than a minute, and the discouraging disadvantage of a long list of side effects that make the drug problematic. I would never begin an anesthetic without succinylcholine being immediately available. No other muscle relaxant supplies as rapid … Continue reading SUCCINYLCHOLINE: VITAL DRUG OR OBSOLETE DINOSAUR? →

HERBAL MEDICINES, SURGERY, AND ANESTHESIA

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 otherwise healthy 50-year-old female patient takes three herb pills daily: gingko, kava, and ginseng. What do you do when this patient needs elective surgery for an ACL reconstruction two days from now? Do you cancel surgery and stop the herbal medicines, or should you proceed? My goal is to give you practical advice on … Continue reading HERBAL MEDICINES, SURGERY, AND ANESTHESIA →

AVOIDING AIRWAY DISASTERS IN ANESTHESIA

the anesthesia consultant 8 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Every anesthesia practitioner dreads airway disasters.  Anesthesiologists and nurse anesthetists are airway experts, but anesthesia professionals are often the only person in the operating room capable of keeping a patient alive if the patient’s airway is occluded or lost. Hypoxia from an airway disaster can lead to brain damage within minutes, so there is little … Continue reading AVOIDING AIRWAY DISASTERS IN ANESTHESIA →

HOW DOES A HEROIN OVERDOSE KILL? AN ANESTHESIOLOGIST’S VIEW

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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On February 2, 2014, Academy Award-winning actor Phillip Seymour Hoffmann was found dead with a needle in his arm and syringes and packets of heroin in his room. How does a heroin overdose kill a person? Anesthesiologists are uniquely qualified to answer this question. Anesthesiologists administer intravenous narcotics every day, because narcotics are important pain-relieving … Continue reading HOW DOES A HEROIN OVERDOSE KILL? AN ANESTHESIOLOGIST’S VIEW →

APRIL 2014 LETHAL INJECTION IN OKLAHOMA – AN ANESTHESIOLOGIST’S VIEW

the anesthesia consultant 5 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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On April 29, 2014 CNN reported the story of the botched intravenous lethal injection execution of convicted murderer Clayton Lockett in Oklahoma. The recipe included execution by three anesthetic drugs: midazolam, vecuronium, and potassium chloride.   Prior to the execution, medical officials tried for nearly an hour to find a vein in Clayton Lockett’s arms, … Continue reading APRIL 2014 LETHAL INJECTION IN OKLAHOMA – AN ANESTHESIOLOGIST’S VIEW →

DR. NOVAK’S DEBUT NOVEL: THE DOCTOR AND MR. DYLAN

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Published in 2017:  The second edition of THE DOCTOR AND MR. DYLAN, a legal mystery which blends anesthesiology and the legacy of Nobel laureate Bob Dylan. Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan: Why does an anesthesiologist write a novel? Anesthesiology is fascinating. We anesthetize patients for operations … Continue reading DR. NOVAK’S DEBUT NOVEL: THE DOCTOR AND MR. DYLAN →

OPERATING ROOM BULLYING

the anesthesia consultant 4 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Does operating room bullying occur? You’re a freshly trained, recently hired anesthesiologist at a new medical center. In your first week on your job, an attending surgeon in the operating room intimidates you, making aggressive, sarcastic, and critical comments such as, “Are you trying to kill my patient? Have you ever done this before? Why … Continue reading OPERATING ROOM BULLYING →

ANESTHESIOLOGIST TRAINING

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 column is for my non-medical layperson readers, and includes a summary of the time course of physician anesthesiologist training. ANESTHESIOLOGIST TRAINING: Anesthesiologists are Medical Doctors.  In the United States, anesthesiologists are required to have the following minimum training following high school: 1.  College degree = 4 years 2.  Medical school degree (M.D. or D.O.) … Continue reading ANESTHESIOLOGIST TRAINING →

STARTING A COMPANY: THE PHYSICIAN ENTREPRENEUR

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Anesthesiologists spend thousands of hours in operating rooms, surrounded by other people’s inventions. We may think, “Why can’t I be a physician entrepreneur? Why can’t I start a company to invent something like the pulse oximeter (i.e. Dr. Bill New, Stanford anesthesiologist-engineer), the laryngeal mask airway (i.e. Dr. Archie Brain of England), or even the … Continue reading STARTING A COMPANY: THE PHYSICIAN ENTREPRENEUR →

WILL YOU HAVE AN ANESTHESIOLOGIST FOR YOUR WISDOM TEETH EXTRACTION SURGERY?

