Category Archives: Anesthesia

Episode 130: Adults with Congenital Heart Disease with Jochen Steppan

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 130: Adults with Congenital Heart Disease with Jochen Steppan
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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.

CME: https://earnc.me/xdIQHT

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.

Episode 129: Vascular Access with Dave Berman

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 129: Vascular Access with Dave Berman
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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.

CME: https://earnc.me/KmE3f4

References are here:

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

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna
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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.

CME: https://earnc.me/jQCZV8

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.

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

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 127: Upper Extremity Blocks with Drs. Segna and Rayaz
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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.

CME: https://earnc.me/enjJHh

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:

Supraclavicular:

Infraclavicular:

Axillary:

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

Episode 126: Key Words with Gillian Isaac Part 2: Ketamine and Laryngospasm

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 126: Key Words with Gillian Isaac Part 2: Ketamine and Laryngospasm
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In this 126th episode I welcome back Dr. Gillian Isaac to discuss 2 more ABA key words: Ketamine and Laryngospasm.

CME: https://earnc.me/GbYGLA

Episode 125: Abusive Head Trauma with Erik Smith

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 125: Abusive Head Trauma with Erik Smith
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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.

CME: https://earnc.me/iFmtNQ

References:

Christian, C. W., Block, R., Committee on Child Abuse and Neglect, & American Academy of Pediatrics. (2009). Abusive Head Trauma in Infants and Children. PEDIATRICS123(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 & Analgesia114(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 Medicine20, 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 & Analgesia122(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 Clinics37(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 Anesthesiology15(4), 307–312. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14508171

Episode 124: POCUS with Lee Goeddel

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 124: POCUS with Lee Goeddel
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In this 124th episode I welcome Dr. Lee Goeddel to the show to discuss Point Of Care Ultrasound (POCUS). We discuss what it is, what it covers in the cardiac, pulmonary, abdominal and vascular system, and what next steps are for those interested in taking their skills further.

CME: https://earnc.me/aEbwZG

References:

Anesth Analg. 2017 Mar;124(3):753-760. doi: 10.1213/ANE.0000000000001861.The Nuts and Bolts of Performing Focused Cardiovascular Ultrasound (FoCUS).PMID:28207445 

J Am Soc Echocardiogr. 2013 Jun;26(6):567-81. doi: 10.1016/j.echo.2013.04.001.Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.Spencer KT1, Kimura BJKorcarz CEPellikka PARahko PSSiegel RJ.PMID 23711341

Chest. 2015 Jun;147(6):1659-1670. doi: 10.1378/chest.14-1313.BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill.Lichtenstein DA1.PMID: 26033127

Surg Clin North Am. 2011 Feb;91(1):195-207. doi: 10.1016/j.suc.2010.10.008.Focused assessment with sonography for trauma: methods, accuracy, and indications.Patel NY1, Riherd JM. PMID: 21184909 

Episode 123: Surgical Airway with Andrew Merelman

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 123: Surgical Airway with Andrew Merelman
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In this 123rd episode I welcome Andrew Merelman to the show. Andrew is a paramedic and medical student with an interest in emergent surgical airway management. We discuss the human factors involved in the procedure, when it is indicated, how to do it and how to practice.

CME: https://earnc.me/kFl0sc

References and Links:

Airway Ap information:


http://www.airwaycollaboration.org/

iOS – https://itunes.apple.com/ca/app/the-airway-app/id1112657910?mt=8

Android- https://play.google.com/store/apps/details?id=com.parse.airway&hl=en 

3D printed models – https://link.springer.com/article/10.1007%2Fs12630-017-0926-9 Videos:

https://vimeo.com/132394603

https://vimeo.com/132394747

https://emcrit.org/emcrit/real-surgical-airway/

https://www.airmedicaljournal.com/article/S1067-991X(09)00037-6/fulltext

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727957/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749220/

https://www.ncbi.nlm.nih.gov/pubmed/20491685

https://www.ncbi.nlm.nih.gov/pubmed/30173584
https://journals.lww.com/jtrauma/Citation/2012/09000/Is_bougie_aided_cricothyrotomy_really__extremely.42.aspx

https://www.researchgate.net/publication/253332531_Comparison_of_a_percutaneous_device_and_the_bougie-assisted_surgical_technique_for_emergency_cricothyrotomy_an_experimental_study_on_a_porcine_model_performed_by_air_ambulance_anaesthesiologists

https://www.ncbi.nlm.nih.gov/pubmed/30686312

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6078881/

Episode 122: Key Words Part 1 with Gillian Isaac: Crichothyroid Membrane and Propofol

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 122: Key Words Part 1 with Gillian Isaac: Crichothyroid Membrane and Propofol
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In this 122nd episode Dr. Gillian Isaac and I launch the first in a series of episodes to give high yield information on ABA key words. The first two we address are the crichothyroid membrane and propofol.

CME: https://earnc.me/rEWDXU

Episode 121: Difficult Airway Response Team With Lynette Mark

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 121: Difficult Airway Response Team With Lynette Mark
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In this 121st episode I welcome Dr. Lynette Mark to the show. Dr. Mark is the founder of our Difficulty Airway Response Team (DART) here at Hopkins and a founding director for the Society of Airway Management. We discuss the origins of the DART program and how to approach a difficult airway.

CME: https://earnc.me/z1E2G1

References:

https://www.criticalcare.theclinics.com/article/S0749-0704(17)30102-1/abstract

Difficult Airway Algorithm and Rescue Cricothyrotomy (DAARC): http://sgschallenge.com/2018daarc/

https://wamm2019.com World Airway Management Meeting, Amsterdam, Netherlands, November, 2019. Drs. Mark and Feinleib will be presenting about the DART program.

Dr. Cooper’s article on surgical airway: https://anesthesiology.pubs.asahq.org/article.aspx?articleid=2724164

Dr. Mark’s article from A&A and the accompanying editorial:

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

https://www.ncbi.nlm.nih.gov/pubmed/26086503