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From 10 epsHost
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41: Do pulmonary artery catheters improve outcomes in cardiac surgery?
Oct 26, 2025
32m 56s
40: Are peripartum opioids safe for breastfeeding mothers?
Apr 9, 2025
41m 29s
39: Should opioid-free anesthesia be implemented? A Pro-Con Debate.
Jan 10, 2025
25m 13s
38: Does remifentanil cause opioid-induced hyperalgesia?
Sep 23, 2024
28m 36s
37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?
May 1, 2024
41m 22s
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| Date | Episode | Topics | Guests | Brands | Places | Keywords | Sponsor | Length | |
|---|---|---|---|---|---|---|---|---|---|
| 10/26/25 | 41: Do pulmonary artery catheters improve outcomes in cardiac surgery?✨ | pulmonary artery catheterscardiac surgery+3 | Dr. Taylor ThomasDr. Matt Vanneman | MGHStanford | — | pulmonary artery cathetercardiac surgery+3 | — | 32m 56s | |
| 4/9/25 | 40: Are peripartum opioids safe for breastfeeding mothers?✨ | peripartum opioidsbreastfeeding safety+3 | Dr. Gopika HariDr. Lana Joudeh | MGH Anesthesia Residency ProgramWashington University School of Medicine in St. Louis+4 | — | peripartum opioidsbreastfeeding+3 | — | 41m 29s | |
| 1/10/25 | 39: Should opioid-free anesthesia be implemented? A Pro-Con Debate.✨ | opioid-free anesthesiaopioid-based anesthesia+3 | Dr. Mary DanielsDr. Scott Cao | MGH anesthesia residency programUniversity of Colorado School of Medicine+1 | — | opioid-free anesthesiaopioid-based anesthesia+3 | — | 25m 13s | |
| 9/23/24 | 38: Does remifentanil cause opioid-induced hyperalgesia?✨ | remifentanilopioid-induced hyperalgesia+3 | Dr. Jess Hawkins | Massachusetts General HospitalPain Medicine+2 | — | remifentanilopioid-induced hyperalgesia+5 | — | 28m 36s | |
| 5/1/24 | 37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?✨ | dexamethasonediabetes mellitus+3 | Dr. Caroline AndrewDr. David Nathan | Massachusetts General HospitalHarvard Medical School+1 | — | dexamethasonediabetes+3 | — | 41m 22s | |
| 12/6/23 | 36. Does tranexamic acid increase the risk of thromboembolism?✨ | tranexamic acidthromboembolism+4 | Dr. Zach CostDr. Tem Bendapudi | Massachusetts General HospitalHarvard Medical School+1 | — | tranexamic acidthromboembolism+5 | — | 1h 00m 48s | |
| 7/30/23 | 35. Does spinal anesthesia decrease the risk of postoperative delirium?✨ | spinal anesthesiapostoperative delirium+3 | Dr. Mark NeumanDr. Sam Falkson | Penn MedicineMassachusetts General Hospital | — | spinal anesthesiapostoperative delirium+4 | — | 58m 07s | |
| 4/2/23 | 34. Are double lumen endotracheal tubes superior to bronchial blockers?✨ | double lumen endotracheal tubesbronchial blockers+3 | Dr. Nick KumarDr. Andy Siemens | Massachusetts General Hospital | — | double lumenendotracheal tubes+5 | — | 46m 45s | |
| 1/4/23 | 33. Do perioperative gabapentinoids decrease postoperative pain?✨ | gabapentinoidspostoperative pain+3 | — | Depth of AnesthesiaAnesthesiology+1 | — | gabapentinpregabalin+3 | — | 27m 16s | |
| 10/18/22 | 32: Do LMAs increase the risk of aspiration compared to ETTs? - Part II of II✨ | risk of aspirationlaryngeal mask airway+3 | Dr. Chris Di CapuaDr. Bryan Glezerson | Depth of Anesthesia PodcastMGH | — | LMAsETTs+3 | — | 35m 06s | |
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| 8/10/22 | 31: Do LMAs increase the risk of aspiration compared to ETTs? - Part I of II | Dr. Chris Di Capua and Dr. Bryan Glezerson (@BryanGlezerson) join the show to discuss the literature around the risk of aspiration with LMAs compared to ETTs. This is part I of a two-part series on LMAs. In part II, we discuss the safety of LMAs in specific patient populations including patients receiving positive pressure ventilation, patients undergoing laparoscopic surgery, obese patients, and pregnant patients. This is an episode produced from the Depth of Anesthesia Podcast Elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Barker P, Langton JA, Murphy PJ, Rowbotham DJ: Regurgitation of gastric contents during general anesthesia using the laryngeal mask airway. Br J Anaesth 1992; 69:314-5. Rabey PG, Murphy PJ, Langton JA, Barker P, Rowbotham DJ. Effect of the laryngeal mask airway on lower oesophage al sphincter pressure in patients during general anaesthesia. Br J Anaesth. 1992 Oct;69(4):346-8. doi: 10.1093/bja/69.4.346. PMID: 1419440. Owens TM, Robertson P, Twomey C, Doyle M, McDonald N, McShane AJ. The incidence of gastroesophageal reflux with the laryngeal mask: a comparison with the face mask using esophageal lumen pH electrodes. Anesth Analg. 1995 May;80(5):980-4. doi: 10.1097/00000539-199505000-00022. PMID: 7726443. Bercker S, Schmidbauer W, Volk T, Bogusch G, Bubser HP, Hensel M, Kerner T. A comparison of seal in seven supraglottic airway devices using a cadaver model of elevated esophageal pressure. Anesth Analg. 2008 Feb;106(2):445-8, table of contents. doi: 10.1213/ane.0b013e3181602ae1. PMID: 18227299. Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth. 1995 Jun;7(4):297-305. doi: 10.1016/0952-8180(95)00026-e. PMID: 7546756. Xu R, Lian Y, Li WX. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. PLoS One. 2016 Jul 14;11(7):e0158137. doi: 10.1371/journal.pone.0158137. PMID: 27414807; PMCID: PMC4944923. | — | ||||||
