Episode 183: Keywords Part 13 with Gillian Isaac: Thyroid for the Basic and Advanced Exams

In this 183rd episode I welcome back Dr. Gillian Isaac to do another keyword episode where we review the ABA keyword topics of Thyroid for the Basic Exam and Thyroid for the Advanced Exam.

References:

Barash Clinical Anesthesia 8th edition

American Board of Anesthesiology Website

Anesthesiahub.com

Random Recs:

Serious Eats Brown Butter Cookie Dough Recipe: Link

The Dragon Prince: https://en.wikipedia.org/wiki/The_Dragon_Prince

Episode 180: Keywords part 12 with Gillian Isaac: Local Anesthetics

In this 180th episode I welcome back Dr. Gillian Isaac for another ABA keyword episode. We review local anesthetics.

Also check out Episode 41 for an in-depth episode on local anesthetics

CORRECTION: At 28:58 I state that hyperventilation increases the seizure threshold. This is incorrect, it DECREASES the seizure threshold.

Reference: Barash Clinical Anesthesia 8th edition: Chapter on Local Anesthetics
Outline by Brian Park, MD

Local anesthetics block nerve conduction by?
a. Closing calcium channels
b. Decreasing intracellular sodium concentration
c. Decreasing K conductance
d. Causing extrusion of intracellular K
e. Inhibiting cellular influx of sodium

Discussion (4:44)

See full interactive post

Episode 176: Keywords Part 11: Barbiturates and Bier Blocks

In this 176th episode I welcome Dr. Gillian Isaac back to the show to discuss another 2 ABA key words. This time we discuss Barbiturates and Bier Blocks. I also take a moment up front to share some thoughts on the horrible tragedy of George Floyd’s death at the hands of the police and the importance of acknowledging white privilege and fighting for the fact that Black Lives Matter.

Reference: Clinical Anesthesia. Publication Year: 2017. Edition: 8th Ed. Authors/Editor: Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.; Cahalan, Michael K.; et al.
Outline by Brian Park, MD

Awakening after a single dose of thiopental is caused by redistribution from the brain primarily to which of the following sites?
(A) Fat
(B) Heart
(C) Liver
(D) Lung

Discussion (11:00)

See full interactive episode

Episode 174: Keywords Part 10: OR Fires and Electrical Safety

In this 174th episode I welcome back Dr. Gillian Isaac to discuss another 2 highly tested ABA keywords, OR fires and electrical safety in the OR.

OR Fires

Fire Triangle (2:52)
Most important aspect of OR fire management? (3:22)

Risk for airway fire during laser resection of tracheal tumor DECREASED in
A. CO2 rather than GAD laser
B. Helium > 60%
C. N2O > 60%
D. PVC ETT
E. Halothane in mixture

Discussion (5:24)


View full interactive post

Episode 164: Keywords part 9: Fentanyl and Breathing Circuits

In this 164th episode I welcome back Dr. Gillian Isaac to do another ABA keywords episode. We discuss fentanyl and breathing systems (Mapleson and Circle systems).

Great info from Aaron Sandock:

The toxicity was reported in rats and research was published in the early-mid 90’s. 

Gonsowski, C., Laster, M., Eger, E., Ferrell, L. and Kerschmann, R. Toxicity of Compound A in Rats: Effect of a 3-Hour Administration

Anesthesiology. 1994;80(3):566-573. 

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1949689

It is actually the case that follow up studies were done in the US on volunteer patients through University of Arizona and Medical College of Wisconsin in the later 1990’s.Ebert, T., Frink, E. and Kharasch, E. Absence of Biochemical Evidence for Renal and Hepatic Dysfunction after 8 Hours of 1.25 Minimum Alveolar Concentration Sevoflurane Anesthesia in Volunteers. Anesthesiology. 1998;88(3):601-610.

https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1948570

Kharasch, E. and Jubert, C. Compound A Uptake and Metabolism to Mercapturic Acids and 3,3,3-Trifluoro-2-fluoromethoxypropanoic Acid during Low-flow Sevoflurane Anesthesia. 

Anesthesiology. 1999;91(5):1267-1278.

https://www.ncbi.nlm.nih.gov/pubmed/10551576

The key point of the final article concludes that humans are nearly devoid of renal beta lyase, the key enzyme in directing biodegradation of compound A to the toxic renal thiol. Essentially, this research was done in the late 90’s but the original possibility of renal toxicity in humans from just a few years prior has stuck in peoples’ minds (and therefore textbooks). 

More recent studies agree:

Ong Sio LDela Cruz R,  and Bautista A. Sevoflurane and renal function: a meta-analysis of randomized trials.

Med Gas Res. 2017 Oct 17;7(3):186-193.

https://www.ncbi.nlm.nih.gov/pubmed/29152212

Gillian’s random recommendation: Born a Crime by Trevor Noah

Circle C Farm: https://www.circlecfarmfl.com

Episode 158: Keywords part 8-hepatic disease for the advanced exam and PACU for the basic exam with Gillian Isaac

In this 158th episode we return with another keywords episode with Dr. Gillian Isaac. We discuss hepatic disease for the advanced exam and PACU care for the basic exam.

Random recs:

Cloud Atlas: https://www.amazon.com/Cloud-Atlas-Novel-Liam-Callanan/dp/0385336950

Wolf Hall: https://www.amazon.com/s?k=wolf+hall+by+hilary+mantel&i=stripbooks&crid=2F978D2O2UCW&sprefix=wolf+hall%2Cstripbooks%2C135&ref=nb_sb_ss_i_1_9

Bottle of Lies: https://www.amazon.com/Bottle-Lies-Inside-Story-Generic-ebook/dp/B07JG49BQW/ref=sr_1_1?keywords=bottle+of+lies&qid=1581089047&s=books&sr=1-1

Thanks to Brian Robinson for pointing out: reversal of  rocuronium with Sugammadex can occasionally cause severe bronchospasm, especially in higher doses, and this was one of the reasons its release was delayed in the U.S.

Although most sugammadex hypersensitivity reactions cause mild symptoms such as sneezing, nausea, rash, and urticaria, there is a small but finite risk of anaphylaxis with potentially life-threatening symptoms such as airway edema, bronchospasm, and cardiovascular collapse.
www.apsf.org › article › sugammadex-the-anaphylactic-risk

Episode 152: Keywords Part 7: MH and Hepatic Disease for the Basic Exam

In this 152nd episode I welcome Dr. Gillian Isaac back for another 2 ABA keywords. We discuss malignant hyperthermia and the portion of hepatic disease that is covered by the Basic Exam. We’ll do the portion covered by the Advanced Exam on the next keywords episode.

Malignant Hyperthermia Website: www.mhaus.org

Great review website where Dr. Isaac gets her questions: http://www.anesthesiahub.com

Atlantic Article: https://www.theatlantic.com/entertainment/archive/2012/03/what-do-fact-checkers-and-anesthesiologists-have-in-common/253838/#note

Episode 150: Keywords Part 6: Supraclavicular, Axillary and Benzos

In this 150th episode I welcome back Dr. Gillian Isaac to do another round of ABA keywords. We discuss 2 additional upper extremity blocks (supraclavicular and axillary) and then benzodiazepines.