Episode 163: Thoracic Wall Blocks with Barbara Versyck

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.

References:

Videos: 

Pecs II: https://www.youtube.com/watch?v=YFWneF4pwOA

Serratus Anterior block: https://www.youtube.com/watch?v=K2w46jjMgfMErector

Spinae plane block: https://www.youtube.com/watch?v=EVowRjEFUfk

Literature: 

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.

Poster: 

https://www.bbraun.com/content/dam/catalog/bbraun/bbraunProductCatalog/S/AEM2015/en-01/b9/thoracic-wall-blocks-forbreastcancersurgery.pdf.bb-.98924081/thoracic-wall-blocks-forbreastcancersurgery.pdf

Episode 162: Hypertensive Disorders of Pregnancy with Juanita Henao

In this 162nd episode I welcome Dr. Henao back to the show to discuss hypertensive disorders of pregnancy and how to manage them.

CLARIFICATIONS:

  1. 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.
  2. 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:

  1. Hofmeyr R, Matjila M, Dyer R. Preeclampsia in 2017: Obstetric and Anaesthesia Management. Best Pract Res Clin Anaesthesiol. 2017 Mar;31(1):125-138.
  2. Dhariwal NK, Lynde GC. Update in the Management of Patients with Preeclampsia. Anesthesiol Clin. 2017 Mar;35(1):95-106.
  3. 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.
  4. 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.
  5. 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

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 160: Non-OB Surgery in Pregnancy With Dave Berman

In this 160th episode I welcome Dr. Dave Berman back to the show to discuss anesthesia for non-OB surgery during pregnancy.

References:

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.

4. UpToDate [Internet]. [cited 2019 Jul 18];Available from: https://www.uptodate.com/contents/management-of-the-pregnant-patientundergoing-nonobstetric-surgery

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.

13. Center for Drug Evaluation, Research. FDA Drug Safety Communication [Internet]. U.S. Food and Drug Administration. 2019 [cited 2019 Jul 21];Available from: http://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communicationfda-review-results-new-warnings-about-using-general-anesthetics-and

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.

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 158: Keywords part 8-hepatic disease for the advanced exam and PACU for the basic exam with Gillian Isaac

In this 158th episode we return with another keywords episode with Dr. Gillian Isaac. We discuss hepatic disease for the advanced exam and PACU care for the basic exam.

Random recs:

Cloud Atlas: https://www.amazon.com/Cloud-Atlas-Novel-Liam-Callanan/dp/0385336950

Wolf Hall: https://www.amazon.com/s?k=wolf+hall+by+hilary+mantel&i=stripbooks&crid=2F978D2O2UCW&sprefix=wolf+hall%2Cstripbooks%2C135&ref=nb_sb_ss_i_1_9

Bottle of Lies: https://www.amazon.com/Bottle-Lies-Inside-Story-Generic-ebook/dp/B07JG49BQW/ref=sr_1_1?keywords=bottle+of+lies&qid=1581089047&s=books&sr=1-1

Thanks to Brian Robinson for pointing out: reversal of  rocuronium with Sugammadex can occasionally cause severe bronchospasm, especially in higher doses, and this was one of the reasons its release was delayed in the U.S.

Although most sugammadex hypersensitivity reactions cause mild symptoms such as sneezing, nausea, rash, and urticaria, there is a small but finite risk of anaphylaxis with potentially life-threatening symptoms such as airway edema, bronchospasm, and cardiovascular collapse.
www.apsf.org › article › sugammadex-the-anaphylactic-risk

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

Episode 156: Personal Finance and Burnout with Jimmy Turner

In this 156th episode I welcome Dr. Jimmy Turner to the show to discuss the intersection of personal finance and physician burnout.

References:

Dr. Turner’s about page: http://thephysicianphilosopher.com/about/

Dr. Turner’s website: https://thephysicianphilosopher.com/

Dr. Turner’s new podcast: http://moneymeetsmedicine.com/

Blogpost about burnout and finance: https://thephysicianphilosopher.com/what-causes-physician-burnout/

How to think about Money book: https://www.amazon.com/Think-About-Money-Jonathan-Clements/dp/1523770813

If You Can free PDF book: https://www.etf.com/docs/IfYouCan.pdf

Leaders Eat Last: https://www.amazon.com/Leaders-Eat-Last-Together-Others/dp/1543614620

Episode 155: Opioid-Free Anesthesia with Michael Manning

In this 155th episode I welcome Dr. Michael Manning to the show to discuss opioid-reduced and opioid-free anesthesia. We discuss the downsides of opioid usage and what we can do to reduce our use in our patients or even eliminate it completely.

References:

1. Koepke EJ, Manning EL, Miller TE et al. The rising tide of opioid use and abuse: the role of the anesthesiologist. Perioper Med (Lond) 2018;7:16.

2. Brummett CM, Waljee JF, Goesling J et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg 2017;152:–e170504.

3. Manchikanti L, Helm SI, Fellows B et al. Opioid Epidemic in the United States. Pain Physician 2012;15:ES9–ES38.

4. Gan TJ, Habib AS, Miller TE et al. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin 2014;30:149–60.

The Road Less Stupid: https://www.amazon.com/Road-Less-Stupid-Keith-Cunningham/dp/0984659269

Armchair Expert Interview with Ira Glass: https://armchairexpertpod.com/pods/ira-glass

Episode 154: EEG monitoring with Dr. Emery Brown

In this 154th episode I welcome Dr. Emery Brown to the show to discuss how we monitor the depth of anesthesia. We discuss the drawbacks to BIS and why Dr. Brown thinks the EEG itself is the best way to go.

References:

EEG reading tutorials: https://eegforanesthesia.iars.org/

Purdon et al: The Ageing Brain: Age-dependent changes in the electroencephalogram during propofol and sevoflurane general anaesthesia

Brown et al: General Anesthesia and Altered States of Arousal: A Systems Neuroscience Analysis. Annu. Rev. Neurosci. 2011.

Brown et al: General Anesthesia, Sleep, and Coma. NEJM. 2010.

Brown et al: Multimodal General Anesthesia: Theory and Practice. A&A 2018.

Purdon et al: Clinical Electroencephalography for Anesthesiologists. Part I: Background and Basic Signatures. Anesthesiology 2015.

Dental Anesthesia info:

Contacts:

Thomas Whitmer: thomas.whitmer.tw@gmail.com

Mana saraghi: msaraghi@gmail.com

References:

https://www.ada.org/en/ncrdscb/dental-specialties/specialty-definitions

http://www.ada.org/~/media/CODA/Files/anes.ashx

American Society of Dentist Anesthesiologists website: https://www.asdahq.org

Virtual tour https://www.youtube.com/watch?v=ZJ1Mo65ah4w&feature=youtu.be