Episode 115: The Contaminated Airway with Steve Freiberg

In this 115th episode I welcome Dr. Steven Freiberg back to the show to discuss management of the contaminated airway.

References:

Han, S; Fisher, J. Airway Management During Persistent Flooding Of the Oropharyngeal Airway.  Anesthesiology News. 2016. March.

Joshi, R; Hypes, C; et al.  Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video Laryngoscopy in the Intensive Care Unit.  Ann Am Thorac Soc. 2017 Mar;14(3):368-375

Stockton, E.; Lockey, D; et. al.  Contamination of the airway in pre-hospital trauma patients. European Journal of Anaesthesiology. 2008. May; 25:188

Uday, J; McCunn, M; et al. Management of the Traumatized Airway.  Anesthesiology. 2016, Vol.124, 199-206

Episode 114: The Business of Anesthesia with Jerry Stonemetz

In this 114th episode I welcome Dr. Jerry Stonemetz to the show to discuss the business side of Anesthesiology. Specifically we discuss billing, compliance, contract negotiation and Jerry’s thoughts on where the industry is heading.

Slides are here:

Episode 113: Anesthesia for Aneurysm Clipping With Dave Mintz

In this 113th episode I welcome Dr. David Mintz back to the show to discuss anesthesia for intracranial aneurysm clipping.

References:

Chapter 13 Anesthetic management of cerebral aneurysm surgery in Cottrell and Young, Neuroanesthesia

https://www.ncbi.nlm.nih.gov/pubmed/25014255

Episode 112: Anesthesia for ECT with Christina Miller

In this 112th episode I welcome Dr. Christina Miller to the show to discuss Anesthesia for Electroconvulsive Therapy (ECT).

References:

Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002 May;94(5):1351-64.

Sadowksy, Jonathan. Electroconvulsvie Therapy: A History of Controversy, but Also of Help.  The Conversation. Scientific American.  January 13, 2017.

Wright, M.D., Bruce A. (1990) “An Historical Review of Electroconvulsive Therapy,” Jefferson Journal of Psychiatry: Vol. 8 : Iss. 2 , Article 10.

Nishihara F, Saito S. Pre-ictal bispectral index has a positive correlation with seizure duration during electroconvulsive therapy. Anesth Analg. 2002 May;94(5):1249-52, table of contents.

Gombar S, Aggarwal D, Khanna AK, Gombar KK, Chavan BS. The bispectral electroencephalogram during modified electroconvulsive therapy under propofol anesthesia: relation with seizure duration and awakening. J ECT. 2011 Jun;27(2):114-8.

Sartorius A, Muñoz-Canales EM, Krumm B, Krier A, Andres FJ, Bender HJ, Henn FA. ECT anesthesia: the lighter the better? Pharmacopsychiatry. 2006 Nov;39(6):201-4. 

Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg. 2004 Sep;99(3):833-9

Episode 111: Tracheostomies, Cricothyrotomies and ENT surgery with Dr. Zandy Hillel

In this 111th episode I welcome Dr. Zandy Hillel to the show. Dr. Hillel is an otolaryngologist here at Johns Hopkins and we discuss tracheostomies, Cricothyrotomies, laryngeal surgery and difficult airways.

References:

Crichothyrotomies:

https://www.ncbi.nlm.nih.gov/pubmed/30054081

https://www.ncbi.nlm.nih.gov/pubmed/30726035

Difficult Airway Response Teams:

https://www.ncbi.nlm.nih.gov/pubmed/26086513

Episode 110: Financial Planning For Healthcare Providers With Justin Harvey

In this 110th episode I welcome Justin Harvey to the show. Justin is a financial planner with an interest in helping anesthesiologists and pain specialists make the best possible financial choices. We discuss financial planning, managing loan repayment, and investing.

Justin’s email: Justin@quantifiplanning.com

Justin’s podcast: AnesthesiaSuccess.com

Justin’s financial planning company: www.quantifiplanning.com

XY Planning network: https://www.xyplanningnetwork.com

Student Loan Planner: https://www.studentloanplanner.com

Resources for getting started with investing:
https://investor.vanguard.com/investing/how-to-invest/asset-allocationhttps://www.marketwatch.com/lazyportfoliohttps://www.amazon.com/Investment-Answer-Daniel-C-Goldie/dp/1455503304/

Places to find a fee-only financial advisor:www.xyplanningnetwork.comwww.napfa.org


Other physician finance blogs Justin Recommends:

whitecoatinvestor.com

physicianonfire.comthephysicianphilosopher.com


A fun calculator to see how soon you can retire based on your monthly free cash flow: 

https://networthify.com/calculator/earlyretirement

Episode 109: Non-Opioid Adjuncts with Drs. Grant and Bicket part 2

In this 109th episode we pick up where we left off in episode 108 and discuss the intraoperative use of non-opioid adjuncts.

References:

Wick EC, Grant MC and Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques A Review. JAMA Surg. 2017;152(7):691-697.

Bahr MP, Williams BA. Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care. Regional Anesthesia and Pain Medicine. 2018:43(8):815-818.

