In this 214th episode I welcome back Dr. Gillian Isaac to do another ABA Keyword episode. We review non-depolarizing neuromuscular blockers and myesthenic syndromes.
CME: https://earnc.me/w4WOk8
Show Notes by Dr. Brian H. Park
Random Recs:
Ted Lasso: https://en.wikipedia.org/wiki/Ted_Lasso
Hamnet: Link
Amicus Podcast Interview with Michael Heller: Link
References:
Barash Clinical Anesthesia 8th edition and Anesthesiahub.com
In this 196th episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword. We discuss urologic surgery and renal failure.
CME: https://earnc.me/GDJ4RR
Show Notes by Dr. Brian H Park
References: Barash Clinical Anesthesia 8th edition and Anesthesiahub.com
Random Recs:
The body keeps the score: Link
Black Klansman: Link
Axios Today: https://www.axios.com/podcasts/today/
In this 193rd episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA Key Word topic. This time we discuss the pharmacology of inhaled anesthetic agents.
CME: https://earnc.me/hxOv4S
Outline by Dr. Brian Park
References: Barash Clinical Anesthesia 8th edition and Anesthesiahub.com
Random Recs:
Chess.com
In this 192nd episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword, maternal physiology.
CME: https://earnc.me/Z3mGJv
References: Barash Clinical Anesthesia 8th edition and Anesthesiahub.com
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.
CME: https://earnc.me/Q9tFah
Show notes by Brian Park, MD
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
In this 180th episode I welcome back Dr. Gillian Isaac for another ABA keyword episode. We review local anesthetics.
CME: https://earnc.me/LzzOvu
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)
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.
CME: https://earnc.me/ucUI9n
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)
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.
CME: https://earnc.me/Adkacw
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)
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).
CME: https://earnc.me/delVJ8
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 L, Dela 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
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.
CME: https://earnc.me/rEmBIA
Show Notes by Dr. Brian Park
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
