Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

In this 195th Episode I welcome Dr. Trevor Gibbs to the show to discuss the process of taking an idea all the way to market as a new device. He talks through how he came up with his novel idea for a unique anesthesia stand, the long process of developing a company, getting a patent …

Continue reading "Episode 195: Invention and Device Development in Anesthesiology with Trevor Gibbs"

In this 194th episode I welcome Dr. Anna Sick-Samuels, a pediatric infectious disease specialist, to the show to discuss COVID in kids. Dr. Sick-Samuels is on Twitter @asicksamuels References: Feldstein LR, Rose EB, Horwitz SM, Collins JP, Newhams MM, Son MBF, et al. Multisystem Inflammatory Syndrome in U.S. Children and Adolescents. N Engl J Med. …

Continue reading "Episode 194: COVID in kids with Anna Sick-Samuels"

In this 193rd episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA Key Word topic. This time we discuss the pharmacology of inhaled anesthetic agents. References: Barash Clinical Anesthesia 8th edition and Anesthesiahub.com Random Recs: Chess.com A Woman of No Importance

In this 192nd episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword, maternal physiology. References: Barash Clinical Anesthesia 8th edition and Anesthesiahub.com

In this episode I welcome Dr. Bobbie Sweitzer to the show to discuss how to identify high risk patients for ambulatory surgery in order to reduce the risk of postop complications. We review important perioperative guidelines and how the patient population for ambulatory surgery is changing. Random Recs: Oreo Cheesecake: https://preppykitchen.com/oreo-cheesecake/ Malcolm X Biography: Link …

Continue reading "Episode 191: Preop assessment for ambulatory surgery with Bobbie Sweitzer"

In this 190th episode I welcome Dr. Yasmeen Beg to the show to discuss how Non-OR Anesthesia (NORA) differs from traditional OR anesthesia and what practitioners should keep in mind for these cases. Dr. Beg is on twitter @yasmeenb2

In this 189th episode I welcome Dr. Jason Chi to the show to discuss what we know about how to plan for surgery in patients who have recovered from COVID-19. Jason’s email: jasonchi1000@gmail.com Random Recs: Minari: https://youtu.be/KQ0gFidlro8 Doctors Without Borders: www.doctorswithoutborders.org Daniel Tiger: https://pbskids.org/daniel/

In this 188th episode I discuss the approach to Anesthesia for patients having thoracic surgery including highly tested concepts for board exams. Reference: Clinical Anesthesia. 2017. 8th Ed. Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K.; Cahalan, Michael K.; Stock, M. Christine; Ortega, Rafael; Sharar, Sam R.; Holt, Natalie F.Publisher: Lippincott Williams & Wilkins …

Continue reading "Episode 188: Anesthesia for Thoracic Surgery"

In this 187th episode I welcome Dr. Gabe Tharp to the show to discuss his recent article in Anesthesiology: “Body Habitus and Dynamic Surgical Conditions Independently Impair Pulmonary Mechanics during Robotic-assisted Laparoscopic Surgery.” We discuss his findings and whether we should be using much higher levels of PEEP than we currently do. Gabe’s group is …

Continue reading "Episode 187: PEEP for Robotic Surgery with Gabe Tharp"

In this 186th episode I welcome Dr. Jennifer Meeker to the show to discuss the increased use of cannabis in the general population and what that means for anesthesiologists taking care of patients who may have acute or chronic use. Random Recs: Tuesday Nights Cookbook: Link Vertellis: https://vertellis.com

In this 185th episode I welcome back Dr. Lee Goeddel to discuss assessment of fluid responsiveness in the operating room. References: Michard F. Changes in Arterial Pressure during Mechanical Ventilation. Anesthesiology. 2005;103(2):419-428. doi:10.1097/00000542-200508000-00026 Using Dynamic Variables to Guide Perioperative Fluid ManagementAzriel Perel, M.D.Anesthesiology October 2020, Vol. 133, 929–935. https://doi.org/10.1097/ALN.0000000000003408

In this 184th episode I welcome back Drs. Kara Segna and Hassan Rayaz to discuss truncal blocks. We discuss rectus sheath, transversus abdominis plane, quadratus lumborum and erector spinae plane blocks. Random Recs: The Wirecutter: https://www.nytimes.com/wirecutter/ How to be an anti-racist: Link Instant Hotel: https://www.netflix.com/title/81023011 Love Island Australia: https://en.wikipedia.org/wiki/Love_Island_Australia

In this 183rd episode I welcome back Dr. Gillian Isaac to do another keyword episode where we review the ABA keyword topics of Thyroid for the Basic Exam and Thyroid for the Advanced Exam. References: Barash Clinical Anesthesia 8th edition American Board of Anesthesiology Website Anesthesiahub.com Random Recs: Serious Eats Brown Butter Cookie Dough Recipe: …

Continue reading "Episode 183: Keywords Part 13 with Gillian Isaac: Thyroid for the Basic and Advanced Exams"

In this 182nd episode I welcome the president of the ASA medical student component, Stacia Griebahn, and the president-elect, Abigail Schirmer to the show to discuss what medical students applying in anesthesiology are concerned about this year and the responses that PDs have to those concerns. ASA medical student component webpage: https://www.asahq.org/education-and-career/asa-medical-student-component Abigail is on …

Continue reading "Episode 182: Med Student Concerns and PD Responses for the COVID Interview Season"

In this 181st episode I welcome Dr. Dave Berman back to the show to discuss what the evidence tells us about how to effectively teach in the perioperative arena. References: Chickering AW, Gamson ZF. Seven principles for good practice in undergraduate education. Biochem Educ 1989;17(3):140–1. Knowles MS. The modern practice of adult education. New York: …

Continue reading "Episode 181: Evidence-based perioperative teaching with Dave Berman."