Grant MC, Ouanes JP, Joshi BL. Perioperative Esmolol and Opioids: Is More Really Less? Regional Anesthesia and Pain Medicine. 2018:43(8):813-814.

IV Lidocaine: https://academic.oup.com/bjaed/article/16/9/292/1743710

Ketamine: https://www.ncbi.nlm.nih.gov/pubmed/29870457

Dextramethorphan: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755866

Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1

In this 108th episode I welcome Dr. Mike Grant and Dr. Mark Bicket to the show to discuss various non-opioid adjuncts such as esmolol, ketamine, dexmedetomidine, lidocaine, and magnesium, and the role they may play in multimodal anesthesia. In this episode, part 1, we discuss pre and post-op use. Intraop use will be discussed in episode 109.

References:

Wick EC, Grant MC and Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques A Review. JAMA Surg. 2017;152(7):691-697.

Bahr MP, Williams BA. Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care. Regional Anesthesia and Pain Medicine. 2018:43(8):815-818.

Grant MC, Ouanes JP, Joshi BL. Perioperative Esmolol and Opioids: Is More Really Less? Regional Anesthesia and Pain Medicine. 2018:43(8):813-814.

IV Lidocaine: https://academic.oup.com/bjaed/article/16/9/292/1743710

Ketamine: https://www.ncbi.nlm.nih.gov/pubmed/29870457

Dextramethorphan: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755866/ R

Episode 107: Suicide in Anesthesia with Mike Fitzsimons

In this 107th episode I welcome Dr. Mike Fitzsimons back to the show to discuss the topic of suicide in physicians in general and in Anesthesia providers specifically.

References:

  1. Bucknill JC, Duke DH. A Manual of Psychological Medicine. London, England: John Churchill;1958
  2. Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC, Nasca TJ. Cause of Death of Residents in ACGME-Accredited Programs 2000-2014: Implications for the eLearning Environment. Acad Med 2017;92:976-983.
  3. Alexander BH, Checkoway H, Nagahama SI, Domino KB. Cause-specific Mortality Risks of Anesthesiologists. Anesthesiology 2000;93:922-930.
  4. Center C, Davis M, Detre T, Ford DE, Hansbrough, Hendin H, et al. Confronting Depression and Suicide in Physicians A Consensus Statement. JAMA 2003;289:3161-3166.
  5. Dyrbye LN, Eacker A, Durning SJ, Brazeau C, Moutier C, Massie FS, Satele D, Sloan JA, Shanafelt TD. The Impact of Stigma and Personal Experiences on the Help-Seeking Behaviors of Medical Students with Burnout. Acad Med 2015;90:961-9.
  6. Moutier C, Norcross W, Jong P, Normal M, Kirby B, McGuire T, Zisook S. The Suicide Prevention and Depression Awareness Program at the University of California, San Diego School of Medicine. Acad Med 2010;87:320-326.
  7. Knox KL, Litts DA, Talcott GW, Feig JC, Caine ED. Risk of suicide and related outcomes after exposure to a suicide prevention programme in the US Air Force: cohort study. BMJ 2003;327:1-5
  8. DesRoches CM, Rao SR, Fromson JA, Iezzoni L, Vogeli C, Campbell EG. Physicians’ Perceptions, Preparedness for Reporting Impaired and Incompetent Colleagues. JAMA 2010;304:187-193.
  9. Bruce DL, Eide KA, Linde HW, Eckenhoff JE. Causes of Death among Anesthesiologists: A 20-Year Survey. Anesthesiology 1968;29:565-569.
  10. Knox KL, Pflanz S, Talcott GW, Campise RL, Lavigne JE, Bjorska A, Tu X, Caine ED. The US Air Force Suicide Prevention Program: Implications for Public Health Policy. Am J Public Health 2010;100:2457-2463.
  11. Hazell P. Adolescent suicide clusters: Evidence, mechanisms, and prevention. Australian and New Zealand Journal of Psychiatry. 1993;27:653-665.

Episode 106: Hydroxyethyl Starches with Marius Fassbinder

In this 106th episode I welcome Dr. Marius Fassbinder to the show to discuss the use of hydroxyethyl starches.

References:

1. Woodcock, T. E. & Woodcock, T. M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an

improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia 108, 384–394 (2012).

2. Westphal, M. et al. Hydroxyethyl starches: different products–different effects. Anesthesiology 111, 187–202 (2009).

3. Brunkhorst, F. M. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N. Engl. J. Med. 358, 125–139

(2008).

4. Perner, A. et al. Hydroxyethyl Starch 130/0.42 versus Ringer’s Acetate in Severe Sepsis. N. Engl. J. Med. 367, 124–134 (2012).

6. Myburgh, J. A. et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N. Engl. J. Med. 367, 1901–1911

(2012).

7. Annane, D. et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with

hypovolemic shock: the CRISTAL randomized trial. JAMA 310, 1809–1817 (2013).

8. Joosten, A. et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A

Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery. Anesthesiology 128, 55–66 (2018).

9. Gillies, M. A. et al. Incidence of postoperative death and acute kidney injury associated with 6% hydroxyethyl starch use: systematic review and meta-analysis. British Journal of Anaesthesia 112, 25–34 (2014).