ACCRAC Podcast

A Podcast for Anesthesia and Critical Care Reviews, Debates and Commentary

ANESTHESIA AND CRITICAL CARE REVIEWS AND COMMENTARY

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

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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

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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

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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).

Episode 105: Blood Management Part 1 With Drs. Frank & Cha

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In this 105th episode, which will be the first part in a series on blood management, I turn over the mic to Dr. Stephanie Cha who interviews Dr. Steve Frank about blood management in cardiac surgery and how to do “bloodless” surgery for patients who refuse blood transfusions.

References:

1.         Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussieres JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Network AIotACT. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 2017;376:136-48.
2.         Frank SM, Wick EC, Dezern AE, Ness PM, Wasey JO, Pippa AC, Dackiw E, Resar LM. Risk-adjusted clinical outcomes in patients enrolled in a bloodless program. Transfusion 2014;54:2668-77.
3.         Cho BC, DeMario VM, Grant MC, Hensley NB, Brown CHt, Hebbar S, Mandal K, Whitman GJ, Frank SM. Discharge hemoglobin level and 30-day readmission rates after coronary artery bypass surgery. Anesth Analg 2018.
4.         Pattakos G, Koch CG, Brizzio ME, Batizy LH, Sabik JF, 3rd, Blackstone EH, Lauer MS. Outcome of patients who refuse transfusion after cardiac surgery: A natural experiment with severe blood conservation. Arch Intern Med 2012;172:1154-60.
5.         Frank SM, Scott AV, Resar LM. Bloodless medicine and surgery: Top 10 things to consider.Anesthesiology News 2016.

Episode 103: Neuromonitoring with Drs. Ritzl and Russo

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In this 103rd episode I welcome Dr. Eva Ritzl and Dr. Alyson Russo to the show to discuss intraoperative neuromonitoring.

Reference: Solt K and Froman S. Correlating the clinical actions and molecular mechanisms of general anesthetics. Curr Op in Anaes. 2007:20(4);300-306.

Episode 101: Coming off Bypass with Stephen Freiberg

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In this 101st episode I welcome back Dr. Stephen Freiberg to the show to discuss how to successfully come off bypass when doing cardiac surgery with cardiopulmonary bypass.

References:

-Barash Anesthesia for Cardiac Surgery
-Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg 2015; 120:749.
-Denault AY, Tardif JC, Mazer CD, et al. Difficult and complex separation from cardiopulmonary bypass in high-risk cardiac surgical patients: a multicenter study. J Cardiothorac Vasc Anesth 2012; 26:608.
-Lomivorotov VV, Efremov SM, Kirov MY, et al. Low-Cardiac-Output Syndrome After Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:291.
-McKinlay KH1, Schinderle DB, Swaminathan M, Podgoreanu MV, Milano CA, Messier RH, El-Moalem H, Newman MF, Clements FM, Mathew JP.JPredictors of inotrope use during separation from cardiopulmonary bypass.  Cardiothorac Vasc Anesth. 2004 Aug;18(4):404-8.

Episode 99: Substance Abuse in Anesthesia Providers with Mike Fitzsimons

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In this episode, episode 99, I welcome Dr. Mike Fitzsimons from MGH to the show to talk about substance abuse in anesthesia providers and his recent article in Anesthesiology detailing their program to decrease rates of abuse.

References:

https://www.ncbi.nlm.nih.gov/pubmed/30020101

 

Episode 96: Peds difficult airway with Nick Dalesio

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In this episode, episode 96, I welcome Dr. Nick Dalesio to the show.  Dr. Dalesio is the director of the pediatric difficult airway program here at Johns Hopkins.  We discuss the pediatric difficult airway response team, consult service, and how to anticipate and manage difficult airways in kids, both anticipated and unanticipated.

Reference:

https://www.apsf.org/article/planning-prevents-poor-performance-an-approach-to-pediatric-airway-management/