Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 240: Inadequate Analgesia During C-section with Mike Hofkamp and Emily Sharpe
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In this 240th episode I welcome Drs. Hofkamp and Sharpe to the show to discuss their work investigating whether there may be inadequate analgesia for patients undergoing cesarean delivery.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 229: Keywords Part 19: Epidurals
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In this 229th episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword. We discuss Epidurals for both the Basic and Advanced Exam.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 216: Intralipid for AFE
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In this 216th episode I discuss case reports of using Lipid Emulsion Therapy for Amniotic Fluid Embolus. Big thanks to Dr. Adam Olson for bringing this to my attention!
CME: Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/sCY01P
References:
Eldor J and Kotlovker V. Intralipid for Amniotic Fluid Embolism (AFE)? Open Journal of Anesthesiology, 2012, 2, 127-133
Lynch W et al. Lipid Emulsion Rescue of Amniotic Fluid Embolism-Induced Cardiac Arrest: A Case Report. A&A Case Reports. 2017;8:64–66.
Gruzman I et al. INTRALIPID Rescue of Amniotic Fluid Embolism: from Theory to Existence. Journal of Health Science and Development. 2019: 2:1 (1-4).
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 172: A Pregnant Patient with Congenital Heart Disease
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In this 172nd episode I welcome a panel of experts to discuss the management of a pregnant patient with congenital heart disease. Drs. Hofkamp, Vaught and Meng join me to discuss the preoperative evaluation, obstetric management, and postoperative care.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 168: COVID in Pregnancy with Dr. Nixon
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In this 168th episode I welcome Dr. Heather Nixon to the show to discuss what is being done for pregnant women and women in labor who have or are suspected to have COVID-19.
CME: https://earnc.me/IqnBVR
The COVID book for kids by Taylor Purvis: https://playatrickonthecoronas.weebly.com/
Link for Anesthesia Toolbox daily online learning session: https://www.anesthesiatoolbox.com/docs/DOC-5178
During our discussion of treatment of eclamptic seizures Dr. Henao said benzos were first line treatment. This is assuming the patient is already getting magnesium. For test questions, the answer for first line treatment should be Mg. In reality, patients will likely get both at the same time.
Serum Mg concentrations can be reported as mmol/L, meq/L or mg/dL. The important ranges to know for testing (though in reality different people may get symptoms at different times) are a therapeutic range of 2-3.5 mmol/L or 4-7 mEq/L or 5-9 mg/dL; A loss of patellar reflexes at >3.5, >7, >9; Respiratory paralysis at >5, >10, >12 and cardiac arrest at >12.5, >25, >30. EKG changes including prolonged PR and widened QRS happen in much the same range as loss of patellar reflexes, maybe a bit before but there is a lot of overlap.
References:
Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):125-138.
Dhariwal NK, Lynde GC. Update in the Management of Patients with Preeclampsia. Anesthesiol Clin. 2017 Mar;35(1):95-106.
Aya AG, Mangin R, Vialles N, Ferrer JM, Robert C, Ripart J, de La Coussaye JE. Patients with severe preeclampsia experience less hypotension during spinal anesthesia for elective cesarean delivery than healthy parturients: a prospective cohort comparison. Anesth Analg. 2003 Sep;97(3):867-72.
Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017 Feb;216(2):110-120.
David Chestnut Cynthia Wong Lawrence Tsen Warwick D Ngan Kee Yaakov BeilinJill Mhyre Brian T. Bateman Naveen Nathan. Chestnut’s Obstetric Anesthesia: Principles and Practice. 5th edition. Chapter 36: Hypertensive Disorders. Pg 825-859
Killers of the Flower Moon (Dr. Henao’s random recommendation): https://www.amazon.com/Killers-Flower-Moon-Osage-Murders/dp/0385534248
1. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016;124(2):270–300.
2. Nonobstetric Surgery During Pregnancy – ACOG [Internet]. [cited 2019 Jul 18];Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Nonobstetric-Surgery-During-Pregnancy?IsMobileSet=false
3. Tolcher MC, Fisher WE, Clark SL. Nonobstetric Surgery During Pregnancy. ObstetGynecol 2018;132(2):395–403.
5. Upadya M, Saneesh PJ. Anaesthesia for non-obstetric surgery during pregnancy. Indian J Anaesth 2016;60(4):234–41.
6. Reitman E, Flood P. Anaesthetic considerations for non-obstetric surgery duringpregnancy. Br J Anaesth 2011;107 Suppl 1:i72–8.
7. Nejdlova M, Johnson T. Anaesthesia for non-obstetric procedures during pregnancy. Contin Educ Anaesth Crit Care Pain 2012;12(4):203–6.
8. Mazze RI, Källén B. Reproductive outcome after anesthesia and operation during pregnancy: a registry study of 5405 cases. Am J Obstet Gynecol 1989;161(5):1178–85.
9. Committee on Obstetric Practice and the American Society of Anesthesiologists. Committee Opinion No. 696: Nonobstetric Surgery During Pregnancy. Obstet Gynecol 2017;129(4):777–8.
10. Wilcox AJ, Weinberg CR, O’Connor JF, et al. Incidence of early loss of pregnancy. N Engl J Med 1988;319(4):189–94.
11. Davidson AJ, Disma N, de Graaff JC, et al. Neurodevelopmental outcome at 2 years of age after general anaesthesia and awake-regional anaesthesia in infancy (GAS): an international multicentre, randomised controlled trial. Lancet 2016;387(10015):239–50.
12. Sun LS, Li G, Miller TLK, et al. Association Between a Single General Anesthesia Exposure Before Age 36 Months and Neurocognitive Outcomes in Later Childhood. JAMA 2016;315(21):2312–20.
14. Huang S-Y, Lo P-H, Liu W-M, et al. Outcomes After Nonobstetric Surgery in Pregnant Patients: A Nationwide Study. Mayo Clin Proc 2016;91(9):1166–72.
Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast
Episode 159: Postpartum hemorrhage with Juanita Henao
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In this 159th episode I welcome Dr. Juanita Henao to the show to discuss prevention and management of postpartum hemorrhage.
One CORRECTION: At about minute 4:30 Dr. Henao states that in women with PPH the mortality rate is 10% but what she meant to say is that PPH accounts for 10% of maternal deaths in the United States.
Thorneloe, J.C.A. Carvalho, K. Downey,M. Balki. Uterotonic drug usage in Canada: a snapshot of the practice in obstetric units of university-affiliated hospitals. Int J Obstet Anesth. 2019 Feb;37:45-51.
Hian Yan Voon , Haris Njoo Suharjono , Asrul Akmal Shafie , Mohamad Adam Bujang Carbetocin versus oxytocin for the prevention of postpartum hemorrhage: A meta-analysis of randomized controlled trials in cesarean deliveries. Taiwan J Obstet Gynecol. 2018 Jun;57(3):332-339.
WOMAN trial collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet. 2017 May 27;389(10084):2105-2116.
David H. Chestnut, Cynthia A Wong, Lawrence C Tsen, Warwick D Ngan Kee, Yaakov Beilin, Jill Mhyre. Chestnut’s Obstetric Anesthesia: Principles and Practice. Fifth edition. Chapter 38, Anterpartum and Postpartum, Hemorrhage.