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Episode 135: A Case For Low Dose Norepinephrine

In this 135th episode I discuss my argument for using low dose norepinephrine to treat or even prevent hypotension in the OR and ICU. I discuss the CENSER trial looking at early norepinephrine in sepsis as well as a paper looking at preemptive norepinephrine in open cystectomies and a review article of trials looking at pressor use in free flap surgery. Join in the conversation here with your comments and on the ACCRAC Facebook page and Twitter @accracpodcast and @jwolpaw.

References:

CENSER: https://www.atsjournals.org/doi/full/10.1164/rccm.201806-1034OC

Cystectomies: https://www.ncbi.nlm.nih.gov/pubmed/24012203

Free Flaps: https://www.ncbi.nlm.nih.gov/pubmed/26340760

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Episode 133: Introducing the Depth of Anesthesia Podcast

In this 133rd episode we bring you the first episode from a new, fantastic anesthesia podcast called “Depth of Anesthesia” hosted by David Hao at MGH. in this episode they explore the evidence behind verifying mask ventilation before administering paralytic.

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Episode 131: Disabilities in Medicine with Drs. Meeks, Brookman and Fitzsimons

In this 131st episode I welcome Drs. Meeks, Brookman and Fitzsimons to the show to discuss what it means to be a resident with a disability, what needs to be done to assure adequate and legal accommodations for these trainees, and why it’s important to do so.

References:

Meeks LM, Herzer KR. Prevalence of self-disclosed disability among medical students in US allopathic medical schools. Jama. 2016 Dec 6;316(21):2271-2. https://jamanetwork.com/journals/jama/article-abstract/2589334 

Meeks, L.M., & Jain, N.R. (2018). Accessibility, inclusion, and action in medical education: Lived experiences of learners and physicians with disabilities. Washington, D.C.: Association of American Medical Colleges. 

Meeks, L.M., Herzer, K., & Jain, N.R. (2018). Removing barriers and facilitating access: Increasing the number of physicians with disabilities (Invited Commentary).Academic Medicine, 93(4), 540-543. doi:10.1097/ACM.0000000000002112 https://bit.ly/2Gyx53x 

Meeks, L.M., & Jain, N.R. (2018). Accessibility, inclusion, and action in medical education: Lived experiences of learners and physicians with disabilities. Washington, D.C.: Association of American Medical Colleges. https://store.aamc.org/accessibility-inclusion-and-action-in-medical-education-lived-experiences-of-learners-and-physicians-with-disabilities.html 

Meeks LM, Jain NR. The guide to assisting students with disabilities: equal access in health science and professional education. Springer Publishing Company; 2015 Aug 13. https://books.google.com/books?hl=en&lr=&id=a1LSCgAAQBAJ&oi=fnd&pg=PP1&dq=Meeks+LM&ots=uXnapo3t_7&sig=2HN6lTPwBo7G9VdlXht9cIccrXg#v=onepage&q=Meeks%20LM&f=false 

Fitzsimons MG, Brookman JC, Arnholz SH, Baker K. Attention-deficit/hyperactivity disorder and successful completion of anesthesia residency: a case report. Academic Medicine. 2016 Feb 1;91(2):210-4. https://www.ncbi.nlm.nih.gov/pubmed/26244258 

Schwarz CM, Zetkulic M. You Belong in the Room: Addressing the Underrepresentation of Physicians With Physical Disabilities. Academic Medicine. 2019;94(1):17-9. https://www.ncbi.nlm.nih.gov/pubmed/30157092 

AAMC Webinars on Disability. https://www.aamc.org/members/gsa/pdopportunities/427068/archivedwebinars.html

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Episode 130: Adults with Congenital Heart Disease with Jochen Steppan

In this 130th episode I welcome back Dr. Jochen Steppan to discuss the perioperative care of adults with congenital heart disease. We discuss the incidence, evaluation and management including the different types of physiology that a provider might see and how to manage each one.

References:

http://www.pted.org/ For pictures of the lesions

Stoelting’s Anesthesia and Co-Existing Disease, 7th EditionChapter 7 “Congenital Heart Disease” by Jochen Steppan and Bryan Maxwell 

Int Anesthesiol Clin. 2018 Fall;56(4):3-20. “When Your 35-Year-Old Patient has a Sternotomy Scar: Anesthesia for Adult Patients with Congenital Heart Disease Presenting for Noncardiac Surgery” By Cheema A, Ibekwe S, Nyhan D, Steppan J.

