I’m on the hunt for a good quality food processor…
Here’s the top three that I’m looking at for a family of 4 (pre-research): Braun, Breville, and Cuisinart. It needs to be durable and low maintenance. I don’t really care about how loud or quiet it is because my kids are typically loud and they sleep with a sound machine. A quiet motor is a nice “want” but not a necessity. Maybe that will matter to me more in 5 years.
After the stellar reviews above as well as the in depth review from Tech Gear Lab and Healthy But Smart, I am leaning toward the Breville Sous Chef. I need a large food processor for 4 people — although my kids are only 1 and 2 years old, they already eat a ton and I know this will only mean bigger appetites as they grow older. Important things for me are chopping, shredding, slicing, and cleaning. After the research, I think the Breville Sous Chef fits the bill.
There’s been a big debate re: who should care for LVAD patients… a general anesthesiologist or a cardiac anesthesiologist? See below for pros and cons of each. Ultimately, I think all anesthesiologists should be comfortable caring for these patients as we’ll see more and more LVAD patients undergoing procedures.
Goals of care for LVAD patients undergoing non-cardiac surgery should be directed at maintaining forward flow and adequate perfusion. Three main factors that affect LVAD flow are preload, RV function, and afterload.
The right ventricle is the primary means of LVAD filling; therefore, maintaining RV function is imperative.
Marked increases in systemic vascular resistance should be avoided.
Generally, decreases in pump flow should first be treated with a fluid challenge. Hypovolemia should be avoided and intraoperative losses should be replaced aggressively. Second line treatment should include inotropic support for the right ventricle.
Low-dose vasopressin (<2.4 U/h) may be the vasopressor of choice due to its minimal effect on pulmonary vascular resistance.
Standard Advanced Cardiovascular Life Support Guidelines should be followed; however, external chest compressions should be avoided during cardiac arrest.
Steep Trendelenburg may increase venous return, risking RV strain. Peritoneal insufflation for laparoscopic surgery also increases afterload and has detrimental effects on preload. Insufflation should utilize minimum pressures and be increased in a gradual, step-wise fashion.
TEE can be extremely valuable in diagnosing the cause of obstruction.
From Left Ventricular Assist Device Management in the ICU Pratt, Alexandra K. MD1; Shah, Nimesh S. MD1; Boyce, Steven W. MD2 Critical Care Medicine: January 2014 – Volume 42 – Issue 1 – p 158–168 doi: 10.1097/01.ccm.0000435675.91305.76 Concise Definitive ReviewLeft Ventricular Assist Device Management in the ICU Pratt, Alexandra K. MD1; Shah, Nimesh S. MD1; Boyce, Steven W. MD2 Critical Care Medicine: January 2014 – Volume 42 – Issue 1 – p 158–168 doi: 10.1097/01.ccm.0000435675.91305.76 Concise Definitive Review
Conclusions: Spinal Anesthesia (SA: hyperbaric bupivacaine 9mg + fentanyl 15mcg) increased the success rate and reduced pain for both primary and re-attempts of External Cephalic Version (ECV), whereas IV Anesthesia (IVA) using remifentanil infusion (0.1mcg/kg/min) only reduced the pain. There was no significant increase in the incidence of fetal bradycardia or emergency CS, with ECV performed under anaesthetic interventions. Relaxation of the abdominal muscles from SA appears to underlie the improved outcomes for ECV.
Editor’s key points: There is no consensus on best anaesthetic technique for external cephalic version (ECV). In this study, success at ECV was higher using spinal anaesthesia compared with remifentanil infusion or no intervention. Pain was also reduced in the remifentanil group but success at ECV was no different to the no intervention group. The effect of spinal anaesthesia in ECV may relate to relaxation of the abdominal musculature.
Neuraxial blockade is associated with minimal hospital and insurer cost changes in the setting of external cephalic version, while reducing the cesarean delivery rate.
It is both effective and cost-effective to utilize spinal anesthesia to perform ECV in term, nulliparous women with breech fetuses. Translation of this potentially impactful approach into broad obstetric practice should be undertaken.
Six RCTs met criteria for study inclusion. Regional anesthesia was associated with a higher external cephalic version success rate compared to intravenous or no analgesia (59.7% vs. 37.6%; pooled RR 1.58, 95% confidence interval [CI] 1.29-1.93). This significant association persisted when the data was stratified by type of regional anesthesia (spinal vs. epidural). The number needed to treat with regional anesthesia to achieve one additional successful ECV was 5. There was no evidence of statistical heterogeneity (p=0.32, I2=14.9%) or publication bias (Harbord test p=0.78). There was no statistically significant difference in the risk of cesarean delivery comparing regional anesthesia to intravenous or no analgesia (48.4% vs. 59.3%; pooled RR 0.80, 95% CI 0.55-1.17). Adverse events were rare and not significantly different between the two groups.
Neuraxial Anesthesia (NA) for External Cephalic Version (ECV) increased the risk of emergent cesarean delivery (CD) without impacting ECV success. These findings differ from previous randomized controlled trials (RCTs). The increased risk and decreased success of our ECVs compared to ECVs performed in the context of RCTs could be explained by patient selection, variation in operator experience or technique, or variation in anesthetic management. Future studies should further evaluate the risk of NA for ECV in true practice scenarios outside of RCTs.
Repeat ECV with spinal anesthesia after a failed first attempt without spinal anesthesia increased vertex presentation at birth and decreased the rate of cesarean delivery.
Results: A total of 240 subjects were enrolled, and 239 received the intervention. External cephalic version was successful in 123 (51.5%) of 239 patients. Compared with bupivacaine 2.5 mg, the odds (99% CI) for a successful version were 1.0 (0.4 to 2.6), 1.0 (0.4 to 2.7), and 0.9 (0.4 to 2.4) for bupivacaine 5.0, 7.5, and 10.0 mg, respectively (P = 0.99). There were no differences in the cesarean delivery rate (P = 0.76) or indication for cesarean delivery (P = 0.82). Time to discharge was increased 60 min (16 to 116 min) with bupivacaine 7.5 mg or higher as compared with 2.5 mg (P = 0.004).
Conclusions: A dose of intrathecal bupivacaine greater than 2.5 mg does not lead to an additional increase in external cephalic procedural success or a reduction in cesarean delivery.
First off, I was very happy with my Apple watch 1. There’s a lot of great notifications for it and it’s user friendly. One thing I did not like about the watch is that the notifications would go directly to the watch without warning me on the iphone despite my ringer being on.
The main reason why I decided to look for a watch outside of my stellar apple watch is because the battery life on the apple watch is incredibly low. I can only go one day between charges. Sometimes, I’m at work for more than 24 hours so it becomes more cumbersome on the logistics. Sure, I could bring my charger and charge it… but that takes time, effort, and extra cords since it doesn’t have a lightning charger. So, enter the Pebble 2…a Kickstarter project!
The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.
Here’s an excerpt:
A San Francisco cable car holds 60 people. This blog was viewed about 410 times in 2014. If it were a cable car, it would take about 7 trips to carry that many people.
Love. Laughter. Life. Medicine. 
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