Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

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 … Continue reading "Episode 15: IV Fluids"

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