In this 180th episode I welcome back Dr. Gillian Isaac for another ABA keyword episode. We review local anesthetics. Random recs: Genius on the edge: The bizarre double life of Dr. William Stewart Halsted: Link Killer Angels: Link The Powder Mage Trilogy: Link References: Barash Clinical Anesthesia 8th edition: Chapter on Local Anesthetics

In this 179th episode I welcome Kali Dayton, an ICU NP, to the show to discuss a major area of interest for her, getting intubated patients up and walking. Kali has a podcast dedicated to the topic called Walking Home from the ICU where she interviews patients about their experiences. Links: Anchor: https://anchor.fm/restoringlife iTunes: https://podcasts.apple.com/us/podcast/walking-home-from-the-icu/id1497431005 Spotify: https://open.spotify.com/show/61pYjGvlyitt3sgALgHYBg Google: https://podcasts.google.com/?feed=aHR0cHM6Ly9hbmNob3IuZm0vcy8xMmU1NWRhMC9wb2RjYXN0L3Jzcw&ved=2ahUKEwjFudzsof_pAhWNaM0KHRLrBLIQ4aUDegQIARAC&hl=en  …

Continue reading "Episode 179: Ambulating While Intubated with Kali Dayton"

In this 178th episode I welcome back Dr. Stephen Freiberg to discuss how to manage the patient in the post cardiopulmonary bypass period. Dr. Freiberg’s social media: thedadesthesiologist.comInstagram: @thedadesthesiologistTwitter: @dadesthesiaTik Tok: @thedadesthesiologist

In this 177th episode I discuss a survey of Anesthesiology program directors where I asked them both what makes a great resident great and what red flags make them worry about a resident. I go through the responses and lay out key points about how to earn the reputation of being a star resident. A …

Continue reading "Episode 177: How To Be a Star Resident"

In this 176th episode I welcome Dr. Gillian Isaac back to the show to discuss another 2 ABA key words. This time we discuss Barbiturates and Bier Blocks. I also take a moment up front to share some thoughts on the horrible tragedy of George Floyd’s death at the hands of the police and the …

Continue reading "Episode 176: Keywords Part 11: Barbiturates and Bier Blocks"

In this 175th episode I welcome Justin Harvey back to the show to discuss the financial implications of COVID-19 for medical students, residents, fellows and attending physicians. Justin is a fee-only financial advisor and CFP (Certified Financial Planner). References: Recommended student loan consulting company: www.studentloanplanner.com Anesthesiologist-founded physician-specific lending: https://www.doc2doclending.com/ A great flow chart for how to think …

Continue reading "Episode 175: Financial Planning in the Time of COVID with Justin Harvey"

In this 174th episode I welcome back Dr. Gillian Isaac to discuss another 2 highly tested ABA keywords, OR fires and electrical safety in the OR. OR Fires Risk for airway fire during laser resection of tracheal tumor DECREASED inA. CO2 rather than GAD laserB. Helium > 60%C. N2O > 60%D. PVC ETTE. Halothane in …

Continue reading "Episode 174: Keywords Part 10: OR Fires and Electrical Safety"

In this episode I welcome Sanjay Vakil, Jackie Boehme and Alex Stone to the show. Jackie and Alex are two of the co-founders of MasksOn.org and Sanjay is the Executive Director. We discuss the story of their company that provides free masks to healthcare workers and how people can go about innovating to help others …

Continue reading "Episode 173: Innovation In The Time of Covid: The MasksOn.org story with Drs. Sanjay Vakil, Jackie Boehme and Alex Stone"

In this 172nd episode I welcome a panel of experts to discuss the management of a pregnant patient with congenital heart disease. Drs. Hofkamp, Vaught and Meng join me to discuss the preoperative evaluation, obstetric management, and postoperative care.

In this 171st episode, a follow up to episode 113, I welcome Dr. Mintz back to the show to discuss anesthetic management for cerebral aneurysm surgery. References: Chapter 13 Anesthetic management of cerebral aneurysm surgery in Cottrell and Young, Neuroanesthesia http://www.joacp.org/article.asp?issn=0970-9185;year=2014;volume=30;issue=3;spage=328;epage=337;aulast=Kundra The Guns of August: https://www.amazon.com/Guns-August-Pulitzer-Prize-Winning-Outbreak/dp/0345476093 Cognitive Aid website: www.rnsascar.com

In this 170th episode I welcome Dr. Brian Garibaldi to the show to discuss his experience taking care of 40 critically ill COVID patients and what we’ve learned. We got through by system, head to toe, and discuss strategies and approaches. References: Lessons from China: https://jamanetwork.com/journals/jama/fullarticle/2762130 Convalescent Plasma: https://jamanetwork.com/journals/jama/fullarticle/2763983?widget=personalizedcontent&previousarticle=2762130 Management of patients with COVID: https://jamanetwork.com/journals/jama/fullarticle/2763879

In this episode I introduce Dr. Christina Miller’s video, linked below, that goes through PPE considerations including how to safely don and doff, and suggestions for how to handle a difficult airway in COVID patients. Video: https://drive.google.com/file/d/1AFYIouqGVLRlstU3xXSOJTHbtorWvQ7L/view

In this 168th episode I welcome Dr. Heather Nixon to the show to discuss what is being done for pregnant women and women in labor who have or are suspected to have COVID-19. The COVID book for kids by Taylor Purvis: https://playatrickonthecoronas.weebly.com/ Link for Anesthesia Toolbox daily online learning session: https://www.anesthesiatoolbox.com/docs/DOC-5178 References: https://s3.amazonaws.com/cdn.smfm.org/media/2277/SMFM-SOAP_COVID_LD_Considerations_3-27-20_(final)_PDF.pdf SOAP website: …

Continue reading "Episode 168: COVID in Pregnancy with Dr. Nixon"

In this 167th episode I review the most recent changes that we’ve made to our protocols for caring for COVID patients and share a fantastic one page summary sheet that 3 of our ICU fellows put together. Huge thanks to Drs. Navarette, Herekar and Baronos for their work on this. It is available for download …

Continue reading "Episode 167: COVID Clinical Care Update"

In this 166th episode I welcome Dr. Aliaksei Pustavoitau to the show to discuss management of the hypoxemia COVID-19 patient including initial triage, escalating support, endotracheal intubation, and ventilator management. References:

In this 165th episode I welcome Drs. Scott and Cereda from University of Pennsylvania and Dr. Nacoti from Italy to talk about COVID-19, what it is, what we know about it, what it’s like on the ground in Italy right now, and what we can learn from their experience to try to prevent it from …

Continue reading "Episode 165: COVID with Drs. Scott, Cereda and Nacoti"

In this 164th episode I welcome back Dr. Gillian Isaac to do another ABA keywords episode. We discuss fentanyl and breathing systems (Mapleson and Circle systems). Great info from Aaron Sandock: The toxicity was reported in rats and research was published in the early-mid 90’s.  Gonsowski, C., Laster, M., Eger, E., Ferrell, L. and Kerschmann, …

Continue reading "Episode 164: Keywords part 9: Fentanyl and Breathing Circuits"

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 …

Continue reading "Episode 163: Thoracic Wall Blocks with Barbara Versyck"

