Archive for September, 2005


Anesthesia for Aortic Aneurysm Repair

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This is the last week of my Cardiac Surgery rotation at the County Hospital. The anesthesia techniques that I have learned this past month have been very interesting. Today I was able to put it all together for a sort of cap-stone experience in a big case.

Aortic dissection repair is not a surgical case that is approached lightly. This condition may result from chronic hypertension and possibly congenital weakness of the intima of the aorta leading to aneurysm formation and dissection. Unchecked an aortic dissection often proves to be fatal. Remember John Ritter from Three’s Company – he fell victim to a ruptured aortic dissection. Death is usually extremely quick and mercifully without drawn out pain.

Surgical Team in the Heart Room

This vascular case required not only sternotomy but a thoracotomy as well. These are big surgeries. Initially, the plan was for circulatory arrest and profound hypothermia with lumbar drain for cerebral protection. The surgical team decided on the double incision providing a greater exposure and was able to perform the surgery without the circulatory arrest. This was a good thing for everyone. Rewarming after a complete circulatory arrest with profound hypothermia takes several hours. As it was the surgery was long.

Preparation and setup for anesthesia was nevertheless extensive with two arterial line placements both a right radial and right femoral, double lumen introducer central line placement in the internal right jugular and floating a pulmonary artery catheter. Additionally because of the thoracotomy and the extensive dissection into the left chest that was required we used a double lumen endotracheal tube which allowed us to deflate the left lung improving the surgical exposure on the left side. At the end of the case the double lumen tube was replaced with a single lumen endotracheal tube. This was a great experience and wonderful case for me to participate in. You can see the entire Slide Show of the case at flickr. I must warn you that some of the pictures are very graphic and not for the squeamish.

By-pass machine

These cases require cardio-pulmonary by-pass. For this case it was a partial bypass that was used when the surgeons isolated the aortic arch. Never the less this resulted in full heparinization and use of the “heart lung machine”. You can see Julia here with her bight smile behind the mask. The presence of the perfusion team in the cardiac room is always a pleasure.

Enjoy the pictures at flickr. If you can recall your anatomy you will notice the aortic arch repair and marvel at the gortex graft creation by the sugical team.

Categories : Anesthesia
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Xiao Hui’s Birthday

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Xiao Hui’s birthday is today. Well not today but yesturday because she is in China. She is across the date line you see and their today is our tomorrow or something like that. Anyway today or yesturday was is her birthday and she is enjoying the celebration with Qian Qian and her husband Henry.

Xiao Hui's birthday

Happy birthday Xiao Hui and hope that you enjoy your day. We miss you.

Categories : General
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Cupid’s Hotddogs

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Cupid's Hotdog sign

Today was the day that we relived the past and drove into the San Fernando Valley to visit Cupid’s Hotdog stand in Northridge. Seth Gary and I all met at the appointed spot and dug into several of these famous “dogs”. There was a fairly long line for a Sunday afternoon which supprised me a little.


Seth’s visit this weekend has been really great. Today we plan on doing some crazy things like visit Cupids Hot Dogs in Northridge California. This was one of his favorite spots growing up and you know how those memories make the hot dogs just taste better. Seeing the huge Cupid Hot Dog sign and munching down on a couple of those dogs was great. They have to be the best hot dogs in the world. For a review of Cupid’s Hot Dogs you can visit the for full details. The dogs we ate today were not as good as I remember but then what is.


For a look at Seth and Gary munching down the dogs follow the link Read More→

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Rich Dad Poor Dad

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Rich Dad Poor DadToday I was able to see Seth during his birthday week. He was here in the United States and Los Angeles briefly and we were able to get together before going to see the Dodgers and the Pirates game at Dodger Stadium. Seth is now an adult and as you might imagine I am very pround of him.

Seth has told me that his plans are to remain in the United States untill Monday and then leave for Barcelona Spain where he plans on continuing to work for the next several months. I am hoping that he will be able to come back to Los Angeles and stay a while. Baring that Jennifer and I may be able to visit him in Spain after I finish school. That would really be nice.

During Seth’s visit this weekend we plan on doing some crazy things like visit Cupids Hot Dogs in Northridge California. This was one of his favorite spots growing up and you know how those memories make the hot dogs just taste better. Believe it or not I am looking forward to seeing the Cupid Hot Dog sign and munching down on a couple of those dogs. They have to be the best hot dogs in the world. For a review of Cupid’s Hot Dogs you can visit the for full details.

Seth Godden on his 29th Birthday

Seth and I had a great talk about life and what it means to he successful. He told me about a book, Rich Dad Poor Dad that he has been reading. You know which one I am. A review of the book by Howard Rothman follows:

Personal-finance author and lecturer Robert Kiyosaki developed his unique economic perspective through exposure to a pair of disparate influences: his own highly educated but fiscally unstable father, and the multimillionaire eighth-grade dropout father of his closest friend. The lifelong monetary problems experienced by his “poor dad” (whose weekly paychecks, while respectable, were never quite sufficient to meet family needs) pounded home the counterpoint communicated by his “rich dad” (that “the poor and the middle class work for money,” but “the rich have money work for them”). Taking that message to heart, Kiyosaki was able to retire at 47. Rich Dad, Poor Dad, written with consultant and CPA Sharon L. Lechter, lays out his the philosophy behind his relationship with money. Although Kiyosaki can take a frustratingly long time to make his points, his book nonetheless compellingly advocates for the type of “financial literacy” that’s never taught in schools. Based on the principle that income-generating assets always provide healthier bottom-line results than even the best of traditional jobs, it explains how those assets might be acquired so that the jobs can eventually be shed.

