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 103: Neuromonitoring with Drs. Ritzl and Russo

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 77: Reversal of Neuromuscular Blockade

In this episode, episode 77, I discuss reversal of neuromuscular blockade.  This is a follow up to episode 66 in which I covered neuromuscular blockade.

Outline by Brian Park: NMB Reversal Outline

References:

Miller’s Anesthesia 8th Edition. Reversal (Antagonism) of Neuromuscular Blockade. Murphy GS, de Boer HD, Eriksson LI and Miller RD. Chapter 35, 995-1027.e5.

Appiah-Ankam J, Hunter J.  Pharmacology of neuromuscular blocking drugs.  Cont Educ Anaesthesia Critical Care & Pain.  2004;4(1):2-7.

Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017 Aug 14;8:CD012763.

Keating GM. Sugammadex: A Review of Neuromuscular Blockade Reversal. Drugs. 2016 Jul;76(10):1041-52.

McLean DJ, Diaz-Gil D, Farhan HN, Ladha KS, Kurth T, Eikermann M. Dose-dependent Association between Intermediate-acting Neuromuscular-blocking Agents and Postoperative Respiratory Complications. Anesthesiology. 2015 Jun;122(6):1201-13.

Schaller S, Fink H.  Sugammadex as a reversal agent for neuromuscular block: an evidence-based review.  Core Evidence.  2013;8:57-67.

Episode 66: Neuromuscular Blockers

In this episode, episode 66, I go through an overview of neuromuscular blockers including how they work, how to use them, and what their adverse effects are.  Happy New Year!

The dose of glycopyrrolate should be 0.01 to 0.015mg/kg, not 0.1 to 0.15.

Outline by Brian Park: Outline

References:

Miller’s Anesthesia 7th edition: Chapter 29: Pharmacology of Muscle Relaxants and Their Antagonists. Naguib M and Lien C.

Rocuronium vs succinylcholine for rapid sequence induction intubation. https://www.ncbi.nlm.nih.gov/pubmed/26512948

Neuromuscular blockade: what was, is and will be: https://www.ncbi.nlm.nih.gov/pubmed/25622380

Reversal of neuromuscular block: https://www.ncbi.nlm.nih.gov/pubmed/19468024

Episode 58: Medications For Neuraxial Anesthesia with Dave Berman and Anh Nguyen

In this episode, episode 58, I welcome our two OB Anesthesia fellows to the show, Dr. Dave Berman and Dr. Anh Nguyen.  We discuss the medications used for neuraxial anesthesia including local anesthetics, opioids, and adjuncts such as epinephrine, clonidine and more.

Dave’s email is dberma20@jhmi.edu and Anh’s is tnguy193@jhmi.edu.

References can be found here: Neuraxial references

Episode 53: Analgesia for C-section with Mike Hofkamp

In this episode, episode 53, I welcome back Dr. Mike Hofkamp to discuss analgesia for cesarean delivery.  We discuss indications for C-section, urgent and emergent sections, anesthetic techniques and associated complications, how to approach the difficult airway in a pregnant patient, and aspiration prophylaxis.

References to the articles discussed are here: References

Episode 51: Labor Analgesia with Jacqueline Galvan

In this episode, episode 51, I welcome back Dr. Jacqueline Galvan to discuss labor analgesia.  We cover opioids including remifentanil, nitrous oxide, neuraxial anesthesia and other nerve blocks.

References:

  • Hess PE, et al. An association between severe labor pain and cesarean delivery. Anesth Analg. 2000 Apr;90(4):881-6
  • Van den Bussche E. Why women prefer epidural analgesia during childbirth: the role of beliefs about epidural analgesia and pain catastrophizing. Eur J Pain. 2007 Apr;11(3):275-82.
  • Varposhti MR et al. Comparison of remifentanil: Entonox with Entonox alone in labor analgesia. Adv Biomed Res. 2013 Nov 30;2:87