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

Continue reading "Episode 162: Hypertensive Disorders of Pregnancy with Juanita Henao"

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/

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 …

Continue reading "Episode 160: Non-OB Surgery in Pregnancy With Dave Berman"

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 …

Continue reading "Episode 159: Postpartum hemorrhage with Juanita Henao"

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 …

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

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

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 …

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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 …

Continue reading "Episode 155: Opioid-Free Anesthesia with Michael Manning"

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 …

Continue reading "Episode 154: EEG monitoring with Dr. Emery Brown"

In this 153rd episode I welcome Dr. Sasha Shillcutt to the show to discuss the movement to support and promote the success of women in Anesthesiology. Dr. Shillcutt is on twitter at @sashashillcutt and @RUBraveEnough. Her website is https://www.becomebraveenough.com References:

In this 152nd episode I welcome Dr. Gillian Isaac back for another 2 ABA keywords. We discuss malignant hyperthermia and the portion of hepatic disease that is covered by the Basic Exam. We’ll do the portion covered by the Advanced Exam on the next keywords episode. Malignant Hyperthermia Website: www.mhaus.org Great review website where Dr. …

Continue reading "Episode 152: Keywords Part 7: MH and Hepatic Disease for the Basic Exam"

In this 151st episode I welcome Brandon Oto to the show. Brandon is an ICU PA and we discuss the roles and relationships of APPs in the ICU environment. Brandon’s blog is http://critcon.org/ Brandon is on Twitter @critconcepts

In this 150th episode I welcome back Dr. Gillian Isaac to do another round of ABA keywords. We discuss 2 additional upper extremity blocks (supraclavicular and axillary) and then benzodiazepines.

In this 149th episode I discuss common challenges to the transition from intern year to CA1 year including some of why it’s difficult, the mistakes commonly made, the causes of those mistakes and some suggested solutions. Although I focus on the intern to CA1 transition, much of this applies to any major transition in life.

In this 148th episode I welcome Dr. Fitzsimons back to the show to discuss the use of marijuana in healthcare providers. We discuss what we know about prevalence, what the potential consequences are, what the status of testing is, and what we may see happen in the future. NEJM article on adverse effects of marijuana: …

Continue reading "Episode 148: Marijuana Use In Healthcare Providers with Mike Fitzsimons"

In this 147th episode I welcome back Drs. Segna and Rayaz to finish up our discussion of lower extremity nerve blocks. This time we cover the front of leg blocks (femoral, adductor canal, fascia iliaca and obturator).

In this 146th episode I welcome back Dr. Lee Goeddel to the show to discuss critical care ultrasound including how it differs from POCUS and how people can prepare for the new certification exam. References: Pears and Pitfalls in Critical Care Ultrasonography: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693549/

In this 145th episode recorded live from Anesthesiology 2019, the annual ASA meeting, I welcome Dr. Jeanine Wiener-Kronish to the show to discuss the progress we’ve made with mechanical ventilation and how we can personalize the way we deliver it to our patients to improve their outcomes. References: Pereira, SM, Tucci, MR, Morais, CCA, Simões, …

Continue reading "Episode 145: Personalized PEEP with Dr. Wiener-Kronish Live from ASA 2019"

In this 144th episode we record live from Anesthesiology 2019 in Orlando Florida. I welcome Dr. Jeffrey Cooper to the show to discuss the relationship between anesthesiologists and surgeons and what can be done to improve it in a way that will foster patient safety. Correction: The Center for Medical Simulation is not part of …

Continue reading "Episode 144: The Anesthesiologist-Surgeon Relationship with Jeffrey Cooper Live From ASA 2019"

In this 143rd episode I welcome Dr. Michael Scott to the show to discuss fluid management in ERAS cases and how cardiac output monitoring may help us do that well. Topmedtalk: https://www.topmedtalk.com

In this 142nd episode I welcome Dr. Marcos Vidal Melo to the show to discuss Driving Pressure and Transpulmonary pressure. We discuss what they are, how they differ from plateau pressure, and how they may help guide safe mechanical ventilation. References: Driving Pressure and Transpulmonary Pressure: How Do We Guide Safe Mechanical Ventilation? Williams EC, Motta-Ribeiro …

Continue reading "Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo"

In this 141st episode I welcome Dr. Paul Wischmeyer to the show to discuss nutrition for critically ill patients with a focus on the question of whether to give enteral feeds to patients on pressors. You can follow Dr. Wischmeyer on twitter @Paul_Wischmeyer. References: Dr. Wischmeyer’s article on enteral nutrition for patients on vasopressors: https://journals.lww.com/ccmjournal/Citation/onlinefirst/Enteral_Nutrition_Can_Be_Given_to_Patients_on.95859.aspx

In this 140th episode I welcome Dr. David Mazer to the show. Dr. Mazer was the PI and first author on the TRICS 3 trial looking at liberal versus restrictive transfusion strategies in moderate to high risk cardiac surgery patients published in the NEJM in 2017. Dr. Mazer would like to add the following random …

Continue reading "Episode 140: Transfusion Triggers and The TRICS 3 Trial with David Mazer"

In this 139th episode I welcome Dr. Gillian Isaac back to the show to discuss another 2 ABA keywords, succinylcholine and interscalene brachial plexus block.

In this 138th episode I welcome Drs. Segna and Rayaz back to the show to discuss lower extremity nerve blocks. We cover the ankle block and sciatic nerve block approaches today and will cover the anterior leg in a later episode. The Medium Article: https://medium.com/@admiralcloudberg/the-near-crash-of-air-canada-flight-759-c61094867d45

In this 137th episode I welcome Steve Kaufman to the show to discuss contracts and negotiation for doctors. Steve is a lawyer with decades of experience helping doctors negotiate contracts. If you have questions for Steve you can contact him directly at 410-659-1385, or email at SKaufman@wcslaw.com and he’s on twitter at @SKaufmanWCS

In this 136th episode I welcome Dr. Gillian Isaac back to the show to discuss another 2 ABA keywords, Celiac Plexus Block and Dexmedetomidine.

In this 135th episode I discuss my argument for using low dose norepinephrine to treat or even prevent hypotension in the OR and ICU. I discuss the CENSER trial looking at early norepinephrine in sepsis as well as a paper looking at preemptive norepinephrine in open cystectomies and a review article of trials looking at …

Continue reading "Episode 135: A Case For Low Dose Norepinephrine"

In this 134th episode I turn over the host chair to Dr. Dave Berman and he interviews me about how I got started in podcasting and things to think about for anyone interested in starting a podcast. Reference: https://www.ncbi.nlm.nih.gov/pubmed/31222949

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.

