Bryan Glezerson

Neuro-anaesthesiologist, certified diagnostic EEGer @TheNeuro_MNI. Int: technical standards/generalizability in anaesthetic EEG. TIVAdiva. Periop Neuro. Oudie.

[Bryan Glezerson @BryanGlezerson]

@MichaelBritoUM Same!

[Bryan Glezerson @BryanGlezerson]

@EmergencyBod Yes

[Bryan Glezerson @BryanGlezerson]

@bobfunn @MMC My hospital charges me 3 dollars for a half-rotten apple.

[Bryan Glezerson @BryanGlezerson]

@Chronotrope @Leedsmedic @charlottetr @BJAJournals @MichiIntrona If you take the propofol low enough I find you can usually reconstitute a nice alpha band in most people. Exception, of course, is the elderly/frail, and for some reason in patients with severe Parkinson’s Dementia, almost independent of age.

[Bryan Glezerson @BryanGlezerson]

@spa1982 @a_hueb @dieracg @Nikkhah1 I like them for long cases with tucked arms; no bends in the IV tubing!

[Bryan Glezerson @BryanGlezerson]

@MilanNigam2

[Bryan Glezerson @BryanGlezerson]

Si un voyageur qui a rendu visite une fois à Montréal peut précisément identifier le lien commun entre l’infrastructure civile pourrie et le manque d’un service de soins de santé moderne et adéquat, c’est qu’il est existe une maladie grave et flagrante dans le leadership du QC.

[Bryan Glezerson @BryanGlezerson]

@bobfunn @glbryson I have never heard anyone hit the nail so sharply and hysterically on the head with one phrase.

[Bryan Glezerson @BryanGlezerson]

@wongdiagnosis @glbryson And to location in the permanent record as well as to research.

[Bryan Glezerson @BryanGlezerson]

@beckimarshRA Oh I think if you’re doing a TEA then adding IT morphine may do little. But as an alternative to an epidural, it certainly has a measurable effect on postoperative pain.

I suspect it is sadly not only in the NHS that compromises must be made in anaesthetic choices.

[Bryan Glezerson @BryanGlezerson]

@DrRobbieErskine @derekedsmith @milliken_don @colinjmccartney @EMARIANOMD That seems to be my observation as well.

[Bryan Glezerson @BryanGlezerson]

Does anybody else get the sense that outside of OB and pediatric spines, intrathecal hydrophilic opioids are grossly underutilized?

@DrRobbieErskine @colinjmccartney @EMARIANOMD

[Bryan Glezerson @BryanGlezerson]

@DrRobbieErskine @glauncel @colinjmccartney @EMARIANOMD I think I would as well. But what sparked this post was that I found myself with a particularly intransigent and unobliging surgeon who refuses that her patients receive high quality regional analgesia. So I adapted and did the next best thing; was quite pleased with the result!

[Bryan Glezerson @BryanGlezerson]

@derekedsmith @milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD I think expectations may also be different between parturients and other laparotomised patients.

[Bryan Glezerson @BryanGlezerson]

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD It is indeed. No doubt in the short term they are more comfortable, though!

[Bryan Glezerson @BryanGlezerson]

@glauncel @DrRobbieErskine @colinjmccartney @EMARIANOMD Seems you can get around 20mg of spared parenteral morphine in 24h with <500mcg IT morphine.

I have been impressed recently by its efficacy at low doses.

[Bryan Glezerson @BryanGlezerson]

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD The best literature on IT morphine is all alongside at least foundational analgesia, so that’s what I did.
I am also quite heavy handed with steroids. I have been sadly underwhelmed by the literature in support of ketamine/dexmedetomidine/lidocaine on pain outcomes after PACU.

[Bryan Glezerson @BryanGlezerson]

@glauncel @DrRobbieErskine @colinjmccartney @EMARIANOMD And yet IT a morphine 100-200mcg is universally provided for cesarean under spinal.

Literature suggests that doses under 500mcg have similar rates of PONV and respiratory depression to PCA alone. Itchiness is the only noteworthy side effect.

https://t.co/V6mTBlIwRk

[Bryan Glezerson @BryanGlezerson]

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD Which of course is made all the more shocking because it is UNIVERSAL in cesarean delivery in North America to use IT morphine. So one wonders why this is not more standard in other laparotomies.

[Bryan Glezerson @BryanGlezerson]

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD So it’s interesting, Don. I think that Canadian adult anaesthetists have forgotten about this.

But I worked at a different hospital than I normally do this week and one of the gynae-oncologists refuses epidurals. So I did spinal morphine 200mcg and for 48h the patient is 0/10.