This is the second of two episodes about opioid medications. In this episode I cover the pharmacokinetics and pharmacodynamics of opioids, some of the common uses for these medications, mixed agonist-antagonist compounds, opioid antagonists, and opioid interaction with other medications.
Slides to go along with this episode are here: Opioids part 2
This is the first of a 2 part series on opioid medications. In this first episode I will talk about how opioids are categorized and their effects on the different body systems. In the next episode I will discuss their pharmacokinetics and pharmacodynamics as well as their various uses and some details on mixed agonist/antagonists.
Slides to go along with this episode are here: Opioids part 1
PLEASE NOTE: Around minute 12 I say that auditory evoked potentials are the most sensitive to anesthetics. This is incorrect. I should have said visual evoked potentials. Thanks to Howard Zee for catching that!
In this episode I welcome Dr. David Mintz, one of our neuroanesthesiologists here at Johns Hopkins, fellow Brown University Alum, and generally all around great guy, to the show to talk about air embolism, what it is, how it happens and how to manage it. A big thanks to Dave for taking the time to prepare this information and for being the first ever guest on ACCRAC.
Outline by Brian Park: Outline
In this episode I discuss hyperoxia and review the evidence in regards to the damage it can cause in patients with a wide variety of illnesses.
Slides to accompany the episode can be found here: hyperoxia slides
In this episode I review the common IV agents used in anesthesia excluding opioids. I cover Propofol, Barbiturates, Benzodiazepines, Ketamine, Etomidate and Dexmedetomidine.
NOTE: There is an error in the audio recording regarding the dosing units for dexmedetomidine. I say on the podcast that the dosing units are mcg/kg/min which is INCORRECT. The correct dosing units are mcg/kg/HOUR. I have corrected this in the accompanying slides. Thanks to Melanie Browder for picking this up!
Good luck to the recent graduates taking their written board exam on July 29th!
Slides to go along with the podcast are here: IV induction agents slides
In this episode I review the basic medication setup for the operating room including premedication, induction, neuromuscular blockade, antibiotics, reversal and antiemetics. I discuss weight based dosing and comment on a few alternatives to consider once you have the basic setup down. This episode should be useful for new CA-1s getting started in the OR but I would also like to ask senior residents to comment on what their basic setup is and how it may differ from what I’ve mentioned here.
Here is a list of the medications I discuss: Basic med setup w dosing
This is the second and final episode dealing with the management of respiratory diseases. In the first episode I covered the initial evaluation and preop preparation. In this episode I cover intraoperative management, post-operative management, special issues related to one lung ventilation and special issues related to total pneumonectomy.
Slides to go along with the episode can be downloaded here: Management of Respiratory Diseases part 2 slides
This is the first of a two part series of episodes on the management of patients with respiratory disease. In this, part 1, I cover the preoperative evaluation, history and physical exam, and the preoperative planning and optimization of the patient. This includes the key board topics of smoking cessation and cardiac risk assessment.
Here are the slides that go along with this episode: Management of Respiratory Diseases slides part 1
In this episode I first announce the new ACCRAC website here at ACCRAC.com. Big thanks to Bryan Mariscalchi for his help setting it up. I also mention the problem the last two episodes had with only playing out of one ear on earphones. I hope I’ve cleared that problem up. I mention a fantastic book called “Missing Microbes” by Martin Blaser, here is a link to the NY Times review: Missing Microbes
The bulk of the episode is a description of the paraglossal approach to endotracheal incubation. Here is a youtube link to a video of the technique: Paraglossal video
Have you ever used this technique? Do you like it?
There are a few announcements I wanted to make including:
Check out pedsanesthesia.net. Dr. Robert Greenberg, a pediatric anesthesiologist here at Johns Hopkins runs it and it has lots of great information and topics in pediatric anesthesiology.
If you have suggestions for a better website than this one please let me know!
If you know a good way to set up an email list serve for these kinds of announcements please let me know that as well.
And, finally, I address a surgeon’s comment to one of our residents that you should always use 100% fio2 when ventilating one lung during a thoracic case. Listen to the podcast for details but the bottom line is you should NOT use 100% oxygen unless you have to in order to prevent hypoxia.
Here is a link to a great review on this topics published last year in Critical Care: https://www.ncbi.nlm.nih.gov/pubmed/26278383