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!
Outline by Brian Park: NMB 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
Rank #2: 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
Rank #3: 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
Rank #4: Episode 97: Waking up
In this episode, episode 97, I discuss how to optimize your wakeup at the end of an anesthetic.
Rank #5: 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.
Rank #6: Episode 83: AICDs and Pacemakers with Jared Miller
Rank #7: Episode 132: Key Words Part 3: Spinals and Etomidate
In this 132nd episode I welcome back Dr. Gillian Isaac to do more ABA keyword review. We review Spinals for the Basic Exam and Etomidate.
Rank #8: 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.
Rank #9: 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
Rank #10: 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.
Rank #11: Episode 52: Diastolic Heart Failure with Todd Dorman
In this episode, episode 52, I welcome Dr. Todd Dorman to the show. Dr. Dorman is a professor of anesthesiology here at Johns Hopkins, is the Vice Chair for Critical Care, and is the immediate past president of the Society of Critical Care Medicine (SCCM). Dr. Dorman and I discuss diastolic heart failure or heart failure with preserved ejection fraction (HFPEF), how it differs from systolic heart failure or heart failure with reduced ejection fraction (HFREF), how it presents, and how to manage it perioperatively.
References for peripheral vasopressors:
- Medlej K et al. Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study. JEM 2018. PMID: 29110979
Rank #12: 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
Rank #13: 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.
Rank #14: Episode 126: Key Words with Gillian Isaac Part 2: Ketamine and Laryngospasm
In this 126th episode I welcome back Dr. Gillian Isaac to discuss 2 more ABA key words: Ketamine and Laryngospasm.
Rank #15: Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1
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.Outline By Brian Park:Download
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
Dextramethorphan: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755866/ R
Rank #16: 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
Rank #17: 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
Rank #18: Episode 133: Introducing the Depth of Anesthesia Podcast
In this 133rd episode we bring you the first episode from a new, fantastic anesthesia podcast called “Depth of Anesthesia” hosted by David Hao at MGH. in this episode they explore the evidence behind verifying mask ventilation before administering paralytic.
Rank #19: Episode 27: Airway Management
In this episode I review the ABA topic of airway management. This is obviously a huge topic but in this episode I highlight key points about the components of airway management recommended by the ABA including identification of a difficult airway, management of a difficult airway, the difficult airway algorithm, different tools and adjuncts, and different types of tubes. This will be the final post of 2016. Thanks so much to all of you for listening and being a part of ACCRAC’s inaugural year in 2016. Here’s wishing you a wonderful start to your 2017!
Rank #20: 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