Posted on

Episode 187: PEEP for Robotic Surgery with Gabe Tharp

In this 187th episode I welcome Dr. Gabe Tharp to the show to discuss his recent article in Anesthesiology: “Body Habitus and Dynamic Surgical Conditions Independently Impair Pulmonary Mechanics during Robotic-assisted Laparoscopic Surgery.” We discuss his findings and whether we should be using much higher levels of PEEP than we currently do.

Gabe’s group is on Twitter: @uvmanesthesia

References:

Tharp et al. Body Habitus and Dynamic Surgical Conditions Independently Impair Pulmonary Mechanics during Robotic-assisted Laparoscopic Surgery. Anesthesiology 2020. PMID: 32675698

Ball L, et al. Br J Anaesth. 2018. PMID: 30236252 

Ferrando, et al Lancet Respir Med. 2018. PMID: 29371130

PROBESE committee JAMA. 2019. PMID: 31157366.

Grassi et al. Anesthesiology. 2020. PMID: 32011342

Posted on

Episode 185: Fluid Responsiveness in the OR with Lee Goeddel

In this 185th episode I welcome back Dr. Lee Goeddel to discuss assessment of fluid responsiveness in the operating room.

References:

Michard F. Changes in Arterial Pressure during Mechanical Ventilation. Anesthesiology. 2005;103(2):419-428. doi:10.1097/00000542-200508000-00026

Using Dynamic Variables to Guide Perioperative Fluid Management
Azriel Perel, M.D.
Anesthesiology October 2020, Vol. 133, 929–935. https://doi.org/10.1097/ALN.0000000000003408

Posted on

Episode 157: Intermittent Fasting with Mark Mattson

In this 157th episode I welcome Dr. Mark Mattson to the show to discuss the science behind intermittent fasting including in the perioperative period.

Dr. Mattson’s review from NEJM: https://www.nejm.org/doi/full/10.1056/NEJMra1905136

Dr. Mattson’s Tedx Talk: https://www.youtube.com/watch?v=4UkZAwKoCP8

Posted on

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.

Outline By Brian ParkDownload

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

Posted on

Episode 143: Fluid management and cardiac output monitors in ERAS with Michael Scott

In this 143rd episode I welcome Dr. Michael Scott to the show to discuss fluid management in ERAS cases and how cardiac output monitoring may help us do that well.

Topmedtalk: https://www.topmedtalk.com

Posted on

Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo

In this 142nd episode I welcome Dr. Marcos Vidal Melo to the show to discuss Driving Pressure and Transpulmonary pressure. We discuss what they are, how they differ from plateau pressure, and how they may help guide safe mechanical ventilation.

References:

  1. Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation? Williams EC, Motta-Ribeiro GC, Vidal Melo MF. Anesthesiology. 2019 Jul;131(1):155-163. 
  2. Loring SH, Topulos GP, Hubmayr RD: Transpulmonary pressure: The importance of precise definitions and limiting assumptions. Am J Respir Crit Care Med 2016; 194:1452–7
  3. Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, Mojoli F, Chiumello D, Piquilloud L, Grasso S, Jubran A, Laghi F, Magder S, Pesenti A, Loring S, Gattinoni L, Talmor D, Blanch L, Amato M, Chen L, Brochard L, Mancebo J; PLeUral pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine): Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med 2016; 42:1360–73
  4. Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, Guérin C, Patroniti N, Ranieri VM, Gattinoni L, Nava S, Terragni PP, Pesenti A, Tobin M, Mancebo J, Brochard L; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine): The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 2014; 189:520–31
Posted on

Episode 141: Nutrition in the ICU with Paul Wischmeyer

In this 141st episode I welcome Dr. Paul Wischmeyer to the show to discuss nutrition for critically ill patients with a focus on the question of whether to give enteral feeds to patients on pressors. You can follow Dr. Wischmeyer on twitter @Paul_Wischmeyer.

References:

Dr. Wischmeyer’s article on enteral nutrition for patients on vasopressors: https://journals.lww.com/ccmjournal/Citation/onlinefirst/Enteral_Nutrition_Can_Be_Given_to_Patients_on.95859.aspx

Additional ReferencesDownload

Posted on

Episode 130: Adults with Congenital Heart Disease with Jochen Steppan

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.

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.

Posted on

Episode 104: Sepsis with Pam Lipsett

In this 104th episode I welcome Dr. Pam Lipsett to the show to discuss the diagnosis and treatment of sepsis.

References:

Sepsis-3 guidelines from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2492881

Marik Sepsis cocktail: Marik PE et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. 2017: 151(6);1229–1238.

ADRENAL trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1705835

APROCCHSS Trial: https://www.nejm.org/doi/10.1056/NEJMoa1705716

SEPSISPAM Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1312173

Posted on

Episode 79: Pediatric Cardiothoracic Anesthesia with Dheeraj Goswami

In this episode, episode 79, I welcome Dr. Dheeraj Goswami to the show to discuss pediatric cardiothoracic anesthesiology.  We discuss the training required to do these cases, the most common cases and concerns, and how it differs from other forms of anesthesia.