G'day it's the 17th of #Blocktober26 -- hope you're all enjoying some weekend fun! Today we're going to talk about another increasingly common clinical scenario that can be tricky...

Thanks @AirwayMxAcademy , I do appreciate there's no evidence that gastric US changes outcomes. That said, there are lots of things we use every day that provide useful information while lacking evidence. Pulse oximetry has not been shown to reduce periop mortality, but I sure ain't gonna stop using it while I await some dude to do a meta-analysis on it. Here's the real value: In the above example, if I scan and find stomach is empty, that means I can proceed confidently with my plan of spinal plus propofol sedation (aka unconsciousness/loss of airway reflexes). If I were just to reflexively intubate the tracheas of every joint replacement on a GLP1 (about 15-20% now), I would now be exposing those patients -- as you point out -- to a new set of risks (airway trauma, bronchospasm, blah blah blah). If I DO find a full stomach, then we have some decisions to make. Spinal with the patient awake through the procedure is one option. Postpone is another. Re-scan an hour or two later is a third. GA with RSI is an option I suppose BUT....RSI is hardly a guarantee of safety. Most operative aspiration events occur during RSI/full stomach. Here's a question for everyone out there (and I'm genuinely curious). If you have a known full stomach and you proceed with GA/ETT for an elective case and the patient has a serious aspiration event, is that defensible? I reaaaallllyyy hate questions that start with "Dr. Gadsden, please explain to the jury ..."

Hi friends, it's the 14th of #Blocktober26 and today we're going to talk about another common scenario/procedure...

Great point @PeterMerjavy ! One of my favorite studies by Ana Lopez, Xavi Sala Blanch and colleagues showed that saphenous reaches the surgical zone (for their surgeons at least) about 3% of the time, so we'll often skip it after a pop block for bunions (but realize that we could get burned if it's the 3%...)

I love teaching axillary brachial plexus blocks. So much cool anatomy to go over. And fun physiology too -- seeing how the hand does a different dance when stimming each nerve separately is (yes, nerd alert) an eye-opener for the trainees. When YOU do this block, what order do you go in?

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

Like some of you, I also love a spinal catheter. You don’t need special equipment (epidural kit fine) and it’s *chef’s kiss* for maintaining stable hemodynamics. For those unfamiliar, here’s a video on the technique: #Blocktober26 Continuous Spinal Anesthesia (Spinal Catheter Technique) youtu.be/3knfs02LQcI

Hey y'all, it's the 10th day of #Blocktober26 -- hope you're enjoying your weekend! Today I want to talk about a common clinical scenario that can be tricky to manage...