| 5/23/22 | 30: Live from the IARS Annual Meeting - Part II of II | In this special two-part series, we record a live episode at the International Anesthesia Research Society meeting. Dr. Dan Saddawi-Konefka and I revisit a question from our very first Depth of Anesthesia episode: is it necessary to confirm mask ventilation before paralyzing? Supporting graphics are available at depthofanesthesia.com and on our Instagram @DepthofAnesthesia. Special thanks to Dr. Seun Johnson-Akeju, Dr. Keith Baker, and Dr. Dan Leisman for their guidance and support. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. __ References available at https://depthofanesthesia.com/exploring-clinical-dogma-with-the-depth-of-anesthesia-podcast-team-iars-2022/ | — | ||||||
| 5/10/22 | 29: Live from the IARS Annual Meeting - Part I of II | In this special two-part series, we record a live episode at the International Anesthesia Research Society meeting. Dr. Dan Saddawi-Konefka and I revisit a question from our very first Depth of Anesthesia episode: is it necessary to confirm mask ventilation before paralyzing? Supporting graphics are available at depthofanesthesia.com and on our Instagram @DepthofAnesthesia. Special thanks to Dr. Seun Johnson-Akeju, Dr. Keith Baker, and Dr. Dan Leisman for their guidance and support. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. __ References available at https://depthofanesthesia.com/exploring-clinical-dogma-with-the-depth-of-anesthesia-podcast-team-iars-2022/ | — | ||||||
| 3/11/22 | 28: What is the infectious risk of arterial catheters? | Dr. Ben Weaver and Dr. Elisa Walsh (@elisacwalsh) from Massachusetts General Hospital join the show to discuss the literature around the infectious risk of arterial catheters and the role of barrier precautions. This is the first episode produced from a new podcast elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Cohen DM, Carino GP, Heffernan DS, et al. Arterial catheter use in the ICU: A national survey of antiseptic technique and perceived infectious risk. Crit Care Med. 2015;43(11):2346-2353. doi:10.1097/CCM.0000000000001250 Koh DBC, Gowardman JR, Rickard CM. Prospective study of peripheral arterial catheter infection and comparison with concurrently sited central venous catheters (Critical Care Medicine (2008) 36, (397-402)). Crit Care Med. 2008;36(4):1394. doi:10.1097/CCM.0b013e31816e6d16 Lucet JC, Bouadma L, Zahar JR, et al. Infectious risk associated with arterial catheters compared with central venous catheters. Crit Care Med. 2010;38(4):1030-1035. doi:10.1097/CCM.0b013e3181d4502e O'Horo JC, Maki DG, Krupp AE, Safdar N. Arterial catheters as a source of bloodstream infection: A systematic review and meta-analysis. Crit Care Med. 2014;42(6):1334-1339. doi:10.1097/CCM.0000000000000166 Raad II, Hohn DC, Gilbreath BJ, et al. Prevention of Central Venous Catheter-Related Infections by Using Maximal Sterile Barrier Precautions during Insertion Srr PREVENTION OF CENTRAL VENOUS CATHETER-RELATED INFECTIONS BY USING MAXIMAL STERILE BARRIER. 1994;15(4). Rijnders BJA, Van Wijngaerden E, Wilmer A, Peetermans WE. Use of full sterile barrier precautions during insertion of arterial catheters: A randomized trial. Clin Infect Dis. 2003;36(6):743-748. doi:10.1086/367936 Rijnders BJA, Wijngaerden E Van, Peetermans WE. Catheter-Tip Colonization as a Surrogate End Point in Clinical Studies on Catheter-Related Bloodstream Infection : How Strong Is the Evidence ? 2002;35:1053-1058. | — | ||||||
| 1/10/22 | 27: Does BIS monitoring reduce accidental awareness during general anesthesia? | Dr. Bryan Glezerson (@BryanGlezerson), a neuroanesthesiologist in Montreal, Canada, joins the show to discuss the literature around BIS monitoring and awareness with recall under general anesthesia. Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References American Society of Anesthesiologists Task Force on Intraoperative Awareness. Practice advisory for intraoperative awareness and brain function monitoring: a report by the american society of anesthesiologists task force on intraoperative awareness. Anesthesiology. 2006 Apr;104(4):847-64. doi: 10.1097/00000542-200604000-00031. PMID: 16571982. Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, Karl L, Kamal S, Torres B, O'Connor M, Evers AS, Gradwohl S, Lin N, Palanca BJ, Mashour GA; BAG-RECALL Research Group. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011 Aug 18;365(7):591-600. doi: 10.1056/NEJMoa1100403. PMID: 21848460. Avidan MS, Mashour GA. Prevention of intraoperative awareness with explicit recall: making sense of the evidence. Anesthesiology. 2013 Feb;118(2):449-56. doi: 10.1097/ALN.0b013e31827ddd2c. PMID: 23263014. Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008 Mar 13;358(11):1097-108. doi: 10.1056/NEJMoa0707361. PMID: 18337600. HUTCHINSON R. Awareness during surgery. A study of its incidence. Br J Anaesth. 1961 Sep;33:463-9. doi: 10.1093/bja/33.9.463. PMID: 14450247. Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev. 2019;9(9):CD003843. Published 2019 Sep 26. doi:10.1002/14651858.CD003843.pub4 Mashour GA, Shanks A, Tremper KK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology. 2012;117(4):717-725. doi:10.1097/ALN.0b013e31826904a6 Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004 May 29;363(9423):1757-63. doi: 10.1016/S0140-6736(04)16300-9. PMID: 15172773. Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O'Connor K, O'Sullivan EP, Paul RG, Palmer JH, Plaat F, Radcliffe JJ, Sury MR, Torevell HE, Wang M, Cook TM; Royal College of Anaesthetists; Association of Anaesthetists of Great Britain and Ireland. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data. Br J Anaesth. 2014 Oct;113(4):540-8. doi: 10.1093/bja/aeu312. Epub 2014 Sep 9. PMID: 25204695. Zhang C, Xu L, Ma YQ, Sun YX, Li YH, Zhang L, Feng CS, Luo B, Zhao ZL, Guo JR, Jin YJ, Wu G, Yuan W, Yuan ZG, Yue Y. Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial. Chin Med J (Engl). 2011 Nov;124(22):3664-9. PMID: 22340221. | — | ||||||
| 7/29/21 | 26: Should buprenorphine be discontinued preoperatively? | Dr. Tony Anderson, an anesthesiologist at the Stanford University School of Medicine, joins us to discuss the evolving literature and evidence around perioperative management of buprenorphine. Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. 2017 Jun;126(6):1180-1186. doi: 10.1097/ALN.0000000000001633. PMID: 28511196; PMCID: PMC7041233. Goel A, Azargive S, Lamba W, Bordman J, Englesakis M, Srikandarajah S, Ladha K, Di Renna T, Shanthanna H, Duggan S, Peng P, Hanlon J, Clarke H. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019 Feb;66(2):201-217. English. doi: 10.1007/s12630-018-1255-3. Epub 2018 Nov 27. PMID: 30484167. Goel A, Azargive S, Weissman JS, Shanthanna H, Hanlon JG, Samman B, Dominicis M, Ladha KS, Lamba W, Duggan S, Di Renna T, Peng P, Wong C, Sinha A, Eipe N, Martell D, Intrater H, MacDougall P, Kwofie K, St-Jean M, Rashiq S, Van Camp K, Flamer D, Satok-Wolman M, Clarke H. Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process. Br J Anaesth. 2019 Aug;123(2):e333-e342. doi: 10.1016/j.bja.2019.03.044. Epub 2019 May 29. PMID: 31153631; PMCID: PMC6676043. Hansen LE, Stone GE, Matson CA, Tybor DJ, Pevear ME, Smith EL. Total joint arthroplasty in patients taking methadone or buprenorphine/naloxone preoperatively for prior heroin addiction: a prospective matched cohort study. J Arthroplasty 2016; 31: 1698-701. (29) Höflich AS, Langer M, Jagsch R, Bäwert A, Winklbaur B, Fischer G, Unger A. Peripartum pain management in opioid dependent women. Eur J Pain. 2012 Apr;16(4):574-84. doi: 10.1016/j.ejpain.2011.08.008. PMID: 22396085; PMCID: PMC3290684. Li A, Schmiesing C, Aggarwal AK.Evidence for Continuing Buprenorphine in the Perioperative Period. Clin J Pain. 2020 Oct; 36(10): 764-774.doi: 10.1097/AJP.0000000000000858. PMID: 32520814 Macintyre PE, Russel RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care 2013; 41: 222-30 (27) Meyer M, Paranya G, Keefer Norris A, Howard D. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain. 2010 Oct;14(9):939-43. doi: 10.1016/j.ejpain.2010.03.002. Epub 2010 May 4. PMID: 20444630. Quaye A, Potter K, Roth S, Acampora G, Mao J, Zhang Y. Perioperative Continuation of Buprenorphine at Low-Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation. Pain Med. 2020 Sep 1;21(9):1955-1960. doi: 10.1093/pm/pnaa020. PMID: 32167541. | — | ||||||
