Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

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: F...

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=...

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 Diso...

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/ Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use...

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 Surger...

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" Our Sponsors...

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%2Cstripboo...

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 Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://ww...

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/w...

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 M...

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...

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: Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check...

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...

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 Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my code FIGSRX for a great deal: ht...

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. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Check out...

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. Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a...

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 M...

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). Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my code FIGSRX for a great deal: https://wea...

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/ Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal:...

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 PEE...

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 Relati...

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 Our Sponsors: * Check out BetterHelp and use my code betterhelp.com for a great deal: https://www.betterhelp.com * Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com * Che...

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 "E...

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/onlinefi...

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 Davi...