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.

In this 131st episode I welcome Drs. Meeks, Brookman and Fitzsimons to the show to discuss what it means to be a resident with a disability, what needs to be done to assure adequate and legal accommodations for these trainees, and why it’s important to do so. References: Meeks LM, Herzer KR. Prevalence of self-disclosed …

Continue reading "Episode 131: Disabilities in Medicine with Drs. Meeks, Brookman and Fitzsimons"

In this 130th episode I welcome back Dr. Jochen Steppan to discuss the perioperative care of adults with congenital heart disease. We discuss the incidence, evaluation and management including the different types of physiology that a provider might see and how to manage each one. References: http://www.pted.org/ For pictures of the lesions Stoelting’s Anesthesia and Co-Existing …

Continue reading "Episode 130: Adults with Congenital Heart Disease with Jochen Steppan"

In this 129th episode I welcome Dr. Dave Berman back to the show to discuss vascular access devices. We talk about what kinds of lines exist, how to choose, what the pros and cons are, and how to know what kind of flow you will get with a given catheter. References are here:

In this 128th episode I welcome Dr. Ashish Khanna to the show to discuss his trial, the PRODIGY trial, looking at opioid induced respiratory depression. We discuss the background of the trial, what it took to run a 16 site, 3 continent trial, what the risk factors were that went into the risk prediction model …

Continue reading "Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna"

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. References: Hadzic, Admir. Hadzic’s textbook of regional anesthesia and acute pain management. McGraw Hill …

Continue reading "Episode 127: Upper Extremity Blocks with Drs. Segna and Rayaz"

In this 126th episode I welcome back Dr. Gillian Isaac to discuss 2 more ABA key words: Ketamine and Laryngospasm.

In this 125th episode I welcome Dr. Erik Smith to the show to discuss Abusive Head Trauma (formerly known as shaken baby syndrome). We discuss how victims present, what to look out for, how to manage their anesthesia, how to report, and how it can impact providers. References: Christian, C. W., Block, R., Committee on …

Continue reading "Episode 125: Abusive Head Trauma with Erik Smith"

In this 124th episode I welcome Dr. Lee Goeddel to the show to discuss Point Of Care Ultrasound (POCUS). We discuss what it is, what it covers in the cardiac, pulmonary, abdominal and vascular system, and what next steps are for those interested in taking their skills further. References: Anesth Analg. 2017 Mar;124(3):753-760. doi: 10.1213/ANE.0000000000001861.The Nuts and Bolts of Performing Focused Cardiovascular Ultrasound (FoCUS).PMID:28207445  J …

Continue reading "Episode 124: POCUS with Lee Goeddel"

In this 123rd episode I welcome Andrew Merelman to the show. Andrew is a paramedic and medical student with an interest in emergent surgical airway management. We discuss the human factors involved in the procedure, when it is indicated, how to do it and how to practice. References and Links: Airway Ap information: http://www.airwaycollaboration.org/ iOS …

Continue reading "Episode 123: Surgical Airway with Andrew Merelman"

In this 122nd episode Dr. Gillian Isaac and I launch the first in a series of episodes to give high yield information on ABA key words. The first two we address are the crichothyroid membrane and propofol.

In this 121st episode I welcome Dr. Lynette Mark to the show. Dr. Mark is the founder of our Difficulty Airway Response Team (DART) here at Hopkins and a founding director for the Society of Airway Management. We discuss the origins of the DART program and how to approach a difficult airway. References: https://www.criticalcare.theclinics.com/article/S0749-0704(17)30102-1/abstract Difficult …

Continue reading "Episode 121: Difficult Airway Response Team With Lynette Mark"

In this first ever ACCRAC lightning round I take the contribution and advice of Andrew Salai, a med student in Brazil, and do some rapid fire review of high yield topics. If you have some factoids you’d like to contribute to a future lightning round send them to accrac@accrac.com.

In this 119th episode I welcome Dr. Robert Sawyer to the show. Dr. Sawyer was the PI on the STOP-IT trial comparing a short course of antibiotics versus a longer course for complicated intraabdominal infections. We discuss the trial, the outcomes, and what the future of antimicrobial management in the surgical ICU may look like. …

Continue reading "Episode 119: STOP-IT Trial with Rob Sawyer"

In this 118th episode which we are publishing a few days before Mother’s Day, 2019, I welcome Dr. Gillian Isaac to the show to discuss the challenges of being a mother and a trainee and some important advice for how to make it through and feel supported. Happy Mother’s Day and Thank you to all …

Continue reading "Episode 118: Mother’s Day"

In this 117th episode I welcome Dr. Matt Danley to the show to discuss his recent trip to Kenya, the different approaches to global health in surgery and anesthesia, and some of the ways to get involved. Matt’s email: Matt.Danley@gmail.com Links: LancetGlobalSurgery.org SafeSurgery2020.org Lifebox.org

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 …

Continue reading "Episode 116: Overview of Pediatric Anesthesia with Bommy Mershon"

In this 115th episode I welcome Dr. Steven Freiberg back to the show to discuss management of the contaminated airway. References: Han, S; Fisher, J. Airway Management During Persistent Flooding Of the Oropharyngeal Airway.  Anesthesiology News. 2016. March. Joshi, R; Hypes, C; et al.  Difficult Airway Characteristics Associated with First-Attempt Failure at Intubation Using Video …

Continue reading "Episode 115: The Contaminated Airway with Steve Freiberg"

In this 114th episode I welcome Dr. Jerry Stonemetz to the show to discuss the business side of Anesthesiology. Specifically we discuss billing, compliance, contract negotiation and Jerry’s thoughts on where the industry is heading. Slides are here:

In this 113th episode I welcome Dr. David Mintz back to the show to discuss anesthesia for intracranial aneurysm clipping. References: Chapter 13 Anesthetic management of cerebral aneurysm surgery in Cottrell and Young, Neuroanesthesia https://www.ncbi.nlm.nih.gov/pubmed/25014255

In this 112th episode I welcome Dr. Christina Miller to the show to discuss Anesthesia for Electroconvulsive Therapy (ECT). References: Ding Z, White PF. Anesthesia for electroconvulsive therapy. Anesth Analg. 2002 May;94(5):1351-64. Sadowksy, Jonathan. Electroconvulsvie Therapy: A History of Controversy, but Also of Help.  The Conversation. Scientific American.  January 13, 2017. Wright, M.D., Bruce A. …

