Category Archives: Pharmacology

Anesthesia, Anesthetic agents, ERAS, Pain, Pharmacology

Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1

February 19, 2019 ACCRAC 12 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1

00:00 / 29:09

In this 108th episode I welcome Dr. Mike Grant and Dr. Mark Bicket to the show to discuss various non-opioid adjuncts such as esmolol, ketamine, dexmedetomidine, lidocaine, and magnesium, and the role they may play in multimodal anesthesia. In this episode, part 1, we discuss pre and post-op use. Intraop use will be discussed in episode 109.

CME: https://earnc.me/oDhyER

Outline By Brian Park:Download

References:

Wick EC, Grant MC and Wu CL. Postoperative Multimodal Analgesia Pain Management With Nonopioid Analgesics and Techniques A Review. JAMA Surg. 2017;152(7):691-697.

Bahr MP, Williams BA. Esmolol, Antinociception, and Its Potential Opioid-Sparing Role in Routine Anesthesia Care. Regional Anesthesia and Pain Medicine. 2018:43(8):815-818.

Grant MC, Ouanes JP, Joshi BL. Perioperative Esmolol and Opioids: Is More Really Less? Regional Anesthesia and Pain Medicine. 2018:43(8):813-814.

IV Lidocaine: https://academic.oup.com/bjaed/article/16/9/292/1743710

Ketamine: https://www.ncbi.nlm.nih.gov/pubmed/29870457

Dextramethorphan: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755866/ R

Anesthesia, Anesthetic agents, Critical Care, Pharmacology, Show Notes

Episode 77: Reversal of Neuromuscular Blockade

March 28, 2018 ACCRAC 15 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 77: Reversal of Neuromuscular Blockade

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30:43

In this episode, episode 77, I discuss reversal of neuromuscular blockade. This is a follow up to episode 66 in which I covered neuromuscular blockade.

CME: https://earnc.me/An714h

Outline by Brian Park: NMB Reversal Outline

References:

Miller’s Anesthesia 8^th Edition. Reversal (Antagonism) of Neuromuscular Blockade. Murphy GS, de Boer HD, Eriksson LI and Miller RD. Chapter 35, 995-1027.e5.

Appiah-Ankam J, Hunter J. Pharmacology of neuromuscular blocking drugs. Cont Educ Anaesthesia Critical Care & Pain. 2004;4(1):2-7.

Hristovska AM, Duch P, Allingstrup M, Afshari A. Efficacy and safety of sugammadex versus neostigmine in reversing neuromuscular blockade in adults. Cochrane Database Syst Rev. 2017 Aug 14;8:CD012763.

Keating GM. Sugammadex: A Review of Neuromuscular Blockade Reversal. Drugs. 2016 Jul;76(10):1041-52.

McLean DJ, Diaz-Gil D, Farhan HN, Ladha KS, Kurth T, Eikermann M. Dose-dependent Association between Intermediate-acting Neuromuscular-blocking Agents and Postoperative Respiratory Complications. Anesthesiology. 2015 Jun;122(6):1201-13.

Schaller S, Fink H. Sugammadex as a reversal agent for neuromuscular block: an evidence-based review. Core Evidence. 2013;8:57-67.

Anesthesia, Anesthetic agents, Critical Care, Pharmacology, Show Notes

Episode 66: Neuromuscular Blockers

January 5, 2018 ACCRAC 19 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 66: Neuromuscular Blockers

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39:48

In this episode, episode 66, I go through an overview of neuromuscular blockers including how they work, how to use them, and what their adverse effects are. Happy New Year!

CME: https://earnc.me/9GRFyG

The dose of glycopyrrolate should be 0.01 to 0.015mg/kg, not 0.1 to 0.15.

Outline by Brian Park: Outline

References:

Miller’s Anesthesia 7th edition: Chapter 29: Pharmacology of Muscle Relaxants and Their Antagonists. Naguib M and Lien C.

Rocuronium vs succinylcholine for rapid sequence induction intubation. https://www.ncbi.nlm.nih.gov/pubmed/26512948

Neuromuscular blockade: what was, is and will be: https://www.ncbi.nlm.nih.gov/pubmed/25622380

Reversal of neuromuscular block: https://www.ncbi.nlm.nih.gov/pubmed/19468024

Critical Care, Pharmacology

Episode 63: Chemo Prophylaxis with Andrew Jarrell

December 1, 2017 ACCRAC Leave a comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 63: Chemo Prophylaxis with Andrew Jarrell

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45:48

In this episode, episode 63, I welcome back Andrew Jarrell to learn to pronounce his name properly, and to discuss VTE and stress ulcer prophylaxis.

