Rank #1: Episode 66: Neuromuscular Blockers
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!
The dose of glycopyrrolate should be 0.01 to 0.015mg/kg, not 0.1 to 0.15.
Outline by Brian Park: Outline
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
Jan 05 2018
Rank #2: Episode 116: Overview of Pediatric Anesthesia with Bommy Mershon
In this 116th episode I welcome Dr. Bommy Mershon to the show. We discuss pediatric anesthesiology including how kids differ from adults, pre-op meds, IV vs. inhaled inductions, parental presence, choosing a tube, when to put on monitors, how to do an inhaled induction, controversies around succinylcholine, weight-based dosing, deep extubation, laryngospasm, emergency delirium, regional anesthesia and pressers. Please note the original release referred to intranasal dexmedetomidine dosing as mg/kg instead of mcg/kg. The correct units are mcg/kg and the audio has now been updated to reflect that.
We also launch our ACCRAC theme music composed by Dr. Dennis Kuo! Check out his website at studymusicproject.com
- Cote and Lerman’s A Practice of Anesthesia for Infants and Children. Fifth Edition.
- Kain, Zeev. 2013 ASA Anesthesiology 2013 Refresher Course: Preoperative Evaluation, Premedication, and Induction of Anesthesia in Infants and Children https://www.apsf.org/article/in-my-opinion-a-debate-is-succinylcholine-safe-for-children/
- McAuliffe G1, Bissonnette B, Boutin C. Should the routine use of atropine before succinylcholine in children be reconsidered? Can J Anaesth. 1995 Aug;42(8):724-9.
- Patel, Davantral. Epidural anesthesia for children. Continuing Education in Anaesthesia Critical Care & Pain. 2006 April;6(2):63-66. https://academic.oup.com/bjaed/article/6/2/63/305090
- McCann ME, et al. Neurodevelopmental outcome at 5 years of age after general anaesthesia or awake-regional anaesthesia in infancy (GAS): an international, muticentre, randomised, controlled equivalence trial. Lancet. 2019 Feb;393(10172):664-677 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32485-1/fulltext
- Andrew J. Davidson, M.B.B.S., M.D., F.A.N.Z.C.A.; Lena S. Sun, M.D., F.A.A.P., D.A.B.A.. Clinical Evidence for Any Effect of Anesthesia on the Developing Brain Anesthesiology 2018 April; 128(4):840-853. http://anesthesiology.pubs.asahq.org/article.aspx?articleid=2664912&resultClick=1
Apr 23 2019
Rank #3: 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
Jul 19 2016
Rank #5: Episode 83: AICDs and Pacemakers with Jared Miller
May 18 2018
Rank #6: Episode 58: Medications For Neuraxial Anesthesia with Dave Berman and Anh Nguyen
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.
References can be found here: Neuraxial references
Oct 11 2017
Rank #7: Episode 77: Reversal of Neuromuscular Blockade
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.
Outline by Brian Park: NMB Reversal Outline
Miller’s Anesthesia 8th 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.
Mar 28 2018
Rank #8: Episode 19: Vasoactive medications
In this episode I review the receptors that vasoactive drugs act on. I then review the main vasoactive medications used in the OR and the ICU to treat acute hypotension and the ones used to treat acute hypertension.
Outline by April Liu: Outline
Nov 11 2016
Rank #9: Episode 44: Intro to cardiac anesthesia with Megan Kostibas
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.
May 23 2017
Rank #10: Episode 97: Waking up
In this episode, episode 97, I discuss how to optimize your wakeup at the end of an anesthetic.
Nov 08 2018
Rank #11: Episode 23: Basic Ventilator Review with Dr. Scott Stephens
In this episode I welcome Dr. Scott Stephens, Pulmonary Critical Care Physician at Johns Hopkins to the show. Dr. Stephens and I discuss basic ventilator settings, how to appropriately ventilate patients with hypoxemic vs. hypercarbic respiratory failure and how to think about weaning patients off of the ventilator.
Outline by Brian Park: Outline
Dec 05 2016
Rank #13: Episode 41: Local Anesthetics
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.
Apr 21 2017
Rank #14: Episode 76: Pain Pathways with Mark Bicket
In this episode, episode 76, I welcome Dr. Mark Bicket to the show to discuss pain pathways. We shape this one around some great board style questions that Mark put together.
Episode outline by Brian Park: Pain Pathways Outline
Mar 14 2018
Rank #15: 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.
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
Jan 07 2020
Rank #16: Episode 93: CABG with Tom Metkus
In the episode, episode 93, I welcome Dr. Tom Metkus back to the show to discuss perioperative considerations for CABG surgery.
Syntax Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa0804626
STICH Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1100356
ROOBY Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa0902905
CORONARY Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1200388
PREVENT IV Trial: https://www.ncbi.nlm.nih.gov/pubmed/16287955
Sep 28 2018
Rank #17: 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 firstname.lastname@example.org or email@example.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
#Cystic Fibrosis and bronchiectasis
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:
Jun 15 2016
Rank #18: Episode 59: Pulmonary HTN with Jochen Steppan
In this episode, episode 59, I welcome international pulmonary hypertension expert Dr. Jochen Steppan to the show to discuss pulmonary hypertension and how to manage the preoperative care of patients with this disease.
Outline by Brian Park: Outline
Oct 17 2017
Rank #19: Episode 127: Upper Extremity Blocks with Drs. Segna and Rayaz
In this 127th episode I welcome Drs. Segna and Rayaz to the show to discuss upper extremity nerve blocks. We discuss how they’re done, what they’re done for, and some high yield board style questions that may come up based on them.Outline by April LiuDownload
Hadzic, Admir. Hadzic’s textbook of regional anesthesia and acute pain management. McGraw Hill Professional, 2017.
Hall, Brian A., and Robert C. Chantigian. Anesthesia: A Comprehensive Review E-Book. Elsevier Health Sciences, 2014.
Horlocker, Terese T., Erik Vandermeuelen, Sandra L. Kopp, Wiebke Gogarten, Lisa R. Leffert, and Honorio T. Benzon. “Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines.” Regional anesthesia and pain medicine43, no. 3 (2018): 263-309.
Jul 04 2019
Rank #20: Episode 101: Coming off Bypass with Stephen Freiberg
In this 101st episode I welcome back Dr. Stephen Freiberg to the show to discuss how to successfully come off bypass when doing cardiac surgery with cardiopulmonary bypass.
References:-Barash Anesthesia for Cardiac Surgery
-Barry AE, Chaney MA, London MJ. Anesthetic management during cardiopulmonary bypass: a systematic review. Anesth Analg 2015; 120:749.
-Denault AY, Tardif JC, Mazer CD, et al. Difficult and complex separation from cardiopulmonary bypass in high-risk cardiac surgical patients: a multicenter study. J Cardiothorac Vasc Anesth 2012; 26:608.
-Lomivorotov VV, Efremov SM, Kirov MY, et al. Low-Cardiac-Output Syndrome After Cardiac Surgery. J Cardiothorac Vasc Anesth 2017; 31:291.
-McKinlay KH1, Schinderle DB, Swaminathan M, Podgoreanu MV, Milano CA, Messier RH, El-Moalem H, Newman MF, Clements FM, Mathew JP.JPredictors of inotrope use during separation from cardiopulmonary bypass. Cardiothorac Vasc Anesth. 2004 Aug;18(4):404-8.
Dec 17 2018