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My "Mid-level" View From The Top

MAC BAR Anyone?

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What can I say? I'm a MAC BAR kind of guy. This is with an Adductor Canal Block and 100 mcg of Fentanyl. Total Knee Arthroplasty with LMA and no tourniquet. We work fast and good. Total knee done in about 21 minutes and closing. Not the best lung volumes, but at 5'6" and 186# I'll take it. This same case with the ACB I would have probably given 250 mcg of Fentanyl. The FIRST 8 MINUTES or so, we keep the pressure a little lower (unless we unable to related to pt history, age, etc...) until the patella is flipped back and then normalize BP closer to a pre-op range. How low do you ask? Everyone has a comfort zone and I am not a knee jerk kind of person. Let's just say that if you are that person that is grabbing ephedrine, phenylephrine, or robinul from my cart while a give you a report before break and you're not listening to me because you cannot stand what you see on the monitor, then you don't want to know the answer. I would never compromise care just for a target BP. We have and can communicate concerns of not going as low as needed for blood loss control and have proceeded to use a tourniquet. I'm not a rockstar or anything. This is something I'm good at, but it's not my life. My family is my life, no contest. If I every have to choose, I'm out. With that being said, it's a great career for which I am blessed to be able to perform day in and day out with a great group of anesthetists. At the end of the day, I'm just another "MID-LEVEL" on top. Yes, we can talk about that later. It is sort of a new running joke around here, but that's for another day. All good stuff.


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