| 6/8/21 | 25: Should stress-dose steroids be given? | In this episode, Dr. Jonathan Charnin and Dr. Daniel Saddawi-Konefka join us to explore the evidence around perioperative stress dose steroids and adrenal insufficiency. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. -- Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. -- References Axelrod L. Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin North Am. 2003 Jun;32(2):367-83. doi: 10.1016/s0889-8529(03)00008-2. PMID: 12800537. Bromberg JS, Baliga P, Cofer JB, et al. Stress steroids are not required for patients receiving a renal allograft and undergoing operation. J Am Coll Surg 1995;180:532–536. Christy NP. Corticosteroid withdrawal. In: Current Therapy in Endocrinology and Metabolism, 3rd Ed, Bardin CW (Ed), BC Decker, New York 1988. P.113. Glowniak JV, Loriaux DL. A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency. Surgery. 1997 Feb;121(2):123-9. doi: 10.1016/s0039-6060(97)90280-4. PMID: 9037222. Kehlet H, Binder C. Adrenocortical function and clinical course during and after surgery in unsupplemented glucocorticoid-treated patients. Br J Anaesth. 1973 Oct;45(10):1043-8. doi: 10.1093/bja/45.10.1043. PMID: 4772640. LEWIS L, ROBINSON RF, YEE J, HACKER LA, EISEN G. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med. 1953 Jul;39(1):116-26. doi: 10.7326/0003-4819-39-1-116. PMID: 13065993. Melanie M. Liu, Andrea B. Reidy, Siavosh Saatee, Charles D. Collard; Perioperative Steroid Management: Approaches Based on Current Evidence. Anesthesiology 2017; 127:166–172 doi: https://doi.org/10.1097/ALN.0000000000001659 Prete A, Yan Q, Al-Tarrah K, Akturk HK, Prokop LJ, Alahdab F, Foster MA, Lord JM, Karavitaki N, Wass JA, Murad MH, Arlt W, Bancos I. The cortisol stress response induced by surgery: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018 Nov;89(5):554-567. doi: 10.1111/cen.13820. Epub 2018 Aug 23. PMID: 30047158. Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019 Aug 29;381(9):852-861. doi: 10.1056/NEJMra1807486. PMID: 31461595. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219(4):416-425. doi:10.1097/00000658-199404000-00013 Thomason JM, Girdler NM, Kendall-Taylor P, Wastell H, Weddel A, Seymour RA. An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study. J Clin Periodontol. 1999 Sep;26(9):577-82. doi: 10.1034/j.1600-051x.1999.260903.x. PMID: 10487307. Woodcock T, Barker P, Daniel S, Fletcher S, Wass JAH, Tomlinson JW, Misra U, Dattani M, Arlt W, Vercueil A. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May;75(5):654-663. doi: 10.1111/anae.14963. Epub 2020 Feb 3. Erratum in: Anaesthesia. 2020 Sep;75(9):1252. PMID: 32017012. Zaghiyan K, Melmed G, Murrell Z, Fleshner P. Are high-dose perioperative steroids necessary in patients undergoing colorectal surgery treated with steroid therapy within the past 12 months? Am Surg. 2011 Oct;77(10):1295-9. PMID: 22127073. | — | ||||||
| 4/27/21 | 24: Is low flow anesthesia with sevoflurane safe? | In this episode, Dr. Ross Kennedy and Dr. Cas Woinarski join us to discuss the evidence on whether low-flow anesthesia with sevoflurane is safe. We discuss Compound A generation and nephrotoxicity. This episode was made possible through production and research support from Davies Agyekum, MD, PhD. Thanks for listening! If you enjoy our content, consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast updates and new literature updates. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Ebert TJ, Frink EJ Jr, Kharasch ED. Absence of biochemical evidence for renal and hepatic dysfunction after 8 hours of 1.25 minimum alveolar concentration sevoflurane anesthesia in volunteers. Anesthesiology. 1998 Mar;88(3):601-10. doi: 10.1097/00000542-199803000-00008. PMID: 9523801. Ebert TJ, Messana LD, Uhrich TD, Staacke TS. Absence of renal and hepatic toxicity after four hours of 1.25 minimum alveolar anesthetic concentration sevoflurane anesthesia in volunteers. Anesth Analg. 1998 Mar;86(3):662-7. doi: 10.1097/00000539-199803000-00042. PMID: 9495434. Eger EI 2nd. Compound A: does it matter? Can J Anaesth. 2001 May;48(5):427-30. doi: 10.1007/BF03028302. PMID: 11394507. Eger EI 2nd, Gong D, Koblin DD, Bowland T, Ionescu P, Laster MJ, Weiskopf RB. Dose-related biochemical markers of renal injury after sevoflurane versus desflurane anesthesia in volunteers. Anesth Analg. 1997 Nov;85(5):1154-63. doi: 10.1097/00000539-199711000-00036. PMID: 9356118. Eger EI 2nd, Koblin DD, Bowland T, Ionescu P, Laster MJ, Fang Z, Gong D, Sonner J, Weiskopf RB. Nephrotoxicity of sevoflurane versus desflurane anesthesia in volunteers. Anesth Analg. 1997 Jan;84(1):160-8. doi: 10.1097/00000539-199701000-00029. PMID: 8989018. Feldman JM, Hendrickx J, Kennedy RR. Carbon Dioxide Absorption During Inhalation Anesthesia: A Modern Practice. Anesth Analg. 2021 Apr 1;132(4):993-1002. doi: 10.1213/ANE.0000000000005137. PMID: 32947290. Fukuda H, Kawamoto M, Yuge O, Fujii K. A comparison of the effects of prolonged (>10 hour) low-flow sevoflurane, high-flow sevoflurane, and low-flow isoflurane anaesthesia on hepatorenal function in orthopaedic patients. Anaesth Intensive Care. 2004 Apr;32(2):210-8. doi: 10.1177/0310057X0403200208. PMID: 15957718. Keijzer C, Perez RS, de Lange JJ. Compound A and carbon monoxide production from sevoflurane and seven different types of carbon dioxide absorbent in a patient model. Acta Anaesthesiol Scand. 