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Episode 129: Vascular Access with Dave Berman

In this 129th episode I welcome Dr. Dave Berman back to the show to discuss vascular access devices. We talk about what kinds of lines exist, how to choose, what the pros and cons are, and how to know what kind of flow you will get with a given catheter.

References are here:

ReferencesDownload

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Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna

In this 128th episode I welcome Dr. Ashish Khanna to the show to discuss his trial, the PRODIGY trial, looking at opioid induced respiratory depression. We discuss the background of the trial, what it took to run a 16 site, 3 continent trial, what the risk factors were that went into the risk prediction model they developed, and where we go from here.

References:

Sun Z, Sessler DI, Dalton JE, et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth Analg. 2015;121(3):709–715. doi:10.1213/ANE.0000000000000836

Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015 Mar;122(3):659-65. doi: 10.1097/ALN.0000000000000564.

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Episode 127: Upper Extremity Blocks with Drs. Segna and Rayaz

In this 127th episode I welcome Drs. Segna and Rayaz to the show to discuss upper extremity nerve blocks. We discuss how they’re done, what they’re done for, and some high yield board style questions that may come up based on them.

References:

Hadzic, Admir. Hadzic’s textbook of regional anesthesia and acute pain management. McGraw Hill Professional, 2017.

Hall, Brian A., and Robert C. Chantigian. Anesthesia: A Comprehensive Review E-Book. Elsevier Health Sciences, 2014.

Horlocker, Terese T., Erik Vandermeuelen, Sandra L. Kopp, Wiebke Gogarten, Lisa R. Leffert, and Honorio T. Benzon. “Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines.” Regional anesthesia and pain medicine43, no. 3 (2018): 263-309.

Interscalene:

Ultrasound-Guided Interscalene Brachial Plexus Block

Supraclavicular:

Ultrasound-Guided Supraclavicular Brachial Plexus Block

Infraclavicular:

Ultrasound-Guided Infraclavicular Brachial Plexus Block

Axillary:

Ultrasound-Guided Axillary Brachial Plexus Block

https://www.nysora.com/techniques/upper-extremity/

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Episode 125: Abusive Head Trauma with Erik Smith

In this 125th episode I welcome Dr. Erik Smith to the show to discuss Abusive Head Trauma (formerly known as shaken baby syndrome). We discuss how victims present, what to look out for, how to manage their anesthesia, how to report, and how it can impact providers.

References:

Christian, C. W., Block, R., Committee on Child Abuse and Neglect, & American Academy of Pediatrics. (2009). Abusive Head Trauma in Infants and Children. PEDIATRICS, 123(5), 1409–1411. https://doi.org/10.1542/peds.2009-0408

Gazoni, F. M., Amato, P. E., Malik, Z. M., & Durieux, M. E. (2012). The Impact of Perioperative Catastrophes on Anesthesiologists. Anesthesia & Analgesia, 114(3), 596–603. https://doi.org/10.1213/ANE.0b013e318227524e

Kochanek, P. M., Tasker, R. C., Carney, N., Totten, A. M., Adelson, P. D., Selden, N. R., … Wainwright, M. S. (2019). Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition. Pediatric Critical Care Medicine, 20, S1–S82. https://doi.org/10.1097/PCC.0000000000001735

Lee, J. K., Brady, K. M., & Deutsch, N. (2016). The Anesthesiologist’s Role in Treating Abusive Head Trauma. Anesthesia & Analgesia, 122(6), 1971–1982. https://doi.org/10.1213/ANE.0000000000001298

Smith, E. B., Lee, J. K., Vavilala, M. S., & Lee, S. A. (2019). Pediatric Traumatic Brain Injury and Associated Topics: An Overview of Abusive Head Trauma, Nonaccidental Trauma, and Sports Concussions. Anesthesiology Clinics, 37(1), 119–134. https://doi.org/10.1016/J.ANCLIN.2018.10.002

Vavilala, M. S., Lee, L. A., & Lam, A. M. (2003). The lower limit of cerebral autoregulation in children during sevoflurane anesthesia. Journal of Neurosurgical Anesthesiology, 15(4), 307–312. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14508171