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In this 111th episode I welcome Dr. Zandy Hillel to the show. Dr. Hillel is an otolaryngologist here at Johns Hopkins and we discuss tracheostomies, Cricothyrotomies, laryngeal surgery and difficult airways. References: Crichothyrotomies: https://www.ncbi.nlm.nih.gov/pubmed/30054081 https://www.ncbi.nlm.nih.gov/pubmed/30726035 Difficult Airway Response Teams: https://www.ncbi.nlm.nih.gov/pubmed/26086513

In this 110th episode I welcome Justin Harvey to the show. Justin is a financial planner with an interest in helping anesthesiologists and pain specialists make the best possible financial choices. We discuss financial planning, managing loan repayment, and investing. Justin’s email: Justin@quantifiplanning.com Justin’s podcast: AnesthesiaSuccess.com Justin’s financial planning company: www.quantifiplanning.com XY Planning network: https://www.xyplanningnetwork.com …

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In this 109th episode we pick up where we left off in episode 108 and discuss the intraoperative use of non-opioid adjuncts. 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 …

Continue reading "Episode 109: Non-Opioid Adjuncts with Drs. Grant and Bicket part 2"

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 …

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In this 107th episode I welcome Dr. Mike Fitzsimons back to the show to discuss the topic of suicide in physicians in general and in Anesthesia providers specifically. References: Bucknill JC, Duke DH. A Manual of Psychological Medicine. London, England: John Churchill;1958 Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin DC, Nasca …

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In this 106th episode I welcome Dr. Marius Fassbinder to the show to discuss the use of hydroxyethyl starches. References: 1. Woodcock, T. E. & Woodcock, T. M. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. British Journal of Anaesthesia 108, 384–394 (2012). 2. …

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In this 105th episode, which will be the first part in a series on blood management, I turn over the mic to Dr. Stephanie Cha who interviews Dr. Steve Frank about blood management in cardiac surgery and how to do “bloodless” surgery for patients who refuse blood transfusions. References: 1.         Myles PS, Smith JA, Forbes …

Continue reading "Episode 105: Blood Management Part 1 With Drs. Frank & Cha"

In this 104th episode I welcome Dr. Pam Lipsett to the show to discuss the diagnosis and treatment of sepsis. References: Sepsis-3 guidelines from JAMA: https://jamanetwork.com/journals/jama/fullarticle/2492881 Marik Sepsis cocktail: Marik PE et al. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock. 2017: 151(6);1229–1238. ADRENAL trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1705835 APROCCHSS Trial: https://www.nejm.org/doi/10.1056/NEJMoa1705716 SEPSISPAM Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1312173

In this 103rd episode I welcome Dr. Eva Ritzl and Dr. Alyson Russo to the show to discuss intraoperative neuromonitoring. Reference: Solt K and Froman S. Correlating the clinical actions and molecular mechanisms of general anesthetics. Curr Op in Anaes. 2007:20(4);300-306.

In this 102nd episode I welcome Dr. Dan Lowenstein to the show.  Dr. Lowenstein is a professor of Neurology and the Executive Vice Chancellor and Provost at University of California San Francisco (UCSF).  We discuss his lessons and advice for how to be successful professionally and personally. The Three Marriages book: http://www.davidwhyte.com/the-three-marriages/

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 …

Continue reading "Episode 101: Coming off Bypass with Stephen Freiberg"

In this 100th episode I respond to questions, both clinical and personal, from ACCRAC listeners.

In this episode, episode 99, I welcome Dr. Mike Fitzsimons from MGH to the show to talk about substance abuse in anesthesia providers and his recent article in Anesthesiology detailing their program to decrease rates of abuse. References: https://www.ncbi.nlm.nih.gov/pubmed/30020101  

In this episode, episode 98, I discuss the BICAR-ICU trial and what it tells us about using sodium bicarbonate to treat metabolic acidosis. References: BICAR-ICU Trial: https://www.ncbi.nlm.nih.gov/pubmed/29910040 BICAR-ICU Editorial: https://www.ncbi.nlm.nih.gov/pubmed/29910039 Forsythe: https://www.ncbi.nlm.nih.gov/pubmed/10631227 Sabatini: https://www.ncbi.nlm.nih.gov/pubmed/18322160 Pulmcrit post: https://emcrit.org/pulmcrit/bicar-icu/  

In this episode, episode 97, I discuss how to optimize your wakeup at the end of an anesthetic.

In this episode, episode 96, I welcome Dr. Nick Dalesio to the show.  Dr. Dalesio is the director of the pediatric difficult airway program here at Johns Hopkins.  We discuss the pediatric difficult airway response team, consult service, and how to anticipate and manage difficult airways in kids, both anticipated and unanticipated. Reference: Planning Prevents …

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In this episode, episode 95, I interview James Prudden, editorial director at Anesthesiology News, on the floor of the ASA conference in San Francisco.  We discuss the coverage of the field of anesthesiology, how providers can contribute, and how to get your work considered for coverage. James can be reached at Jprudden@mcmahonmed.com

In this episode, episode 94, I welcome Clint Burns to the show.  Clint received a liver transplant in 1994, then went on to go to nursing school, have 4 children, be an ICU nurse, and he now runs the organ and tissue donation program here at Johns Hopkins.  We discuss his story, the process of …

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In the episode, episode 93, I welcome Dr. Tom Metkus back to the show to discuss perioperative considerations for CABG surgery. References: 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 ART Trial: https://www.nejm.org/doi/full/10.1056/NEJMoa1610021

In this episode, episode 92, I welcome Dr. Sapna Kudchadkar to the show to discuss her PICU Up program for early mobility in the PICU.  We discuss the benefits of early mobility in general and specifically with pediatric patients, how she started her program, and what has led it to be so successful. Dr. Kudchadkar …

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In this episode, episode 91, I welcome Dr. Tom Metkus back to the show to discuss how we risk-stratify patients for non-cardiac surgery. Outline by Dr. Kimia Kashkooli References: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000104 http://www.onlinejacc.org/content/64/22/e77 https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/ESC-ESA-Guidelines-on-non-cardiac-surgery-cardiovascular-assessment-and-managem http://www.onlinejacc.org/content/accj/69/14/1861.full.pdf

In this episode, episode 90, I discuss best practices for preoperative management of adults with Obstructive Sleep Apnea (OSA). Outline by April Liu: Episode 90 References: Gross JB et al. Practice Guidelines for the Perioperative Managementof Patients with OSA. Aneshtesiology 2014: 120(2): 1-19 Chung F, et al. STOP-Bang Questionnaire: A practical Approach to Screen for …

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In this episode, episode 89, I welcome Dr. Bonnie Gatson to the show.  She is a veterinary anesthesiologist and we discuss her training, the differences and similarities between human and animal anesthesia, and the benefits of working together.