2007 Jan;51(1):31-7. doi: 10.1111/j.1399-6576.2006.01187.x. Epub 2006 Nov 10. PMID: 17096668. Kennedy RR, Hendrickx JF, Feldman JM. There are no dragons: Low-flow anaesthesia with sevoflurane is safe. Anaesth Intensive Care. 2019 May;47(3):223-225. doi: 10.1177/0310057X19843304. Epub 2019 May 24. PMID: 31124374. Kharasch ED, Frink EJ Jr, Artru A, Michalowski P, Rooke GA, Nogami W. Long-duration low-flow sevoflurane and isoflurane effects on postoperative renal and hepatic function. Anesth Analg. 2001 Dec;93(6):1511-20, table of contents. doi: 10.1097/00000539-200112000-00036. PMID: 11726433. Mazze RI, Jamison RL. Low-flow (1 l/min) sevoflurane: is it safe? Anesthesiology. 1997 Jun;86(6):1225-7. doi: 10.1097/00000542-199706000-00001. PMID: 9197289. McGain F, Bishop JR, Elliot-Jones LM, Story DA, Imberger GL. A survey of the choice of general anaesthetic agents in Australia and New Zealand. Anaesth Intensive Care. 2019 May;47(3):235-241. doi: 10.1177/0310057X19836104. Epub 2019 May 15. PMID: 31088129. | — | ||||||
| 3/30/21 | 23: What is the data on COVID-19 vaccines? + FAQ | In this episode, Dr. Adam Flaczyk from Massachusetts General Hospital joins us to summarize the data on the latest COVID-19 vaccines and to answer frequently asked questions. Frequently asked questions start at 30:03 including: What is the data on side effects? What is the potential for anaphylaxis? Any data on use of antipyretics or NSAIDS with vaccination? — Thanks for listening! If you enjoy our content, consider donating to our Patreon at https://bit.ly/3n0sklh. Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
| 3/16/21 | 22: Is evidence-based medicine easy? | In this special episode, Dr. Justin Morgenstern of First10EM joins us to discuss a 6-step approach to primary literature. His strategy will give you the tools to feel more comfortable with taking an active role in reading and critically evaluating the literature. Step 1: How do I find a paper to read? Step 2: Is this paper worth reading? Step 3: Read the paper Step 4: Interpret the paper (stats are less important than you think) Step 5: Ask for help Step 6: Apply the research — Thanks for listening! If you enjoy our content, consider donating to our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Justin Morgenstern, "Evidence Based Medicine is Easy", First10EM blog, January 8, 2018. Available at: https://first10em.com/ebmiseasy/. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
| 2/16/21 | 21: Should smaller endotracheal tubes be used for elective surgery? | In this episode, we explore the evidence on whether smaller endotracheal tubes are... 1. Less likely to maintain a secure patent airway 2. Less reliable in facilitating positive pressure ventilation 3. Less able to seal the trachea and protect the lungs from aspiration We also discuss the potential harms associated with larger endotracheal tubes. Our guests are Dr. Shamir Karmali and Dr. Peter Rose from the Department of Anesthesiology at Vancouver General Hospital. Thanks for listening! If you enjoy our content, consider donating to our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Coordes A, Rademacher G, Knopke S, Todt I, Ernst A, Estel B, Seidl RO. Selection and placement of oral ventilation tubes based on tracheal morphometry. Laryngoscope. 2011 Jun;121(6):1225-30. doi: 10.1002/lary.21752. Epub 2011 May 6. PMID: 21557233. Dominelli PB, Ripoll JG, Cross TJ, Baker SE, Wiggins CC, Welch BT, Joyner MJ. Sex differences in large conducting airway anatomy. J Appl Physiol (1985). 2018 Sep 1;125(3):960-965. doi: 10.1152/japplphysiol.00440.2018. Epub 2018 Jul 19. PMID: 30024341; PMCID: PMC6335094. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016 Jun;71(6):706-17. doi: 10.1111/anae.13438. Epub 2016 Mar 28. PMID: 27158989. Ellis SF, Pollak AC, Hanson DG, Jiang JJ. Videolaryngoscopic evaluation of laryngeal intubation injury: incidence and predictive factors. Otolaryngol Head Neck Surg. 1996 Jun;114(6):729-31. doi: 10.1016/s0194-5998(96)70093-1. PMID: 8643294. Fiastro JF, Habib MP, Quan SF. Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest. 1988 Mar;93(3):499-505. doi: 10.1378/chest.93.3.499. PMID: 3277803. Futagawa K, Takasugi Y, Kobayashi T, Morishita S, Okuda T. Role of tube size and intranasal compression of the nasotracheal tube in respiratory pressure loss during nasotracheal intubation: a laboratory study. BMC Anesthesiol. 2017 Oct 17;17(1):141. doi: 10.1186/s12871-017-0432-1. PMID: 29041911; PMCID: PMC5645985. Hu B, Bao R, Wang X, Liu S, Tao T, Xie Q, Yu X, Li J, Bo L, Deng X. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One. 2013 Oct 4;8(10):e74467. doi: 10.1371/journal.pone.0074467. PMID: 24124452; PMCID: PMC3790787. Hwang JY, Park SH, Han SH, Park SJ, Park SK, Kim JH. The effect of tracheal tube size on air leak around the cuffs. Korean J Anesthesiol. 