the anesthesia consultant 20 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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In the United States, will you have an anesthesiologist for your wisdom teeth extraction surgery? If you are a healthy patient, the answer is: probably not. In the United States, oral surgeons perform most wisdom teeth extraction surgeries.  This is a very common surgery, with the operation performed on up to five million times in … Continue reading WILL YOU HAVE AN ANESTHESIOLOGIST FOR YOUR WISDOM TEETH EXTRACTION SURGERY? →

10 WAYS PRIVATE PRACTICE ANESTHESIA DIFFERS FROM ACADEMIC ANESTHESIA

the anesthesia consultant 5 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Academic and private practice anesthesia differ. I’m fortunate to be a member of the clinical faculty in the Department of Anesthesia, Perioperative and Pain Medicine at Stanford University. Stanford is a unique academic hospital, staffed by both academic and private practice physicians. From 2001 until 2015, I served as the Deputy Chief of Anesthesia at … Continue reading 10 WAYS PRIVATE PRACTICE ANESTHESIA DIFFERS FROM ACADEMIC ANESTHESIA →

HOW TO SCREEN OUTPATIENTS PRIOR TO SURGERY

the anesthesia consultant 4 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Screening prior to outpatient surgery is important. Over 70% of elective surgeries in the United States are ambulatory or outpatient surgeries, in which the patient goes home the same day as the procedure. There are increasing numbers of surgical patients who are elderly, obese, have sleep apnea, or who have multiple medical problems. How do … Continue reading HOW TO SCREEN OUTPATIENTS PRIOR TO SURGERY →

JANUARY 2014 LETHAL INJECTION WITH MIDAZOLAM AND HYDROMORPHONE … AN ANESTHESIOLOGIST’S OPINION

the anesthesia consultant 5 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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On January 16, 2014, the New York Times reported that Dennis McGuire was executed by a lethal  injection of midazolam and hydromorphone. McGuire was previously convicted of the 1994 rape and murder of a 22-year-old pregnant woman.   The lethal injection occurred at the Southern Ohio Correctional Facility in Lucasville, Ohio. It was the first … Continue reading JANUARY 2014 LETHAL INJECTION WITH MIDAZOLAM AND HYDROMORPHONE … AN ANESTHESIOLOGIST’S OPINION →

OBAMACARE AND ANESTHESIA

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Key questions in our specialty in 2014 related to Obamacare and anesthesia. This article was originally published in 2014, when Barack Obama was the President of the United States. A key question in our specialty at that time was “How will ObamaCare affect anesthesiology?” The following essay represents my thoughts as of 2014, prior to … Continue reading OBAMACARE AND ANESTHESIA →

HOW TO WAKE UP PATIENTS PROMPTLY FOLLOWING GENERAL ANESTHETICS

the anesthesia consultant 14 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Two patients arrive simultaneously in the recovery room following general endotracheal anesthetics. One patient is unresponsive and requires an oral airway to maintain adequate respiration. In the next bed, the second patient is awake, comfortable and conversant. How can this be? It occurs because different anesthetists practice differently. Some can wake up patients promptly, and … Continue reading HOW TO WAKE UP PATIENTS PROMPTLY FOLLOWING GENERAL ANESTHETICS →

RECOMMENDED ANESTHESIA WEBSITES

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 post is for my non-medical layperson readers, to highlight the Internet resources for recommended anesthesia websites. The two best sources are the American Society of Anesthesiologists website, and the National Institute of Health indexing website called Pubmed. These two will enable readers to trace the facts, guidelines, and recent literature publications in anesthesiology. American … Continue reading RECOMMENDED ANESTHESIA WEBSITES →

THE ANESTHESIA CONSULTANT HOME

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 profession of medicine offers a lifetime of fascination, and no specialty is more fascinating than anesthesiology. The Anesthesia Consultant is designed to inform and entertain both laypeople and medical specialists, and provides answers not found in traditional textbooks.The Anesthesia Consultant is written by Richard Novak, MD, an Adjunct Clinical Professor of Anesthesiology, Perioperative and … Continue reading THE ANESTHESIA CONSULTANT HOME →

ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: ANESTHETIC TECHNIQUES

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 column is for non-medical laypeople, and pertains to the different types of anesthetic techniques used in the 21st century. See below: GENERAL ANESTHESIA A general anesthetic renders the patient asleep and insensitive to pain for surgery. Prior to beginning anesthesia, the anesthesiologist places monitors of blood pressure, electrocardiogram, pulse and oxygen saturation of the … Continue reading ANESTHESIA FACTS FOR NON-MEDICAL PEOPLE: ANESTHETIC TECHNIQUES →

THE TOP 11 DISCOVERIES IN THE HISTORY OF ANESTHESIA

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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Important advances in the history of anesthesia changed the specialty forever. Humans have inhabited the Earth for 200,000 years, yet the discovery of surgical anesthesia was a recent development in 1846. For thousands of years most surgical procedures were accompanied by severe pain. The only strategies available to blunt pain were to give patients alcohol … Continue reading THE TOP 11 DISCOVERIES IN THE HISTORY OF ANESTHESIA →

HOW DOES THE ANESTHESIOLOGIST DECIDE WHAT DOSE OF ANESTHETIC TO GIVE A PATIENT?

