In this episode, episode 49, I welcome Dr. Peter Pronovost to the show to discuss the high reliability movement and how it relates to healthcare. Dr. Pronovost is one of the world’s foremost experts on patient safety and we discuss how a hospital can be as reliably safe as an aircraft carrier and how best to approach an angry patient in the ICU.
In this episode, episode 48, I welcome Dr. Clint Tippett to the show. Dr. Tippett is a cardiac anesthesiologist with an interest in anesthesia for Transcutaneous Aortic Valve Replacement (TAVR) and we discuss the approach to anesthesia for these cases including preoperative planning, intraoperative management, and post-operative concerns.
Regarding stroke risk here is an editorial (Thanks to Stephen Freiberg for providing this link): http://circinterventions.ahajournals.org/content/8/6/e002801
And Dr. Tippett wanted to add that early studies of the 1st and second generation valves had higher stroke rates than SAVR, however the most current genreration valves(Edwards Sapien 3 and Medtronic Evolut R) both have been shown to have not significantly different stroke rates from TAVR.(Surtavi trial and this observational study http://thelancet.com/pdfs/journals/lancet/PIIS0140-6736(16)30073-3.pdf).
Finally, when discussing benefits of TAVR, we should have mentioned a significantly lower risk of post-op AFib in addition to lower bleeding risk and lower rates of AKI.
In this episode, episode 47, I welcome back Dr. Stephen Freiberg, one of our chief residents, to discuss all you ever wanted to know about arterial lines. We discuss the indications, contraindications, complications, placement technique, and how to interpret the waveform.
Slides with figures mentioned in the podcast can be found here: Arterial Line Podcast Images
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In this episode, episode 46, I welcome back Dr. Mike Hofkamp to discuss obstetric pharmacology and fetal assessment.
In this episode, episode 45, I welcome Dr. Charlie Brown to the show. Dr. Brown is one of our cardiac anesthesiologists with a research interest in postop delirium. We discuss risk factors, consequences, prevention and treatment of postop delirium.
In this episode, episode 44, I welcome Dr. Megan Kostibas to the show. Dr. Kostibas is trained in cardiac anesthesia and critical care medicine and is an assistant professor here at Hopkins. She is also the associate program director for the cardiac anesthesia fellowship. We discuss the basics of how to prepare, induce and manage difference cardiac pathology as well as how to go on and off cardiopulmonary bypass.
In this episode, episode 43, I welcome Dr. Mike Hofkamp to the show. Dr. Hofkamp is Director of OB Anesthesia at Baylor Scott & White Memorial Hospital and Clinical Associate Professor of Anesthesiology at Texas A&M Health Science Center College of Medicine. We discuss the changes to women’s physiology when they become pregnant and the implications of those changes for anesthetic management.
In this episode, episode 42, I discuss Post-op Nausea and Vomiting (PONV). I discuss risk factors, complications, treatment and prevention and side effects.
UPDATE April, 2018: In this episode I mention that the evidence is not good for Midazolam in preventing PONV. However, a good friend and colleague, Dr. Michael Grant, did a nice meta-analysis of available trials which concluded that it actually does work fairly well. Check out his study:
Grant MC, Kim J, Page AJ, et al. The Effect of Intravenous Midazolam on Postoperative Nausea and Vomiting: A Meta-Analysis. Anesthesia & Analgesia: 2016:122(3); 656–663.
In this episode, episode 41, I review local anesthetics including the mechanism of action, commonly used agents, pharmacodynamics and kinetics, toxicity and treatment, and common blocks.
In this episode, episode 40, I go over the basics of Vent modes and settings in the operating room and how they differ from the ICU. I also discuss a few common special cases and how to adjust the vent to deal with them.