In this episode, episode 88, I welcome Dr. Mike Grant to the show to discuss Enhanced Recovery After Surgery (ERAS) protocols for cardiac surgery. References: https://www.ncbi.nlm.nih.gov/pubmed/?term=Enhanced+recovery+after+surgery+pathway+for+patients+undergoing+cardiac+surgery%3A+a+randomized+clinical+trial https://www.ncbi.nlm.nih.gov/pubmed/?term=Enhanced+Recovery+for+Cardiac+Surgery+Noss https://www.ncbi.nlm.nih.gov/pubmed/27321791 https://www.ncbi.nlm.nih.gov/pubmed/?term=27832832

In this episode, episode 87, I welcome Dr. Tom Metkus to the show.  Dr. Metkus is a cardiologist and intensivist and we discuss the etiology, presentation, management and outcomes of acute aortic dissections. Outline by Brian Park: Aortic Dissection Outline

In this episode, episode 86, I welcome Dr. Bob Sikorski back to the show to discuss thromboelastography (TEG) and thromboelastometry (ROTEM).  We discuss how they work, what they tell us and how we can use them. Example TEG:

In this episode, episode 85, I welcome back Dr. Tina Tran and we discuss how to be successful as a medical student on an anesthesia clerkship, how to be a successful teacher if you are a resident teaching medical students, and how to create a great medical student rotation if you are a clerkship director.

In this episode, episode 84, I welcome back Dr. Alyson Russo to discuss anesthesia for spine surgery.

In this episode, episode 83, I welcome Dr. Jared Miller to the show.  Dr. Miller is finishing his electrophysiology fellowship and we discuss the preoperative management of pacemakers and AICDs. Outline by Brian Park: AICD Outline Reference: https://www.ncbi.nlm.nih.gov/pubmed/24182719

In this episode, episode 82, I welcome Dr. Deb Schwengel back to the show to discuss pediatric obstructive sleep apnea (OSA).  We discuss the prevalence, diagnosis and preoperative management. Outline by Brian Park: Peds OSA Outline

In this episode, episode 81, I welcome Dr. Alyson Russo to the show to discuss how to prepare for and conduct anesthesia for craniotomy surgery.

In this episode, episode 80, I welcome Dr. Jonathan Curley to the show.  Jonathan is an anesthesia resident and a veteran of an elite pararescue unit in the United States Air Force.  We talk about some of the lessons that Jonathan learned from his time in the military and from some of the brave soldiers …

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In this episode, episode 79, I welcome Dr. Dheeraj Goswami to the show to discuss pediatric cardiothoracic anesthesiology.  We discuss the training required to do these cases, the most common cases and concerns, and how it differs from other forms of anesthesia.

In this episode, episode 78, I do something a little different as I review the fantastically interesting book, “The Obesity Code: Unlocking the secrets of weight loss”, by Dr. Jason Fung.  Full disclosure, there’s no real relationship to anesthesia and critical care, just some really interesting insights into the obesity epidemic and what can be …

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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 References: 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 …

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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

In this episode, episode 75, I welcome back Drs. Galvan and Hofkamp to do an OB oral board stem.  We juxtapose examples of “right” and “wrong” answers to highlight important approaches to the exam. The stem is here: Stem

In this episode, episode 74, I welcome Dr. Chad Brummett to the show.  Chad is the co-director of the Opioid Prescribing Engagement Network (OPEN) in Michigan and leads some fantastic and extremely effective initiatives to combat the opioid crisis.  His website has more details and materials for anyone interested in starting similar initiatives elsewhere.  Check …

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In this episode, episode 73, I welcome Darrell Ranum, an attorney and malpractice insurance executive, to the show to discuss his article on Anesthesia related liability claims.  We discuss why people sue anesthesia providers and how to reduce the risk of being sued. The article is: Ranum D, Beverly A, Shapiro FE and Urman RD. …

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In this episode, episode 72, I finish the oral board prep episode that was started in episode 71 with Drs. Tran and Beaudry.  In a twist, they flip the tables on me and make me be the examinee. The stem and questions are here: Oral board stem  

In this episode, episode 71, combined with the next episode, episode 72, I welcome back Drs. Tran and Beaudry to do an oral board prep example.  We got through how not to do it and then how to do it well.  This is part 1, episode 72 will be part 2. The stem and questions …

Continue reading "Episode 71: Oral Board Prep 2: part 1"

In this mini episode I thank Shirley Li, an Anesthesia Assistant student in Texas, for teaching me a bit about the career path of an Anesthesia Assistant and I share some of what she shared with me for any who are interested.

In this episode, Episode 69, I welcome Dr. Bob Sikorski, director of trauma anesthesiology at Johns Hopkins, to the show to discuss a general overview of trauma anesthesia.  We discuss prehospital, ER and OR management and key things to keep in mind when caring for trauma patients. References: Trauma references list TEG diagram:   

In this episode, episode 68, I welcome our chief CRNA, Andy Benson, to the show to discuss his career path and how we can all work together to provide the best patient care possible.

In this episode, episode 67, I welcome Dr. Pam Johnson to the show.  Dr. Johnson is a radiologist here at Hopkins who has taken an interest in high value care initiatives.  She and I discuss what this means and how people can get involved in reducing unnecessary testing and improving the quality of the care …

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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 References: Miller’s Anesthesia 7th edition: Chapter 29: …

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In this episode, episode 65 and the last of 2017, I give my tips and tricks for being as efficient as possible with your time management so that you can maximize your success with your work and your life in general.  Have a wonderful holiday and start to the new year! Outline by Brian Park: Outline

In this episode, episode 64, I welcome back Dr. Jacqueline Galvan to finish our discussion of programs during pregnancy and delivery.  We discuss hematologic, neurologic, respiratory, renal and infectious disease issues and how they affect pregnancy, delivery, and anesthetic management. Slides with references and notes: Problems during pregnancy part 2

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. References are here: References

In this episode, episode 62, I discuss problems that can occur during pregnancy with Dr. Jacqueline Galvan.  We discuss a wide range of high yield topics from gestational diabetes to molar pregnancies to maternal heart disease. References are here: References Outline by April Liu