2011 Jul;61(1):24-9. doi: 10.4097/kjae.2011.61.1.24. Epub 2011 Jul 21. PMID: 21860747; PMCID: PMC3155132. Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia. 2020 Nov;75(11):1529-1539. doi: 10.1111/anae.15041. Epub 2020 May 16. PMID: 32415788. Koh KF, Hare JD, Calder I. Small tubes revisited. Anaesthesia. 1998 Jan;53(1):46-50. doi: 10.1111/j.1365-2044.1998.00290.x. PMID: 9505742. Pavlin EG, VanNimwegan D, Hornbein TF. Failure of a high-compliance low-pressure cuff to prevent aspiration. Anesthesiology. 1975 Feb;42(2):216-9. doi: 10.1097/00000542-197502000-00019. PMID: 1115375. Randestad A, Lindholm CE, Fabian P. Dimensions of the cricoid cartilage and the trachea. Laryngoscope. 2000 Nov;110(11):1957-61. doi: 10.1097/00005537-200011000-00036. PMID: 11081618. Shah C, Kollef MH. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med. 2004 Jan;32(1):120-5. doi: 10.1097/01.CCM.0000104205.96219.D6. PMID: 14707569. Stenqvist O, Sonander H, Nilsson K. Small endotracheal tubes: ventilator and intratracheal pressures during controlled ventilation. Br J Anaesth. 1979 Apr;51(4):375-81. doi: 10.1093/bja/51.4.375. PMID: 465261. Tanaka A, Isono S, Ishikawa T, Sato J, Nishino T. Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway. Anesthesiology. 2003 Aug;99(2):252-8. doi: 10.1097/00000542-200308000-00005. PMID: 12883396. Tonnesen AS, Vereen L, Arens JF. Endotracheal tube cuff residual volume and lateral wall pressure in a model trachea. Anesthesiology. 1981 Dec;55(6):680-3. doi: 10.1097/00000542-198155060-00013. PMID: 7305056. Walker EMK, Bell M, Cook TM, Grocott MPW, Moonesinghe SR; Central SNAP-1 Organisation; National Study Groups. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth. 2016 Jun 12;117(6):758-766. doi: 10.1093/bja/aew381. Erratum in: Br J Anaesth. 2017 Sep 1;119(3):552. PMID: 27956674. Wilson AM, Gray DM, Thomas JG. Increases in endotracheal tube resistance are unpredictable relative to duration of intubation. Chest. 2009 Oct;136(4):1006-1013. doi: 10.1378/chest.08-1938. Epub 2009 May 1. PMID: 19411293. Young PJ, Rollinson M, Downward G, Henderson S. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth. 1997 May;78(5):557-62. doi: 10.1093/bja/78.5.557. PMID: 9175972. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
| 12/11/20 | 20: Do lower intraoperative tidal volumes reduce postoperative pulmonary complications? | In this episode, we explore the evidence on whether lower intraoperative tidal volumes (e.g., 6 vs. 9 cc/kg) reduce postoperative pulmonary complications. Our guest is Dr. Avery Tung. Dr. Tung is Professor of Anesthesia & Critical Care at the University of Chicago and Section Editor for Critical Care & Resuscitation for Anesthesia & Analgesia. Thanks for listening! If you enjoy our content, consider donating to our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Karalapillai D, Weinberg L, Peyton P, et al. Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA. 2020;324(9):848–858. doi:10.1001/jama.2020.12866 Acute Respiratory Distress Syndrome Network, Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1301-8. doi: 10.1056/NEJM200005043421801. PMID: 10793162. Brower RG, Shanholtz CB, Fessler HE, Shade DM, White P Jr, Wiener CM, Teeter JG, Dodd-o JM, Almog Y, Piantadosi S. Prospective, randomized, controlled clinical trial comparing traditional versus reduced tidal volume ventilation in acute respiratory distress syndrome patients. Crit Care Med. 1999 Aug;27(8):1492-8. doi: 10.1097/00003246-199908000-00015. PMID: 10470755. Amato MB, Barbas CS, Medeiros DM, Magaldi RB, Schettino GP, Lorenzi-Filho G, Kairalla RA, Deheinzelin D, Munoz C, Oliveira R, Takagaki TY, Carvalho CR. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998 Feb 5;338(6):347-54. doi: 10.1056/NEJM199802053380602. PMID: 9449727. Tobin MJ. Culmination of an era in research on the acute respiratory distress syndrome. N Engl J Med. 2000 May 4;342(18):1360-1. doi: 10.1056/NEJM200005043421808. PMID: 10793169. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012 Oct 24;308(16):1651-9. doi: 10.1001/jama.2012.13730. PMID: 23093163. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S; IMPROVE Study Group. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013 Aug 1;369(5):428-37. doi: 10.1056/NEJMoa1301082. PMID: 23902482. Serpa Neto A, Hemmes SN, Barbas CS, Beiderlinden M, Biehl M, Binnekade JM, Canet J, Fernandez-Bustamante A, Futier E, Gajic O, Hedenstierna G, Hollmann MW, Jaber S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Putensen C, Ranieri M, Scavonetto F, Schilling T, Schmid W, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Gama de Abreu M, Pelosi P, Schultz MJ; PROVE Network Investigators. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology. 