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 column is directed to my non-medical layperson readers. How does an anesthesiologist decide what dose of anesthetic to administer to a patient? You are a 100-pound, 70-year-old woman. Your son is a 200-pound, 35-year-old man. Do you both require the same doses of general anesthetic if you each need to have your gall bladder … Continue reading HOW DOES THE ANESTHESIOLOGIST DECIDE WHAT DOSE OF ANESTHETIC TO GIVE A PATIENT? →

READING IN THE OPERATING ROOM

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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 attending anesthesiologist. You enter another colleague’s operating room to give him a bathroom break during his 6-hour plastic surgery case, and you find him tapping on an iPad and reading in the operating room. What do you do? Discussion:  Is it OK for the anesthesiologist to be reading in the operating room? Is … Continue reading READING IN THE OPERATING ROOM →

HOW RISKY IS A TONSILLECTOMY?

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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13-year-old Jahi McMath of Oakland, California suffered sudden bleeding from her nose and mouth and cardiac arrest following a December 9th 2013 tonsillectomy, a surgery intended to help treat her obstructive sleep apnea. After the bleeding she lapsed into a coma. Three days later she was declared brain-dead. How could this happen? Behind circumcision and … Continue reading HOW RISKY IS A TONSILLECTOMY? →

WHY DOES ANYONE DECIDE THEY WANT TO BECOME AN ANESTHESIOLOGIST?

the anesthesia consultant 15 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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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A question anesthesiologists are commonly asked is, “Why did you want to become an anesthesiologist?” Let’s assume a young man or woman has the discipline and intellect to attend medical school. Once that individual gains their M.D. degree, they will choose a specialty from a long line-up that includes multiple surgical specialties (general surgery, orthopedics, … Continue reading WHY DOES ANYONE DECIDE THEY WANT TO BECOME AN ANESTHESIOLOGIST? →

COVER STORY, OUTPATIENT SURGERY ARTICLE ON TECHNIQUES FOR STARTING DIFFICULT IV’S

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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. Novak intubating a patient using a McGrath 5 videolaryngoscope in the operating room. Full story available at Outpatient Surgery Magazine.   Vascular Access Made Easy Time-tested tips for locating veins and starting IVs. Richard Novak, MD Categories: Anesthesia ALL SMILES The best IV starts are the ones patients don’t remember. Talented surgeons, a staff full … Continue reading COVER STORY, OUTPATIENT SURGERY ARTICLE ON TECHNIQUES FOR STARTING DIFFICULT IV’S →

USEFUL PEDIATRIC ANESTHESIA EQUATIONS

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

You are driving to the hospital, en route to doing a pediatric anesthetic on a 2-year-old that will require an endotracheal tube. You are thinking through the case in advance. What can you do to plan your anesthetic? There are some useful pediatric anesthesia equations you can use to prepare yourself.     During my … Continue reading USEFUL PEDIATRIC ANESTHESIA EQUATIONS →

ANESTHESIA EXPERT WITNESS CONSULTATION – RICHARD NOVAK, MD

the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

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 CONSULTATION – RICHARD NOVAK, MD →

HOW IS YOUR ANESTHESIA BILL CALCULATED?

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

How is your anesthesia bill calculated?     It depends. An anesthesiologist’s bill depends on several factors, including: The duration of the anesthesia care The complexity of the surgical procedure The insurance status of the patient Let’s look at each of these factors in turn: 1. The duration of the anesthesia care.  Anesthesia provider bills … Continue reading HOW IS YOUR ANESTHESIA BILL CALCULATED? →

ANESTHESIA FOR SPECIALTY SURGERIES

the anesthesia consultant 1 Comment
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

This column is specifically for my non-medical layperson readers, and is a discussion of the different types of anesthesia for specialty surgeries. See below:   I.  CHILDBIRTH (OBSTETRIC ANESTHESIA): Most obstetric anesthesia is for either vaginal delivery or for Cesarean sections. Anesthesia for Vaginal Delivery:  Anesthesia for vaginal delivery is utilized to diminish the pain … Continue reading ANESTHESIA FOR SPECIALTY SURGERIES →