In this episode, episode 61, I welcome Dr. Shravani Durbhakula, one of our chronic pain doctors, to the show.  We discuss the opioid crisis in American from the perspective of a chronic pain physician including what it is, how it came about, how it impacts our patients, and what we can do about it. References …

Continue reading "Episode 61: The Opioid Crisis with Shravani Durbhakula"

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. A fantastically helpful outline of the episode …

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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

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. Outline by Brian Park: Outline Dave’s email is dberma20@jhmi.edu and Anh’s is tnguy193@jhmi.edu. References …

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

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. Outline by April LiuSee other interactive posts

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. Skip to specific topics: …

Continue reading "Episode 56: Bugs and Drugs Part 1 with Rachel Kruer"

In this episode, episode 55, I welcome back frequent guest of the show Dr. Mike Hofkamp to pick up where I left off last time with Dr. Jacqueline Galvan as we discuss problems that can occur with pregnancy at term (part 2) including complications of labor and delivery. Outline by Brian Park: Outline

In this episode, episode 54, I welcome back Dr. Jacqueline Galvan and we discuss complications and physiology of term pregnancy.  This is part 1 of a 2 part series. Outline by Brian Park: Outline

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. Additional information: Outline by Brian Park Discussion references Urgent cesarean section …

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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 …

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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. 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 …

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In this episode, episode 50, I welcome back Dr. Mike Hofkamp, and, for the first time, I welcome Dr. Jacqueline Galvan to the show.  Drs. Hofkamp and Galvan go head to head in a debate over which is a better, more evidence-based technique, the traditional epidural or the CSE (combined spinal epidural). All of the …

Continue reading "Episode 50: CSE vs Epidural Debate with Mike Hofkamp and Jacqueline Galvan"

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 …

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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 …

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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. Outline by Brian Park: Outline

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 …

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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 …

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In this episode, episode 42, I discuss Post-op Nausea and Vomiting (PONV).  I discuss risk factors, complications, treatment and prevention and side effects. Outline by April Liu: Outline 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 …

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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. Outline by April Liu: Outline

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. Outline by April Liu: Episode 40

In this episode, episode 39, I interview Dr. Steve Frank, Professor of Anesthesia and Critical Care Medicine at Johns Hopkins, Medical Director of Blood Management for Johns Hopkins Health System and Chief of Adult Anesthesiology about anesthesia for liver transplants.

In this episode, episode 37, I go over crises that can happen in the OR, when to suspect them, and what to do about them.  I draw from two excellent sets of OR crisis checklists that are available for free.  The Stanford Anesthesia Cognitive Aid Group’s lists and the Ariadne Labs/Brigham/Harvard School of Public Health …

Continue reading "Episode 37: OR Crises"

In this episode, episode 36, I welcome Dr. Deb Schwengel, one of our pediatric anesthesiologists and our residency program director, to the show to discuss the differences in anatomy and physiology in pediatric versus adult patients. Outline by April Liu: Outline

In this episode, number 35, I welcome Dr. David Feller-Kopman to the show.  Dr. Feller-Kopman is an associate professor of medicine and Otolaryngology and the director of Bronchoscopy and Interventional Pulmonology here at Johns Hopkins.  I interview him about pleural effusions including what they are, where they come from, how to categorize them, how to …

Continue reading "Episode 35: Pleural effusions with Dr. David Feller-Kopman"

In this episode, episode 34, I welcome Dr. Tina Tran and Dr. Steve Beaudry to the show to give you two run throughs of an oral board stem.  First Dr. Tran demonstrates some common errors and then Dr. Beaudry demonstrates an example of the “right way” to do it.  We then mention some learning points …

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In this episode, episode 33, I welcome cardiac anesthesiologist Dr. Rosanne (Rosie) Sheinberg to the show to discuss ECMO.  We go through a comprehensive overview of what ECMO is, how it is used, how it is managed, the complications that can be seen and how to manage them and how to wean it off.

This episode is not about the practice of anesthesia or critical care.  I wanted to take a few minutes to share my feelings on the recent, abhorrent, un-American executive order known as the Muslim Ban.  This isn’t about political party, it’s about decency and humanity. I urge you to make your voice heard to your representatives, …

Continue reading "Episode 32: Thoughts on the executive order"

In this episode, episode 31, I welcome one of our amazing chief residents to the show, Dr. Stephen Freiberg.  Stephen has taken an interest in massive transfusion and he goes over the highlights of when to do it, how to do it, what complications you see from it and how to manage those complications.

In this episode, episode 30, I discuss the new American College of Cardiology Guidelines for the periprocedural management of anticoagulation for patients with non-valvular atrial fibrillation.  This includes whether to stop, when to stop, whether to bridge, how to bridge, and how and when to restart. Outline by Brian Park: AC for Afib Outline

In this episode, episode 29, I welcome to the show Dr. Glenn Whitman.  Dr. Whitman is a cardiac surgeon and intensivist and runs the cardiac surgical ICU here at Johns Hopkins.  I interview Dr. Whitman about PA catheters.  We discuss when to place them, when not to place them, how to use them and when …

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In this episode I welcome Dr. Laeben Lester to the show.  Dr. Lester is trained in Emergency Medicine and Anesthesiology and has completed fellowship training in Cardiac Anesthesiology.  He shares with us his “Nearly Needleless 5-Step Approach” to airway topicalization for awake intubation.

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 …

Continue reading "Episode 27: Airway Management"

In this episode I welcome Dr. Amit Prabhakar, one of our critical care fellows, to the show to discuss Sugammadex, a relatively recently approved (in the USA) reversal agent for Rocuronium and Vecuronium. Outline by Brian Park: Sugammadex outline

In this episode I am joined once again by Dr. Scott Stephens as we review advanced ventilator modes, prone positioning, and ventilation of patients on VV ECMO. Outline by April Liu: Outline The fantastic review article I mentioned is: Mireles-Cabodevila E. Et al. Alternative Modes of mechanical ventilation: A review for the hospitalist. Cleveland Clinic …

Continue reading "Episode 25: Advanced Ventilator Modes With Dr. Scott Stephens"

In this episode I first suggest you take a look at the recently published (ahead of print) VANCS study on the use of vasopressin as a sole agent in the treatment of vasoplegic shock.  Then I review the reasons never to use sodium bicarbonate in lactic acidosis. The Vancs study: https://www.ncbi.nlm.nih.gov/pubmed/27841822 The two articles I recommend …

Continue reading "Episode 24: The Evils of Sodium Bicarbonate"

