Anesthesia Clerkship Podcast

VTDAT Approach This should complement teachings you've likely already received on an ABCDE approach. Three boxes: Anesthetic, Surgical, Patient Categories: Hypovolemic, Distributive, Cardiogenic, Obstructive, Mixed Use history, physical, non-invasive and invasive monitors, investigations (ECG, blood work, ultrasound, etc) to rule in or rule out your differential. Trial treatments. Assess respo...

PDPH is a recognised complication of neuraxial anesthesia. Around 4 minutes I misspoke and stated an 18G spinal needle - I meant epidural needle, I corrected myself the second time I stated it, sorry for the confusion! Have questions, comments, corrections, or concerns? Please reach out via email: ⁠anesthesiaclerkship@gmail.com References: 1. Gobel, Hartmut. “7.2.1 Post-Dural Puncture Headache.” I...

In this episode, we define multimodal analgesia and give a brief introduction to the many agents that can be utilised. Opioids are a mainstay of treating post-surgical pain and the goal of multimodal analgesia is not to avoid opioids (termed opioid-sparing analgesia) but to reduce the negative side effects while providing adequate post-surgical pain. The medications listed are those that are typic...

We discussed the VTDAT approach to unstable patients in the OR (although this could also apply to out-of-OR situations). Vitals (Alert the Room) Temporize Differential Diagnosis Assessment Treatment We also discuss an approach to high airway pressure - patient to machine or machine to patient. Have questions, comments, corrections, or concerns? Please reach out via email: ⁠anesthesiaclerkship@gmai...

We give an example of an "unanticipated" difficult airway situation along with a basic overview of some of the algorithm suggestions. I would strongly encourage you to check out the Vortex approach, the link is at the bottom of the references. Have questions, comments, corrections, or concerns? Please reach out via email: ⁠anesthesiaclerkship@gmail.com⁠ References: 1. Apfelbaum, Jeffrey...

This episode focuses on an overview of physiological changes in pregnancy and how this can impact anesthesia. We discuss the preference for neuraxial anesthesia and use the ABCDE approach to cover some anesthetic considerations. Have questions, comments, corrections, or concerns? Please reach out via email: anesthesiaclerkship@gmail.com References: 1. Gropper MA, Cohen NH, Eriksson LI, Fleisher LA...

Behind the Drapes: Highlights of teaching sessions in the operating room. Ep 1: Airway Assessment - A Deeper Dive with Dr. John Veall. TLDR: Airway management is a complex interplay of anatomy, physiology, circumstance and human factors. Our assessment, preparation and training should reflect that. References: Huitink JM, Bouwman RA. The myth of the difficult airway: airway management revisited. A...

This episode focuses on general anesthesia in pediatric patients.  When organising your "considerations" - (I wouldn't worry about this much as an MSI3, but for any MSI4s preparing for electives this is a good thing to start practising) try to develop a system to maintain an organised approach. We introduce an ABCDE method in this episode.  Link to the website / app for Anesthesia Consid...

References:  1. Uptodate 2. Sullivan P. Ottawa Anesthesia Primer. ECHO BOOK PUBLISHING; 2012. 3. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail’s Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013. 4. Snider, K. T., Kribs, J. W., Snider, E. J., et al. (2008). Reliability of Tuffierʼs Line as an Anatomic Landmark. Spine, 33(6), E161–E165. doi:10.1097/brs.0b013e318166f58c 5....

Neuromuscular Blockade: - Facilitates intubation - Facilitates better surgical conditions - Facilitates mechanical ventilation (i.e. ARDS, hyperventilating in increased ICP) Two Categories:  - Depolarizing: ex. Succinylcholine (1-1.5mg/kg IV) depolarizes the muscle and prevents repolarization. - Non-depolarizing: ex. Rocuronium (0.6-1.2mg/kg IV) Outcompetes ACh for the receptor on the endplat...

Post-op nausea and vomiting is associated with high levels of patient dissatisfaction, longer admissions and therefore higher costs to the medical system.  Screen with the APFEL score + the other risk factors (younger age, type and length of surgery, anesthetic gases or nitrous exposure) 1+ risk factors? 2 prophylactic anti-emetics.  3+ risk factors? 3-4 prophylactic anti-emetics. ...

Preoperative Physical Exam: 1. Inspect for factors indicative of difficult BVM, LMA, or Intubation.  2. Apply the 332-1 Rule (The 1 is the Upper Lip Bite Test which should equal about one pinky finger width of forward jaw protrusion)  3. Assign a Mallampati Score  4. Screen for neck mobility  5. Focused Cardio-Resp exam. Can examine patients veins too. References: 1.  Shar...

Pre-Op Acronym: YAMPLLE Y - Why are you here A- Anesthetic History  M - Meds and Allergies  P - Past Medical History / ROS/ ASA L - Last meal (NPO) L - Labs and Investigations  E - Airway and Cardio-Resp Exam.  References: 1.  Sullivan P. Ottawa Anesthesia Primer . ECHO BOOK PUBLISHING; 2012. 2.  Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail’s Clinical Anes...