SHOULD YOU CANCEL SURGERY FOR A BLOOD PRESSURE OF 170/99?

the anesthesia consultant 39 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

Clinical Case for Discussion:  This month’s question is on hypertension and anesthesia. You are scheduled to anesthetize a 71-year-old male for an arthroscopic rotator cuff repair.  His blood pressure when you meet him in pre-op is 170/99 mmHg.  The nurses and the surgeon are alarmed.  What would you do? Should you cancel surgery for a … Continue reading SHOULD YOU CANCEL SURGERY FOR A BLOOD PRESSURE OF 170/99? →

LETHAL INJECTION AND THE ANESTHESIOLOGIST

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

Lethal injection requires someone to administer anesthetic medications in high concentrations, without supporting breathing or cardiac function. This column discusses lethal injection and the anesthesiologist. In the 2011 movie The Lincoln Lawyer, Matthew McConaughey’s character, a criminal defense lawyer working in Los Angeles, taunts his client who is on trial for murder to tell the truth … Continue reading LETHAL INJECTION AND THE ANESTHESIOLOGIST →

IS YOUR GRANDMOTHER TOO OLD FOR SURGERY?

the anesthesia consultant 4 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

This column is for my non-medical layperson readers. Your 85-year-old grandmother had two gallstone attacks in the past 6 months. Is she too old for surgery? Is it safe for her to have her gallbladder removed?   It depends. A general surgeon would serve as the consultant as to the natural history of the gallbladder … Continue reading IS YOUR GRANDMOTHER TOO OLD FOR SURGERY? →

LANDING THE ANESTHESIA PLANE: WHEN SHOULD YOU EXTUBATE THE TRACHEA?

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

This column is for my readers who are anesthesia professionals. When should you extubate the trachea? Clinical Case for Discussion: You’re anesthetizing a 60-year-old woman for a thyroidectomy. The surgeon tells you, “If this woman bucks on the endotracheal tube on awakening it could cause a neck hematoma and damage my surgical closure. Can you extubate … Continue reading LANDING THE ANESTHESIA PLANE: WHEN SHOULD YOU EXTUBATE THE TRACHEA? →

FAQ ABOUT ANESTHESIA

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the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

This column is directed to my non-medical layperson readers. As an experienced board-certified physician anesthesiologist, I will attempt to answer frequently asked questions FAQ about anesthesia. WILL I BE NAUSEATED OR VOMIT AFTER GENERAL ANESTHESIA? One of the most common fears patients have before surgery is, “Will the anesthesia make me nauseated? The answer is, … Continue reading FAQ ABOUT ANESTHESIA →

KEEPING ANESTHESIA SIMPLE: THE KISS PRINCIPLE

the anesthesia consultant 4 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

Clinical Cases:  You’re scheduled to anesthetize a 70-year-old man for a carotid endarterectomy, a 50-year-old man for an arthroscopic rotator cuff repair, and a 30-year-old woman for an Achilles tendon repair.  What anesthetics would you plan? “Keep It Simple, Stupid…” The KISS principle applies in anesthesiology, too.   Discussion:  In 1960, U.S. Navy aircraft engineer Kelly … Continue reading KEEPING ANESTHESIA SIMPLE: THE KISS PRINCIPLE →

SEVEN DEADLY DRUGS IN AN ANESTHESIOLOGIST’S DRAWER

the anesthesia consultant 2 Comments
the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

As anesthesiologists we are the only physicians who routinely prescribe and administer injectable medications ourselves. Most physicians write orders for medications. Registered nurses then administer the medications on hospital wards, in intensive care units, in emergency rooms, and in clinics. As anesthesiologists we have our own drug cart, stocked with dozens of medications, including hypnotics, … Continue reading SEVEN DEADLY DRUGS IN AN ANESTHESIOLOGIST’S DRAWER →

ROBOT ANESTHESIA

the anesthesia consultant
Physician anesthesiologist at Stanford at Associated Anesthesiologists Medical Group
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)

Artificial intelligence in medicine is coming. Will robots replace anesthesiologists? I am the Medical Director of a surgery center in California that does 5,000 gastroenterology endoscopies per year.  Recently a national marketing firm contacted me to seek my opinion regarding an automated device to infuse propofol.  The device was envisioned as a tool for gastroenterologist/nursing … Continue reading ROBOT ANESTHESIA →