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the anesthesia consultant

anesthesiologist at StanfordnoAssociate Medical Group Anästhesiologen

Richard Novak, MD, is a Stanford Board-Certified Physician of Anaesthesiology and Internal Medicine. Novak is an Associate Clinical Professor in the Department of Anaesthesiology, Perioperative Medicine and Pain at Stanford University, Medical Director of the Waverley Surgery Center in Palo Alto, California, and a member of the Associate Anesthesiologists Medical Group in Palo Alto, California.
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These are the common anesthetics currently used in the United States:


1. PROPOFOL. Propofol is an intravenous sedative and hypnotic and the most widely used general anesthetic in the United States. Because propofol can stop a patient's breathing, its use is limited to physicians who specialize in airway and respiratory management. Propofol has ultra-fast onset and stop times, often resulting in intoxication within seconds of injection. Because the drug works quickly, it's often given as a continuous intravenous drip or infusion. When propofol is administered without other anesthetics, the patient usually wakes up within minutes of stopping the drug. Propofol does not relieve pain, and most painful surgeries require additional medication.

2. MIDAZOLAM (trade name VERSED). Midazolam is a short-acting anxiolytic drug belonging to the Valium or benzodiazepine class. Midazolam is commonly injected as the first drug at the onset of anesthesia because it gives patients a sense of calm and often causes amnesia for a few minutes afterwards. Midazolam is a drug commonly given during sedation for colonoscopy procedures because most patients are unaware of the procedure, although they are usually awake.

3. NARCOTICS. Most surgical procedures cause pain, and narcotics are intravenous pain relievers. Commonly used narcotics include morphine, meperidine (brand name Demerol), fentanyl, and remifentanil. Narcotics have the desired effect of dulling the brain's perception of pain. Narcotics cause drowsiness at higher doses and have the common side effect of nausea in some patients. Morphine and Demerol are slower and longer-acting narcotics, while fentanyl and remifentanil are shorter and faster-acting narcotics.

4. PARALYTIC MEDICATIONS. Some surgeries and anesthesia require the patient to be paralyzed, which means the muscles must be relaxed so the patient cannot move. It is imperative that the patient is first given the appropriate intravenous or inhaled anesthetics so that the patient does not realize they are unable to move. Common paralytics are vecuronium, rocuronium, pancuronium and succinylcholine. Because paralyzing drugs prevent a patient from breathing, their use is limited to physicians who specialize in airway and respiratory management. Anesthesiologists use paralyzing drugs before inserting a breathing tube (endotracheal tube) into the patient's windpipe. Paralyzing drugs are used during certain surgical procedures that require the surgeon to relax the patient's muscles, such as abdominal surgery, some neck surgeries, and some chest surgeries.

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1. POWERFUL INHALATION ANESTHETICS. Effective inhalation anesthetics include sevoflurane, isoflurane, and desflurane. These drugs are liquid and are administered through anesthetic vaporizers, which convert them into gases that are inhaled. They are generally given at low concentrations (1% to 4% for sevoflurane, 1% to 2% for isoflurane, and 3% to 6% for desflurane) because the higher sustained concentrations of these drugs cause life-threatening depression in the respiratory and cardiac pathways. Functions Because strong inhalation anesthetics can stop patients breathing, their use is reserved for physicians specializing in airway and respiratory management.

2. Nitrous Oxide. Nitrous oxide is a relatively weak inhalation anesthetic, typically administered at concentrations of 50% to 70%. At these doses, nitrous oxide causes significant drowsiness but does not render the patient unconscious. Nitrous oxide has the advantage of being a rapid onset and recovery drug and is inexpensive. Since each patient must inhale at least 21% oxygen, the maximum dose of nitrous oxide is 100 to 21 or 79%. As a safety precaution, oxygen is usually administered at a concentration of at least 30%, so concentrations of nitrous oxide administered rarely exceed 70%.


1. LIDOCAINE. Lidocaine is injected into the tissue to block pain at that location. The onset of local anesthesia occurs within seconds and the duration is short, usually less than an hour. Lidocaine can be injected into the back during spinal or epidural anesthesia to numb part of the patient's body without causing loss of consciousness. Lidocaine can also be injected near major nerves, which is called a nerve block. Nerve blocks involve injections to numb an arm, leg, hand, or foot.

2. PROCAIN (trade name Novocaine). Although the term novocaine is commonly heard, the use of this drug has been largely abandoned and replaced with lidocaine.

3. BUPIVICAINE (trade name Marcaine). Bupivcaine is injected into the tissue to block pain at that point. Local anesthesia starts within minutes and lasts longer than lidocaine, usually 2 to 6 hours depending on the injection site. Bupivcaine can be injected into the back during spinal or epidural anesthesia to numb part of the patient's body without causing unconsciousness. Bupivcaine can also be injected near major nerves, which is called a nerve block. Nerve blocks involve injections to numb an arm, leg, hand, or foot.

The most popular publications for laypeople inThe anesthesia consultantcontain:

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Published September 2017: The second edition ofTHE DOCTOR AND MR. dilan, the first novel by Dr. Novak, a medico-legal mystery that blends the science and practice of anesthesiology with unforgettable characters, a flipping storyline and the legacy of Nobel laureate Bob Dylan.


In this debut thriller, tragedy strikes an anesthetist as he tries to start a new life with his son.

Doctor Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, an influential real estate agent obsessed with money. His son Johnny, an eleventh grader with immense potential, is struggling to get the grades he needs to attend an Ivy League university. After a falling out with Alexandra, Nico moves with Johnny from Palo Alto, California to the frozen childhood home in Hibbing, Minnesota. The move is intended to help Johnny improve his grades and look more attractive for college, but Nico also loves his wife's freedom. Hibbing is also the hometown of music icon Bob Dylan. When he joins the hospital staff, Nico clashes with a grumpy anesthesiologist who calls himself Bobby Dylan and plays Dylan songs twice a week at a bar called Heaven's Door. When Nico and Johnny move in, their lives change; They even date gorgeous mother-daughter duo Lena and Echo Johnson. However, when Johnny accidentally gets Echo pregnant, the life of Hibbing's transplants begins to implode. In true page-turning style, the young novelist begins by killing the soulless Alexandra and hastening the downfall of her oppressed protagonist, who is now accused of murder. The dialogue is impeccable, and the insults between Nico and his wife are as hilarious as they are heartbreaking: "Are you my man, Nico? Or my relative? The author's medical background is central to the plot, and there are some chilling moments, such as "dark blood" oozing out of a patient's nostrils "like coffee grounds." Bob Dylan details lend weirdness to what could be a cold revenge story; For example, we're told that Dylan "taught every singer with a less than perfect voice... how to mock and distort syllables." The courtroom scenes toward the end sizzle with energy, although a scene involving a snowmobile ties a distinct plot line well. In the end Nico rolled with a lot of punches.

Distinctive characterization and clever details help launch this debut.

Click on the image below to access the Amazon linkThe Doctor and Mr. Dilan:


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