CME: https://earnc.me/tcjDJm

References are here: References

Anesthesia, Pharmacology, Show Notes

Episode 60: Surgical Antibiotic Prophylaxis with Andrew Jarrell

October 27, 2017 ACCRAC 3 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 60: Surgical Antibiotic Prophylaxis with Andrew Jarrell

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48:46

In this episode, episode 60, I welcome Andrew Jarrell, one of our amazing surgical ICU pharmacists to the show. We discuss antibiotic prophylaxis for surgery including what to use, how to time it, how long to continue it, and what the evidence says about things like indwelling drains.

CME: https://earnc.me/MthcTD

A fantastically helpful outline of the episode put together by Brian Park is here: Outline

Anesthesia, Anesthetic agents, OB, Pharmacology, Show Notes

Episode 58: Medications For Neuraxial Anesthesia with Dave Berman and Anh Nguyen

October 10, 2017 ACCRAC 2 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 58: Medications For Neuraxial Anesthesia with Dave Berman and Anh Nguyen

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54:35

In this episode, episode 58, I welcome our two OB Anesthesia fellows to the show, Dr. Dave Berman and Dr. Anh Nguyen. We discuss the medications used for neuraxial anesthesia including local anesthetics, opioids, and adjuncts such as epinephrine, clonidine and more.

CME: https://earnc.me/N8xw8b

Outline by Brian Park: Outline

Dave’s email is dberma20@jhmi.edu and Anh’s is tnguy193@jhmi.edu.

References can be found here: Neuraxial references

Critical Care, Interactive, Pharmacology, Show Notes

Episode 57: Bugs and Drugs Part 2 With Rachel Kruer

October 5, 2017 ACCRAC 4 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 57: Bugs and Drugs Part 2 With Rachel Kruer

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39:14

In this episode, episode 57, I welcome back Rachel Kruer, our amazing SICU pharmacist and we complete our two part series on bugs and drugs in the ICU. We discuss different infections that are commonly seen in ICUs and how to treat them.

CME: https://earnc.me/OMacEP

Episode Notes

Critical Care, Interactive, Pharmacology, Show Notes

Episode 56: Bugs and Drugs Part 1 with Rachel Kruer

September 28, 2017 ACCRAC 3 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 56: Bugs and Drugs Part 1 with Rachel Kruer

00:00 / 55:44

In this episode, episode 56, I welcome Rachel Kruer to the show. Rachel is one of our amazing ICU pharmacists and we discuss common bacteria and the drugs we use to treat them. This is part 1 of a 2 part series that I’ll be doing with Rachel on this topic.

CME: https://earnc.me/1McYTq

Skip to specific topics:

Pharmacodynamics vs. Pharmacokinetics (1:08)
Categorizing Bacteria (7:10)
Beta-Lactams (12:10)
Aztreonam (19:40)
Carbapenems (21:20)
Case Examples (24:20)
Fluoroquinolones (30:36)
Vancomycin (33:15)
Aminoglycosides (35:31)
Macrolides (39:45)
Linezolid (40:33)
Daptomycin (43:05)
Sulfonamide Antibiotics (44:05)
Clindamycin (45:49)
Colistin (47:17)
Glycylcycline (48:43)
Metronidazole (Flagyl) (49:55)
Vancomycin Resistant Enterococcus (51:11)
Surgical Prophylaxis (53:40)

Outline by April Liu
See other interactive posts

Anesthesia, Anesthetic agents, OB, Pharmacology, Show Notes

Episode 53: Analgesia for C-section with Mike Hofkamp

August 11, 2017 ACCRAC 4 Comments

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 53: Analgesia for C-section with Mike Hofkamp

00:00 / 1:02:12

In this episode, episode 53, I welcome back Dr. Mike Hofkamp to discuss analgesia for cesarean delivery. We discuss indications for C-section, urgent and emergent sections, anesthetic techniques and associated complications, how to approach the difficult airway in a pregnant patient, and aspiration prophylaxis.

CME: https://earnc.me/r63bjW

Additional information:

Outline by Brian Park
Discussion references

Urgent cesarean section
Maternal indications (1:52)
Fetal indications (7:35)
Urgent (11:59) vs emergent (17:10)
See full interactive post

Anesthesia, Anesthetic agents, OB, Pharmacology

Episode 51: Labor Analgesia with Jacqueline Galvan

July 24, 2017 ACCRAC Leave a comment

Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

Episode 51: Labor Analgesia with Jacqueline Galvan

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49:35

In this episode, episode 51, I welcome back Dr. Jacqueline Galvan to discuss labor analgesia. We cover opioids including remifentanil, nitrous oxide, neuraxial anesthesia and other nerve blocks.

CME: https://earnc.me/hlwk7u

References:

Hess PE, et al. An association between severe labor pain and cesarean delivery. Anesth Analg. 2000 Apr;90(4):881-6
Van den Bussche E. Why women prefer epidural analgesia during childbirth: the role of beliefs about epidural analgesia and pain catastrophizing. Eur J Pain. 2007 Apr;11(3):275-82.
Varposhti MR et al. Comparison of remifentanil: Entonox with Entonox alone in labor analgesia. Adv Biomed Res. 2013 Nov 30;2:87