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.
In this 171st episode, a follow up to episode 113, I welcome Dr. Mintz back to the show to discuss anesthetic management for cerebral aneurysm surgery.
Chapter 13 Anesthetic management of cerebral aneurysm surgery in Cottrell and Young, Neuroanesthesia
The Guns of August: https://www.amazon.com/Guns-August-Pulitzer-Prize-Winning-Outbreak/dp/0345476093
Cognitive Aid website: www.rnsascar.com
In this 170th episode I welcome Dr. Brian Garibaldi to the show to discuss his experience taking care of 40 critically ill COVID patients and what we’ve learned. We got through by system, head to toe, and discuss strategies and approaches.
Lessons from China: https://jamanetwork.com/journals/jama/fullarticle/2762130
Convalescent Plasma: https://jamanetwork.com/journals/jama/fullarticle/2763983?widget=personalizedcontent&previousarticle=2762130
Management of patients with COVID: https://jamanetwork.com/journals/jama/fullarticle/2763879
In this episode I introduce Dr. Christina Miller’s video, linked below, that goes through PPE considerations including how to safely don and doff, and suggestions for how to handle a difficult airway in COVID patients.
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.
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
SOAP website: https://soap.org/
In this 167th episode I review the most recent changes that we’ve made to our protocols for caring for COVID patients and share a fantastic one page summary sheet that 3 of our ICU fellows put together. Huge thanks to Drs. Navarette, Herekar and Baronos for their work on this. It is available for download below. References are on the second page of the attachment.
In this 165th episode I welcome Drs. Scott and Cereda from University of Pennsylvania and Dr. Nacoti from Italy to talk about COVID-19, what it is, what we know about it, what it’s like on the ground in Italy right now, and what we can learn from their experience to try to prevent it from happening here.
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. doi:10.1001/jama.2020.4031
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).
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
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.
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.
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:
Med Gas Res. 2017 Oct 17;7(3):186-193.
Gillian’s random recommendation: Born a Crime by Trevor Noah
Circle C Farm: https://www.circlecfarmfl.com
In this 163rd episode I welcome Dr. Barbara Versyck to the show to discuss thoracic wall blocks. We discuss the types of blocks, what they are used for, and what the evidence is for their efficacy.
Serratus Anterior block: https://www.youtube.com/watch?v=K2w46jjMgfMErector
Spinae plane block: https://www.youtube.com/watch?v=EVowRjEFUfk
Chin, Ki Jinn. “Thoracic wall blocks: from paravertebral to retrolaminar to serratus to erector spinae and back again–a review of the evidence.” Best Practice & Research Clinical Anaesthesiology (2019).
Versyck, B., G‐J. van Geffen, and K‐J. Chin. “Analgesic efficacy of the Pecs II block: a systematic review and meta‐analysis.” Anaesthesia 74.5 (2019): 663-673.