2015 Jul;123(1):66-78. doi: 10.1097/ALN.0000000000000706. PMID: 25978326. PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology, Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet. 2014 Aug 9;384(9942):495-503. doi: 10.1016/S0140-6736(14)60416-5. Epub 2014 Jun 2. PMID: 24894577; PMCID: PMC6682759. Marret E, Cinotti R, Berard L, Piriou V, Jobard J, Barrucand B, Radu D, Jaber S, Bonnet F; and the PPV study group: Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: a double-blind randomised controlled trial. Eur J Anaesthesiol 2018; 35:727–35 Neto AS, Hemmes SN, Barbas CS, Beiderlinden M, Fernandez-Bustamante A, Futier E, Gajic O, El-Tahan MR, Ghamdi AA, Günay E, Jaber S, Kokulu S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Ranieri VM, Scavonetto F, Schilling T, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Amato MB, Costa EL, de Abreu MG, Pelosi P, Schultz MJ; PROVE Network Investigators. Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016 Apr;4(4):272-80. doi: 10.1016/S2213-2600(16)00057-6. Epub 2016 Mar 4. Erratum in: Lancet Respir Med. 2016 Jun;4(6):e34. PMID: 26947624. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
| 11/11/20 | 19: Is hydrocortisone, ascorbic acid (Vitamin C), and thiamine therapy effective for treatment of sepsis? | In this episode, we discuss the role of hydrocortisone, ascorbic acid (Vitamin C) and thiamine (HAT therapy) in the treatment of patients with septic shock. We discuss biological plausibility and comprehensively review the latest evidence. Our guest is Dr. Jonathan Charnin. Dr. Charnin is an assistant professor of anesthesiology in the Divisions of Multi-specialty Anesthesia and Critical Care Medicine at the Mayo Clinic Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! If you enjoy our content, please rate us on iTunes and share our podcast with your colleagues. Music by Stephen Campbell, MD. -- References Fujii T, Luethi N, Young PJ, et al. Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial. JAMA. 2020;323(5):423–431. doi:10.1001/jama.2019.22176 Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C, and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study. Chest. 2017 Jun;151(6):1229-1238. doi: 10.1016/j.chest.2016.11.036. Epub 2016 Dec 6. PMID: 27940189. Englard S, Seifter S. The biochemical functions of ascorbic acid. Annu Rev Nutr. 1986;6:365-406. doi: 10.1146/annurev.nu.06.070186.002053. PMID: 3015170. Fowler AA 3rd, Truwit JD, Hite RD, Morris PE, DeWilde C, Priday A, Fisher B, Thacker LR 2nd, Natarajan R, Brophy DF, Sculthorpe R, Nanchal R, Syed A, Sturgill J, Martin GS, Sevransky J, Kashiouris M, Hamman S, Egan KF, Hastings A, Spencer W, Tench S, Mehkri O, Bindas J, Duggal A, Graf J, Zellner S, Yanny L, McPolin C, Hollrith T, Kramer D, Ojielo C, Damm T, Cassity E, Wieliczko A, Halquist M. Effect of Vitamin C Infusion on Organ Failure and Biomarkers of Inflammation and Vascular Injury in Patients With Sepsis and Severe Acute Respiratory Failure: The CITRIS-ALI Randomized Clinical Trial. JAMA. 2019 Oct 1;322(13):1261-1270. doi: 10.1001/jama.2019.11825. Erratum in: JAMA. 2020 Jan 28;323(4):379. PMID: 31573637; PMCID: PMC6777268. Donnino MW, Andersen LW, Chase M, Berg KM, Tidswell M, Giberson T, Wolfe R, Moskowitz A, Smithline H, Ngo L, Cocchi MN; Center for Resuscitation Science Research Group. Randomized, Double-Blind, Placebo-Controlled Trial of Thiamine as a Metabolic Resuscitator in Septic Shock: A Pilot Study. Crit Care Med. 2016 Feb;44(2):360-7. doi: 10.1097/CCM.0000000000001572. PMID: 26771781; PMCID: PMC4754670. Woolum JA, Abner EL, Kelly A, Thompson Bastin ML, Morris PE, Flannery AH. Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock. Crit Care Med. 2018 Nov;46(11):1747-1752. doi: 10.1097/CCM.0000000000003311. PMID: 30028362. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
| 10/7/20 | 18: Is mixing in lidocaine effective for preventing burning with propofol? | In this episode, we discuss the mechanisms of burning with propofol infusion and explore the evidence behind strategies like mixing lidocaine with propofol. Our guest today is Dr. Stu Forman, Professor of Anesthesiology at Massachusetts General Hospital. He is an investigator on several NIH-sponsored basic research grants and co-director of the Harvard Anesthesia Research Training Fellowship. Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues. Music by Stephen Campbell, MD. -- References Bengalorkar GM, Bhuvana K, Sarala N, Kumar T. Fospropofol: clinical pharmacology. J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):79-83. PMID: 21804712; PMCID: PMC3146164. Dajun Song, Mohamed A. Hamza, Paul F. White, Stephanie I. Byerly, Stephanie B. Jones, Amy D. Macaluso; Comparison of a Lower-lipid Propofol Emulsion with the Standard Emulsion for Sedation during Monitored Anesthesia Care. Anesthesiology 2004; 100:1072–1075 doi: https://doi.org/10.1097/00000542-200405000-00007 Euasobhon P, Dej-Arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, Lumbiganon P. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev. 2016 Feb 18;2(2):CD007874. doi: 10.1002/14651858.CD007874.pub2. PMID: 26888026; PMCID: PMC6463799. Fischer MJ, Leffler A, Niedermirtl F, Kistner K, Eberhardt M, Reeh PW, Nau C. The general anesthetic propofol excites nociceptors by activating TRPV1 and TRPA1 rather than GABAA receptors. J Biol Chem. 2010 Nov 5;285(45):34781-92. doi: 10.1074/jbc.M110.143958. Epub 2010 Sep 7. PMID: 20826794; PMCID: PMC2966094. Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Pace NL, Apfel CC; Perioperative Clinical Research Core. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011 Mar 15;342:d1110. doi: 10.1136/bmj.d1110. PMID: 21406529. Klement W, Arndt JO. Pain on i.v. injection of some anaesthetic agents is evoked by the unphysiological osmolality or pH of their formulations. Br J Anaesth. 1991 Feb;66(2):189-95. doi: 10.1093/bja/66.2.189. PMID: 1817619. Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clin Pharmacokinet. 2018;57(12):1539-1558. doi:10.1007/s40262-018-0672-3 Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia. 1988 Jun;43(6):492-4. doi: 10.1111/j.1365-2044.1988.tb06641.x. PMID: 3261547. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
| 9/9/20 | 17: Is it important to reverse to a train-of-four target of 90%? - Part 2 of 2 | In this part II or II series on neuromuscular blockade, we investigate the claim that a train-of-four target of 90% is important to achieve prior to extubation. Our guest today is Dr. Daniel Saddawi-Konefka, residency program director at Mass General. Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues. Music by Stephen Campbell, MD. -- References Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110-119. doi:10.1213/ANE.0b013e3181c07428 Ali HH, Kitz RJ. Evaluation of recovery from nondepolarizing neuromuscular block, using a digital neuromuscular transmission analyzer: preliminary report. Anesth Analg. 1973;52(5):740-745. Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth. 1975;47(5):570-574. doi:10.1093/bja/47.5.570 Sundman E, Witt H, Olsson R, Ekberg O, Kuylenstierna R, Eriksson LI. The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal videoradiography and simultaneous manometry after atracurium. Anesthesiology. 2000;92(4):977-984. doi:10.1097/00000542-200004000-00014 Eikermann M, Groeben H, Hüsing J, Peters J. Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade. Anesthesiology. 2003;98(6):1333-1337. doi:10.1097/00000542-200306000-00006 Gopalaiah Venkatesh Kumar, Anita Pramod Nair, Hanuman Srinivasa Murthy, Koppa Ramegowda Jalaja, Karnate Ramachandra, Gundappa Parameshwara; Residual Neuromuscular Blockade Affects Postoperative Pulmonary Function. Anesthesiology 2012; 117:1234–1244 doi: https://doi.org/10.1097/ALN.0b013e3182715b80 Eriksson LI, Lennmarken C, Wyon N, Johnson A. Attenuated ventilatory response to hypoxaemia at vecuronium-induced partial neuromuscular block. Acta Anaesthesiol Scand. 1992;36(7):710-715. doi:10.1111/j.1399-6576.1992.tb03550.x Suzanne J. L. Broens, Martijn Boon, Chris H. Martini, Marieke Niesters, Monique van Velzen, Leon P. H. J. Aarts, Albert Dahan; Reversal of Partial Neuromuscular Block and the Ventilatory Response to Hypoxia: A Randomized Controlled Trial in Healthy Volunteers. Anesthesiology 2019; 131:467–476 doi: https://doi.org/10.1097/ALN.0000000000002711 Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765-771. doi:10.1097/00000542-199704000-00005 Glenn S. Murphy, Joseph W. Szokol, Jesse H. Marymont, Steven B. Greenberg, Michael J. Avram, Jeffery S. Vender, Margarita Nisman; Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Meeting Abstracts and Adverse Respiratory Events in the Postanesthesia Care Unit. Anesthesiology 2008; 109:389–398 doi: https://doi.org/10.1097/ALN.0b013e318182af3b Butterly A, Bittner EA, George E, et al. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. BJA: British Journal of Anaesthesia. 2010 Sep;105(3):304-309. DOI: 10.1093/bja/aeq157. Section Editor(s): Brull, Sorin J.Murphy, Glenn S. MD; Szokol, Joseph W. MD; Marymont, Jesse H. MD; Greenberg, Steven B. MD; Avram, Michael J. PhD; Vender, Jeffery S. MD Residual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit, Anesthesia & Analgesia: July 2008 - Volume 107 - Issue 1 - p 130-137 doi: 10.1213/ane.0b013e31816d1268 Kirmeier E, Eriksson LI, Lewald H, et al. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study [published correction appears in Lancet Respir Med. 2018 Nov 6;:]. Lancet Respir Med. 2019;7(2):129-140. doi:10.1016/S2213-2600(18)30294-7 __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital. | — | ||||||
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