The World of Anesthesiology Podcast

Can supraglottic airway and similar devices cause cranial nerve injury? What nerves are affected? Diagnosis? Outcome? Can you avoid them and How?

Pulmonary hypertension is a critical factor in outcome for patients undergoing non-cardiac surgery. In this episode, I discuss definition, classification, pathogenesis, treatment, preoperative evaluation, intra and post operative management of patients of pulmonary hypertension Pulmonary hypertension and its management in patients undergoing non-cardiac surgery
S. A. Pilkington,1 D. Taboada2 and G. Martinez3 Anaesthesia 2015, 70, 56–70

Neostigmine reversal of Neuromuscular blockade, Does it decrease respiratory complication after general anesthesia? Should you, Would you, May you place Interscaline nerve block under general anesthesia? Effects of Neostigmine Reversal of Nondepolarizing Neuromuscular Blocking Agents on Postoperative Respiratory Outcomes (ANESTHESIOLOGY 2014; 121:959-68) Interscalene Brachial Plexus Blocks Under General Anesthesia in Children: Is This Safe Practice? A Report From the Pediatric Regional Anesthesia Network (PRAN) Regional Anesthesia and Pain Medicine • Volume 39, Number 6, November-December 2014

Review of Long QT syndrome, predisposing factors, mechanism, Treatment and prevention in the perioperative period _____________________________________ J Anesth. 2013 Feb 15. [Epub ahead of print] QT interval abnormalities: risk factors and perioperative management in long QT syndromes and Torsades de Pointes. Kaye AD, Volpi-Abadie J, Bensler JM, Kaye AM, Diaz JH. Source Department of Anesthesiology, LSU School of Medicine, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA, alankaye44@hotmail.com. PMID: 23412014 ====== Letters from listeners ====== Dr. Saied, Excellent job on the podcasts, I appreciate your hard work and effort.   I just had one point.  I have had two electrophysiology patients, one with borderline QT interval prolongation and one with congenital QT interval prolongation.  Both of them were very anxious teenagers and refused iv's until after they were asleep.  Both of them had baseline ECG's while in the EP study room prior to induction with Sevoflurane/N2O and continuous ECG's monitored by the cath room tech.   1.  The borderline QT interval prolongation patient developed more prolonged QT interval after Sevoflurane mask induction.  The EP physician asked us if there was anything else we could use and we used Propofol TIVA after which the QT went back to baseline and we finished the study. 2.  For the second patient,  we explained to the patient and family the risk of prolonged QT interval and inhalational agents and that we would like to have an iv for Propofol TIVA so we could avoid inhaled agents, but the patient refused and wanted to be asleep for the iv.  The patient with congenital prolonged QT interval was masked induced with Sevoflurane/N2O with an immediate plan to switch to Propofol TIVA after an iv was placed.  As the iv was being placed the patient had further prolonging of the QT interval and an episode of Torsades that self resolved within seconds.  In the meantime we switched off the Sevoflurane and started propofol, no issues after this.  The EP physician confirmed this in real time with their ECG readings and printed me a copy. These are two examples of what many do not know in anesthesia, and should be aware of, Halogenated inhaled agents prolong the QT interval and can lead to Torsades in patients with congenital QT prolongation. Keep up the good work. SA

Dexmedetomidine as an adjuvant to ropivacaine prolongs peripheral nerve block: a volunteer study British Journal of Anesthesia   02/28/2013

Volume resuscitation is a pivotal element in sepsis management. Guidelines point out to goal directed fluid therapy according to CVP and restoration of intravascular volume. However, there are no guidelines to define upper limits if any exists!

Anesthesia crystalizes into a profession and Surgery transformation begins. Its is great to recognized how Anesthesia propelled surgery and continue to do so to this day. A trip into memory lane from the 1800s where a new science is born and a profession that grew and continue to grow since then.

Resuscitation of patients while under anesthesia for surgical procedures may not be your everyday ACLS. While ACLS may fit a wide range of providers and out of hospital Circulatory arrest, the skill set presented by the anesthesiologist, the etiology of arrest and availability of unique technologies call for deviation from the rigid ACLS algorithms.

Is Transversus Abdominis block after spinal anesthesia with intrathecal narcotics helpful?

Obstructive sleep apnea patients are abound. Many outpatient procedures are required. Should we administer general anesthesia to those patients in an ambulatory surgery center setting or must they go to the big house ?

Echo use by intensivist in ICU is gaining ground very quickly. This article examine the role of protocol of ultrasound exam in diagnosis and treatment in comparison to the gold standards. I have compiled few high quality web resources to learn echo for critical care below (click website link in iTunes) Echo Links: Stanford University Echocardiography in ICU: https://www.stanford.edu/group/ccm_echocardio/ Vanderbilt Emergency Medicine: https://emdas.mc.vanderbilt.edu/us/ Sonography.com: http://123sonography.com e-echocardiography: http://e-echocardiography.com/index.php

Raj is back and we are a duo again! Awareness under anesthesia is rare but with major consequences. What should you do to minimize the risk of such events. In this diverse patients, the authors explore the use of Awareness monitor vs simple anesthetic concentration (MAC) alerting system to do just that. Which tool is best for you and your patients?

Antifibrinolytics had been tried for decades to lower surgical blood loss for cardiac and non cardiac surgery patients. Some were hailed for sometime then demonized and were removed, Aprotinin is a classic example. What about Tranexamic acid? what about using it in off-pump coronary bypass grafting ? Do we know all we need to know to use it routinely ?

Does protective lung ventilation apply to patients with normal lungs? Should use high PEEP, Low tidal volume ? How does mechanical ventilation affect lung injury and and systemic inflammatory response ? If you like to know, tune in!

Does the anesthesiologist age increase litigation potential? At what age should the anesthesiologist retire? What makes some older anesthesiologists safer than others? Join me in the next 20 min to explore a new look at a taboo topic finally being opened ...