[Verse 1]
Obese patient on the table, OSA in the chart,
Mask ventilation risky from the very start,
Ramped position, pre-ox five minutes full,
TIVA induction, prop and remi pull,
Laparoscopic pressures pushing on the diaphragm,
Ventilate with PEEP, protect the parenchyma,
ETCO2 climbing with the pneumoperitoneum,
Adjust your minute ventilation, track it on the screen
Sugammadex reversal, wait for T4 over T1,
Extubate awake and upright, watch the SpO2 run,
Handover to PACU, OSA protocol in place,
Document your reasoning, every step and every space
[Chorus]
P-O-S-T — assess before you pass,
Plan, Optimize, Systematize, Then transfer at last,
Know your Why before your What, justify the choice,
Self-assess at every turn, precision is your voice,
PONV, MEP, delayed wake — three tests of what you know,
Audit your own reasoning, that's how experts grow
[Verse 2]
Delayed emergence, don't just wait and hope,
Work through it methodically — it's not a slippery slope,
Check the volatile concentration, check the reversal done,
Hypoglycemia, hypoxia, hypothermia — run
Through hypotension, opioid excess, CO2 retained,
Benzodiazepines lingering, residual drug restrained,
Flumazenil and naloxone if the story fits the clue,
Physostigmine if anticholinergic toxidrome broke through
Rule out stroke and intracranial catastrophe last,
Self-assess your differential — how complete, how fast,
Could you name twelve causes without looking at a list?
That's the gap between competent and nothing that was missed
[Chorus]
P-O-S-T — assess before you pass,
Plan, Optimize, Systematize, Then transfer at last,
Know your Why before your What, justify the choice,
Self-assess at every turn, precision is your voice,
PONV, MEP, delayed wake — three tests of what you know,
Audit your own reasoning, that's how experts grow
[Bridge]
Spine surgery, MEP monitoring, history of wretched nausea,
Volatile agents suppress the signal, that's the data,
Nitrous amplifies the emesis cascade,
TIVA with propofol — the cleaner choice is made,
Remifentanil infusion keeps the analgesia tight,
Motor evoked potentials read crisp and bright,
You didn't guess — you cross-referenced the evidence,
Then documented why, with clinical deference
Ask yourself: could I defend this to a skeptic in review?
If the answer hesitates, there's more work left to do
[Verse 3]
Self-assessment isn't ego, isn't checking off a box,
It's interrogating comfort zones, dismantling the blocks,
Did the induction go exactly as I planned it?
Where did I improvise — and do I understand it?
Write the case debrief while the memory runs hot,
Identify the three things that worked, the two that did not,
Calibrated confidence — not too tight, not too loose,
Knowing where your ceiling is cuts medical misuse
The attending watched you manage every pivot, every turn,
But the sharper judge is inward — what did you actually learn?