Episode 10: IV Induction Agents

In this episode I review the common IV agents used in anesthesia excluding opioids.  I cover Propofol, Barbiturates, Benzodiazepines, Ketamine, Etomidate and Dexmedetomidine.

NOTE: There is an error in the audio recording regarding the dosing units for dexmedetomidine.  I say on the podcast that the dosing units are mcg/kg/min which is INCORRECT.  The correct dosing units are mcg/kg/HOUR.  I have corrected this in the accompanying slides. Thanks to Melanie Browder for picking this up!

Good luck to the recent graduates taking their written board exam on July 29th!

 

Slides to go along with the podcast are here: IV induction agents slides

Episode 9: Basic Med Setup

In this episode I review the basic medication setup for the operating room including premedication, induction, neuromuscular blockade, antibiotics, reversal and antiemetics.  I discuss weight based dosing and comment on a few alternatives to consider once you have the basic setup down.  This episode should be useful for new CA-1s getting started in the OR but I would also like to ask senior residents to comment on what their basic setup is and how it may differ from what I’ve mentioned here.

 

Here is a list of the medications I discuss: Basic med setup w dosing

Episode 8: Management of Respiratory Diseases Part 2

This is the second and final episode dealing with the management of respiratory diseases.  In the first episode I covered the initial evaluation and preop preparation.  In this episode I cover intraoperative management, post-operative management, special issues related to one lung ventilation and special issues related to total pneumonectomy.

Slides to go along with the episode can be downloaded here: Management of Respiratory Diseases part 2 slides

 

 

Episode 7: Management of the patient with respiratory disease part 1

This is the first of a two part series of episodes on the management of patients with respiratory disease.  In this, part 1, I cover the preoperative evaluation, history and physical exam, and the preoperative planning and optimization of the patient.  This includes the key board topics of smoking cessation and cardiac risk assessment.

Here are the slides that go along with this episode: Management of Respiratory Diseases slides part 1

 

Episode 6: The Paraglossal Approach to Intubation

In this episode I first announce the new ACCRAC website here at ACCRAC.com.  Big thanks to Bryan Mariscalchi for his help setting it up.  I also mention the problem the last two episodes had with only playing out of one ear on earphones.  I hope I’ve cleared that problem up.  I mention a fantastic book called “Missing Microbes” by Martin Blaser, here is a link to the NY Times review: Missing Microbes

The bulk of the episode is a description of the paraglossal approach to endotracheal incubation.  Here is a youtube link to a video of the technique: Paraglossal video

Have you ever used this technique?  Do you like it?

 

Episode 5: Restrictive Lung Disease

In this episode I review restrictive lung disease.  This is meant to be a companion episode to Episode 4 which covered obstructive lung disease.  I cover the following topics:

-Definition and diagnosis of restrictive lung disease

-Spirometry

-Extra-pulmonary causes (neurologic, musculoskeletal, pleural/mediastinal)

-Parenchymal causes

-Infant RDS

-ARDS

-Pulmonary Fibrosis

The accompanying slides can be downloaded here: Restrictive Lung Disease slides

Remember to join the mailing list by clicking on the link at the top right on the website.  You can leave comments on the website or email accrac@accrac.com or accracpodcast@gmail.com.

Episode 4: Obstructive Lung Disease

In this episode I mention the new ACCRAC mailing list which you can sign up for with the link right below the show description on the website accrac.libsyn.com.  You can also post comments on the website and email questions to accrac@accrac.com or accracpodcast@gmail.com.  I also highlight Rob MacSweeney’s fantastic critical care site called criticalcarereviews.com and his newsletter which you can subscribe to on his site.  The weekly newsletter includes the week’s top trials and papers in critical care.

The rest of the episode is a high yield board review of the ABA topic of obstructive lung disease.  I cover the following topics:

#Upper airway obstruction including extra thoracic and intra thoracic obstruction

#Flow volume loops and how to interpret them

#Lower airway and parenchymal obstruction including

#COPD

#Asthma

#Cystic Fibrosis and bronchiectasis

#Mediastinal masses

The slides to go along with this episode can be downloaded here: Obstructive_Lung_Disease_slides

And the article that I mentioned about full helmet Bipap can be found here:

Helmet Bipap Article

Episode 3: Announcements and FIO2 in one lung ventilation

There are a few announcements I wanted to make including:

Check out pedsanesthesia.net.  Dr. Robert Greenberg, a pediatric anesthesiologist here at Johns Hopkins runs it and it has lots of great information and topics in pediatric anesthesiology.

If you have suggestions for a better website than this one please let me know!

If you know a good way to set up an email list serve for these kinds of announcements please let me know that as well.

And, finally, I address a surgeon’s comment to one of our residents that you should always use 100% fio2 when ventilating one lung during a thoracic case.  Listen to the podcast for details but the bottom line is you should NOT use 100% oxygen unless you have to in order to prevent hypoxia.

Here is a link to a great review on this topics published last year in Critical Care: https://www.ncbi.nlm.nih.gov/pubmed/26278383

Episode 2: Temperature Regulation

In this episode I review the topics of intraoperative hypothermia and temperature regulation.  Lots of good board review topics and some sample board review questions.  The slides are available here: Temperature Regulation Slides

You can leave comments here or email accracpodcast@gmail.com.

Topics covered:

Hypothermia: Etiology, Prevention, Treatment, Complications

Effect of Drugs/Anesthesia on Temperature regulation

Heat Loss and mechanisms

Temperature Regulating centers

Heat Production and Conservation

Body Temperature measurement sites and gradients

Non MH hyperthermia syndromes

Fever facts

NOTE: I updated this episode a couple of days after it was first published.  One of our residents pointed out that I had incorrectly stated that hypothermia increases MAC when it actually lowers it. I have now corrected the episode to reflect that and to clarify the role of increasing the temperature of the operating room itself.