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

In this episode I interview Dr. Joseph Hughes, one of our neuro anesthesiologists, about the history, etiology, pathophysiology and prevention of postoperative visual loss. We refer to a thromboelastogram which looks like this.  It is the fibrinolysis portion that can be prevented with tranexamic acid (TXA): High Yield Outline by Brian Park can be found …

Continue reading "Episode 22: Postop Visual Loss with Dr. Joe Hughes"

In this episode I interview Dr. Chris Wu, professor of anesthesiology and pain medicine and internationally renowned expert in Enhanced Recovery After Surgery (ERAS) pathways.  We discuss the different aspects of ERAS pathways and the evidence for improved outcomes. The ERAS society website can be found here: http://erassociety.org Check out this fantastic outline of the episode …

Continue reading "Episode 21: ERAS with Dr. Chris Wu"

In this episode I review two methods for managing arterial blood gasses in hypothermic patients, usually during cardiac surgery–pH Stat and Alpha Stat. Check out this fantastic episode recap put together by Brian Park from Drexel Medical School: Show recap

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

In this episode I go over some tips and tricks for maximizing your success with peripheral IVs, arterial lines, central venous catheters and pulmonary artery catheters (Swan Ganz catheters). The New England Journal videos that I recommend you take a look at for detailed reviews of each of these are here: Peripheral IV: http://www.nejm.org/doi/full/10.1056/NEJMvcm0706789 Arterial: …

Continue reading "Episode 18: Tips and Tricks for Line Placement"

In this episode I discuss awake intubation.  I discuss the indications, techniques, nerve blocks, sedation and different methods of performing awake intubation. Slides to go along with the podcast are here: awake intubation slides The youtube video of the MGH anesthesiologist intubating himself is here: self-intubation  

In this episode I welcome back Dr. David Mintz, neuroanesthesiologist, to discuss the treatment of increased intracranial pressure in the perioperative period and brain relaxation during neurosurgery.  Dr. Mintz will be back in the future to talk about the physiology of increased ICP.

In this episode I discuss the use of IV fluids for perioperative use including how to decide when to give fluid, the downsides of over resuscitation, whether to use crystalloid or colloid, and whether to use saline or a balanced salt solution such as LR.   Slides to go along with this episode are here: IV …

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This is the second of two episodes about opioid medications.  In this episode I cover the pharmacokinetics and pharmacodynamics of opioids, some of the common uses for these medications, mixed agonist-antagonist compounds, opioid antagonists, and opioid interaction with other medications. Slides to go along with this episode are here: Opioids part 2

This is the first of a 2 part series on opioid medications.  In this first episode I will talk about how opioids are categorized and their effects on the different body systems.  In the next episode I will discuss their pharmacokinetics and pharmacodynamics as well as their various uses and some details on mixed agonist/antagonists. …

Continue reading "Episode 13: Opioids part 1"

In this episode I welcome Dr. David Mintz, one of our neuroanesthesiologists here at Johns Hopkins, fellow Brown University Alum, and generally all around great guy, to the show to talk about air embolism, what it is, how it happens and how to manage it.  A big thanks to Dave for taking the time to …

Continue reading "Episode 12: Air Embolism with Dr. David Mintz"

In this episode I discuss hyperoxia and review the evidence in regards to the damage it can cause in patients with a wide variety of illnesses.   Slides to accompany the episode can be found here: hyperoxia slides

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 …

Continue reading "Episode 10: IV Induction Agents"

In this episode I review the basic medication setup for the operating room including premedication, induction, neuromuscular blockade, antibiotics, reversal and antiemetics.  I discuss weight based dosing and comment on a few alternatives to consider once you have the basic setup down.  This episode should be useful for new CA-1s getting started in the OR …

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This is the second and final episode dealing with the management of respiratory diseases.  In the first episode I covered the initial evaluation and preop preparation.  In this episode I cover intraoperative management, post-operative management, special issues related to one lung ventilation and special issues related to total pneumonectomy. Slides to go along with the …

Continue reading "Episode 8: Management of Respiratory Diseases Part 2"

This is the first of a two part series of episodes on the management of patients with respiratory disease.  In this, part 1, I cover the preoperative evaluation, history and physical exam, and the preoperative planning and optimization of the patient.  This includes the key board topics of smoking cessation and cardiac risk assessment. Here …

Continue reading "Episode 7: Management of the patient with respiratory disease part 1"

In this episode I first announce the new ACCRAC website here at ACCRAC.com.  Big thanks to Bryan Mariscalchi for his help setting it up.  I also mention the problem the last two episodes had with only playing out of one ear on earphones.  I hope I’ve cleared that problem up.  I mention a fantastic book …

Continue reading "Episode 6: The Paraglossal Approach to Intubation"

In this episode I review restrictive lung disease.  This is meant to be a companion episode to Episode 4 which covered obstructive lung disease.  I cover the following topics: -Definition and diagnosis of restrictive lung disease -Spirometry -Extra-pulmonary causes (neurologic, musculoskeletal, pleural/mediastinal) -Parenchymal causes -Infant RDS -ARDS -Pulmonary Fibrosis The accompanying slides can be downloaded …

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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 accrac@accrac.com or accracpodcast@gmail.com.  I also highlight Rob MacSweeney’s fantastic critical care site called criticalcarereviews.com and his newsletter which …

Continue reading "Episode 4: Obstructive Lung Disease"

There are a few announcements I wanted to make including: Check out pedsanesthesia.net.  Dr. Robert Greenberg, a pediatric anesthesiologist here at Johns Hopkins runs it and it has lots of great information and topics in pediatric anesthesiology. If you have suggestions for a better website than this one please let me know! If you know …

Continue reading "Episode 3: Announcements and FIO2 in one lung ventilation"

In this episode I review the topics of intraoperative hypothermia and temperature regulation.  Lots of good board review topics and some sample board review questions.  The slides are available here: Temperature Regulation Slides You can leave comments here or email accracpodcast@gmail.com. Topics covered: Hypothermia: Etiology, Prevention, Treatment, Complications Effect of Drugs/Anesthesia on Temperature regulation Heat Loss …

Continue reading "Episode 2: Temperature Regulation"

This is a very high yield episode to help you review for the anesthesia board exam.  I cover the board key word section entitled gas laws which includes a focus on volatile anesthetics, their properties, and how they act on, and in, the human body. Topics covered will include: Full post for episode links Vapor …

Continue reading "Episode 1: Properties and laws of volatile anesthetics"