Happy Birthday, Matty.

ha ha
Happy Birthday!

Oh, Beck, you scamp.
Happy birthday, bud.

BWHAHAHA!!

That's funny Beck!

But really...

Happy Birthday Beck!

Happy Birthday Beck!

In my ongoing effort to make this site your key source of Venture Brothers news, I bring you this item: Jackson Publick says the new season starts June 1.

right now I am building across the street from those commercial buildings. right now the HSBC and I think the walmart or home depot is being built. I was under the impression that is was supposed to be a self contained communty for all of the windermere developments. A sort of large strip mall. (possibly to keep traffic down) It is deffinatly walking distance for the ambelside on windermere residents, but the other two (north, and upper windermere) are on the other side of terwilliger drive, which is having another two lanes added, bringing the total up to 4 lanes of 70 km/h traffic. not very pedestrian freindly in my opinion. It'll be an interesting setup once everything is done. There will be the bungalows I'm bulding going for 700 grand I'm told through lower income high density housing right down the street. any and everyone will be living there. i wonder if everyone will get along.... It'll be a busy place this summer for sure for builders if nothing else.

To answer your question directly, tay, no, I've never seen it used. I have seen automatic tourniquets used to flood an entire are with local anaesthetic -- a really interesting technique that leads to some very bizarre sensations for the patient -- but never as a means to assess waking paralysis.

It's interesting that you bring it up now, though; our case-of-the-week this week is anaesthesia-related, and I'm responsible for exploring the ins and outs of balanced anaesthesia -- the roles of various IV and inhaled drugs in pain control, sedation, amnesia and muscle relaxation. So I'm doing the research right now anyway.

Frankly, the anaesthetists I work with don't put a lot of stock into fears of waking paralysis; when you consider a stat like 1 in 600, and couple it with the likelihood of someone with an amnestic drug like sevoflurane or midazolam on board remembering that it happened, the number of patients who are affected by waking paralysis seems like it would exceedingly small. (None of the anaesthetists here have ever had a patient describe it to them.)

(As an aside, it may seem to trivialize things to say that not remember a traumatic incident will mitigate its impact -- a fair and intuitive assessment -- nevertheless we do use drugs like midazolam for just such a purpose. It's routinely used in endoscopy -- colonoscopes and that kind of thing -- and really does mitigate the otherwise obviously traumatic impact of having a camera inserted into one's colon.)

A quick search on MD Consult finds a study that examined close to 12000 patients, of which 18 had recall after 7-14 days post-op. Another study found the rate of awareness in non-obstetric, non-cardiac surgery to be 0.2%. To be fair, the rate is far higher in trauma surgery (11-43%), but generally it appears to be pretty low.

There is a mention of isolated forearm as a technique in Miller`s Anaesthesia, but:

Although the incidence of purposeful movement in the isolated arm was high, the incidence of actual intraoperative recall was low (only one subject).

Other investigators have not been able to correlate other clinical signs of light anesthesia or postoperative recall to the isolated arm movement response.[59][60][61] Moreover, the effects of ischemia from prolonged inflation of the tourniquet at pressures higher than arterial blood pressure on this methodology are unknown.

...

The foregoing studies suggest that the occurrence of purposeful movement in an isolated extremity is not a good predictor of intraoperative recall.

Something I heard about a few years ago, and finally found some info on:

Currents Windermere

When I first heard about the concept, it sounded like a very cool mini-town development (almost a European combination of commercial and residential) . On paper though... it looks like a mini South Edmonton Common with lots of parking lots and some houses a few blocks away.

Paras, have you ever seen anyone use the "isolated forearm" technique when administering a general anesthetic? According to the BBC (which I was listening to on the radio last night) it's a simple method for determining if a patient has "woken" after supposedly being put under and then administered a muscle relaxant. 1 in 600 patients will awaken during surgery and it is usually unkown to the doctors. Patients usually suffer from post-traumatic stress in these situations as they can feel every incision being performed but are unable to move. Apparently the Isolated Forearm technique works like this: you administer all your anesthetics and everything to prepare the patient for surgery, but before you administer the muscle relaxant that essentially paralyzes the patient (obviously necessary because you don't want the patient twitching or moving and fucking up your cuts), you put a torniquet on their forearm which hinders the muscle relaxant from fully taking effect on the fingers. The doctor then simply asks the patient to move their fingers if they can hear him/her. For such a simple process, doctors (in england anyway) almost never use the technique, thinking (incorrectly) that monitoring heart rate will allow them to tell if a patient has come awake. Apparently machines that test brain activity are equally fallible. A torniquet trumps them all.

This is all according to the BBC anyhow. I make no claims to the truth of these statements myself. I just thought maybe you'd be interested in this technique if you had never encountered it before. I certainly thought it was interesting.