Episode 161: Dual Training in Anesthesiology and Emergency Medicine

In this 161st episode I welcome Drs. Regan and Lester to the show to discuss the country’s first combined Anesthesiology and Emergency Medicine dual training program.

Website for the program: https://www.hopkinsmedicine.org/emergencymedicine/combined-residency/

Episode 159: Postpartum hemorrhage with Juanita Henao

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.

References:

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.

Main EKGoffman DScavone BMLow LKBingham DFontaine PLGorlin JBLagrew DCLevy BSNational Partnership for Maternal SafetyCouncil on Patient Safety in Women’s Health Care.National Partnership for Maternal Safety: Consensus Bundle on Obstetric Hemorrhage. Obstet Gynecol. 2015 Jul;126(1):155-62.

Duffield A1McKenzie CCarvalho BRamachandran BYin VEl-Sayed YYRiley ETButwick AJ. Effect of a High-Rate Versus a Low-Rate Oxytocin Infusion for Maintaining Uterine Contractility During Elective Cesarean Delivery: A Prospective Randomized Clinical Trial. Anesth Analg. 2017 Mar;124(3):857-862

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. 

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

Episode 140: Transfusion Triggers and The TRICS 3 Trial with David Mazer

In this 140th episode I welcome Dr. David Mazer to the show. Dr. Mazer was the PI and first author on the TRICS 3 trial looking at liberal versus restrictive transfusion strategies in moderate to high risk cardiac surgery patients published in the NEJM in 2017.

Dr. Mazer would like to add the following random recommendation: For a great combination of live jazz and good food and drinks in Toronto, check out the Jazz Bistro just up the street from St. Michael’s Hospital.

Reference: https://www.nejm.org/doi/full/10.1056/NEJMoa1711818

Dr. Mazer can be reached at David.Mazer@UnityHealth.To

Episode 135: A Case For Low Dose Norepinephrine

In this 135th episode I discuss my argument for using low dose norepinephrine to treat or even prevent hypotension in the OR and ICU. I discuss the CENSER trial looking at early norepinephrine in sepsis as well as a paper looking at preemptive norepinephrine in open cystectomies and a review article of trials looking at pressor use in free flap surgery. Join in the conversation here with your comments and on the ACCRAC Facebook page and Twitter @accracpodcast and @jwolpaw.

References:

CENSER: https://www.atsjournals.org/doi/full/10.1164/rccm.201806-1034OC

Cystectomies: https://www.ncbi.nlm.nih.gov/pubmed/24012203

Free Flaps: https://www.ncbi.nlm.nih.gov/pubmed/26340760

Episode 129: Vascular Access with Dave Berman

In this 129th episode I welcome Dr. Dave Berman back to the show to discuss vascular access devices. We talk about what kinds of lines exist, how to choose, what the pros and cons are, and how to know what kind of flow you will get with a given catheter.

References are here:

Episode 119: STOP-IT Trial with Rob Sawyer

In this 119th episode I welcome Dr. Robert Sawyer to the show. Dr. Sawyer was the PI on the STOP-IT trial comparing a short course of antibiotics versus a longer course for complicated intraabdominal infections. We discuss the trial, the outcomes, and what the future of antimicrobial management in the surgical ICU may look like.

Reference:

STOP-IT Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1411162

Episode 106: Hydroxyethyl Starches with Marius Fassbinder

In this 106th episode I welcome Dr. Marius Fassbinder to the show to discuss the use of hydroxyethyl starches.

References:

1. Woodcock, T. E. & Woodcock, T. M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an

improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia 108, 384–394 (2012).

2. Westphal, M. et al. Hydroxyethyl starches: different products–different effects. Anesthesiology 111, 187–202 (2009).

3. Brunkhorst, F. M. et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N. Engl. J. Med. 358, 125–139

(2008).

4. Perner, A. et al. Hydroxyethyl Starch 130/0.42 versus Ringer’s Acetate in Severe Sepsis. N. Engl. J. Med. 367, 124–134 (2012).

6. Myburgh, J. A. et al. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N. Engl. J. Med. 367, 1901–1911

(2012).

7. Annane, D. et al. Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with

hypovolemic shock: the CRISTAL randomized trial. JAMA 310, 1809–1817 (2013).

8. Joosten, A. et al. Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A

Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery. Anesthesiology 128, 55–66 (2018).

9. Gillies, M. A. et al. Incidence of postoperative death and acute kidney injury associated with 6% hydroxyethyl starch use: systematic review and meta-analysis. British Journal of Anaesthesia 112, 25–34 (2014).

Episode 105: Blood Management Part 1 With Drs. Frank & Cha

In this 105th episode, which will be the first part in a series on blood management, I turn over the mic to Dr. Stephanie Cha who interviews Dr. Steve Frank about blood management in cardiac surgery and how to do “bloodless” surgery for patients who refuse blood transfusions.

References:

1.         Myles PS, Smith JA, Forbes A, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussieres JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Network AIotACT. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med 2017;376:136-48.
2.         Frank SM, Wick EC, Dezern AE, Ness PM, Wasey JO, Pippa AC, Dackiw E, Resar LM. Risk-adjusted clinical outcomes in patients enrolled in a bloodless program. Transfusion 2014;54:2668-77.
3.         Cho BC, DeMario VM, Grant MC, Hensley NB, Brown CHt, Hebbar S, Mandal K, Whitman GJ, Frank SM. Discharge hemoglobin level and 30-day readmission rates after coronary artery bypass surgery. Anesth Analg 2018.
4.         Pattakos G, Koch CG, Brizzio ME, Batizy LH, Sabik JF, 3rd, Blackstone EH, Lauer MS. Outcome of patients who refuse transfusion after cardiac surgery: A natural experiment with severe blood conservation. Arch Intern Med 2012;172:1154-60.
5.         Frank SM, Scott AV, Resar LM. Bloodless medicine and surgery: Top 10 things to consider.Anesthesiology News 2016.

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