Seth and his Dad

Categories : General
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More Chinese Sayings

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Rebecca is my dear sweet niece from China that is visiting for summer vacation. She says she is very “Cool” and she wears jeans with holes in them so I guess she is cool indeed. Anyway here is a little story about her.

When she first came to Los Angeles she kept talking about how ‘America was coming’ down but by the end of her trip here she was commenting on how educated the average man from California seemed to be. Besides, it was fun it was to here which is the best of all.


Rebecca says, “The lips live with teeth”. This is a famous Chinese saying meaning what? Rebecca says, “If you let your neighbor country be attacked without helping and the country falls to its enemies then you will be next to be attacked. So the moral is that when your neighbor meets difficulty you must help.” This is her explanation for why China helped Korea during the war with the US. Now I am really confused.

Rebecca at Balboa Island

We will be hearing more from Rebecca Cui in the future. She is such a bright and shinning star that the media is clamoring for more from her pithy wit.

Categories : General
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Sunday Bicycle Ride Part Duce

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Its Sunday again and the fall weather is calling us out to the open road. Bicycling in the cool of the fall is really wonderful here in Southern California. Today was no exception. The camera came along today and I was able to pick up a few pictures and load them all up to flickr. If you would like to see all of the Sunday Rider pack have a look at the Sunday Bicycle Rider flickr folder.

This morning we had a great time at the rest stop in South Pasadena before heading off to the Rose Bowl and the hills in Altadena. Frank was up to his tricks and tried to pick up the coffee girl. He noticed right away that she was friendly and wanted a couple of hugs. Frank being the stud muffin that he is could not refuse her.

Frank and the coffee Diva
Frank and the Coffee Diva

The rest of us just had coffee while Frank was busy helping himself to a big mug of hot chocolate with plenty of whipped cream. He sure knows how to live Frank does.

The rest stop Coffee break

The only problem with our Rest Stop Break is that we all enjoy talking so much that it’s hard to get going again after cooling down. Well Sunday Bicycle Riders take it easy any way and there is no rush.

Rest Stop in South Pasadena

To see the rest of the pictures of all of these outstanding athletes visit flickr “Sunday Bicycle Riders“.

Categories : Cycling
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Google Blog Search

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The Google Blog Search engine is up and running. What fun this is. Now it is possible to search a subject and find blogs that relate. I just checked out “anesthetist” and found a couple of anesthesia related blogs that looked pretty cool. I was happy to see that “” was featured squarly in the center of all of the activity and well represented with posts.

For those that are interest in the Blog Search engine here is the Google link:
Google Blog Search

Categories : General
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Cardiac Surgery at LAC-USC

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This month I have been in the Cardiac Surgery Room at LAC-USC and sharing the rotation with me is the coolest MD resident AJ Vaca. We all just call him Angel or Eeyore which ever comes to mind first but mostly we just call him AJ.

The rotation with him here at LAC-USC has really been a great experience. AJ has been terrific to work with and our time together has been of great benefit to me. I just keep him laughing at my clumsiness so he is entertained and is getting something out of this too.

AJ and David at LAC-USC Anesthesia Office
AJ and David at the LAC-USC Anesthesia Office after giving report to the Chief.

The great thing about AJ is his humility. One thing I have learned in the process of anesthesia training and working with the MD residents is that we are all in training together and that humility is one of the great survival traits. It’s wonderful to know the book and to be able to put those principles into practice but even better to be able to learn from all of those around – even when they see things differently than you do.

How do I say this with political correctness? In the process of training it is possible to run into some of the more experienced practitioners that have seen much more and paying attention to ‘their’ wisdom is always a good thing. Sometimes that wisdom for me comes in doing other than what is explained but for the most part keeping an open mind and being receptive to input from experience has been very helpful in my anesthesia training. AJ is really good at this. He calls everyone, “Sir” no matter who they are and always takes the humble position. I have really enjoyed working with Eeyore, which is what everyone calls AJ.

AJ Vaca and the Cardiac Surgery Rotation
Eeyore in the Cardiac Surgery Rotation

Categories : Anesthesia
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Anesthesia Library

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David Avitar ArrowheadI am in the process of updating the Anesthesia Library information transferring and expanding on the information that I have in the Library Page. All of the books that I review and list in the Anesthesia Library I own and have looked through. My recommendations for texts are well thought out and have cost me more than a few pennies to research.

Enjoy the trip as I have because it is all very good. There are a few books that have redundant material but for the most part all of these texts add something worthwhile. In the past several months I have been simplifying my reading and going back to the basics. My reading plan of one chapter a day is working out well. I recommend the text, Basics of Anesthesia by Miller as a review daily. You could not spend too much time in this text as simple as it is every line is well thought out and of value. Have a pleasant ride.

Categories : Anesthesia
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flickr Pictures

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flickr is a web based photo storage and organizing software service that I have been trying out for the last couple of months. One of the advantages of using flickr for the photo storage is that multiple web sites may link to the picture and save space on your home web site. I am sure that there are other benefits that will become apparent with continued use.

Chris Stein at Harbor UCLA
Chris Stein at Harbor UCLA Professional Aspects lecture

Categories : General
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