Welcome to Depth of Anesthesia.This is a podcast with residents and attendings from the Massachusetts General Hospital that critically explores our clinical practices.Anesthesia is full of claims. A claim is a practice decision that we either believe is true or is something we default to. We think that for every claim in anesthesia, we should know what is supported or refuted by evidence and what claims have no evidence base but "stand to reason".We hope you start to see these claims and become less satisfied not knowing what you don't know. We hope you question your practice a little more and get curious.
We explore three claims about reversal of neuromuscular blockade. 1. Location of train-of-four assessment matters 2. Train-of-four is unnecessary with "sufficient" time from the last dose 3. Fade can be discriminated by tactile assessment Our guest today is Dr. Daniel Saddawi-Konefka of the Massachusetts General Hospital. Full show notes available at depthofanesthesia.com. Recommend a guest or topic at firstname.lastname@example.org or tweet us @DepthAnesthesia. Rate us on iTunes. -- References Arain Sr, Kern S, Ficke DJ, Ebert TJ. Variability of duration of action of neuromuscular blocking drugs in elderly patients. Acta Anaesthesiol Scand. 2005;49:312–315. Caldwell JE. Reversal of residual neuromuscular block with neostigmine at one to four hours after a single intubating dose of vecuronium. Anesth Analg 1995;80:1168 –74 JØRGEN VIBY-MOGENSEN, NIELS HENRIK JENSEN, JENS ENGBAEK, HELLE ØRDING, LENE THEIL SKOVGAARD, BENT CHRAEMMER-JØRGENSEN; Tactile and Visual Evaluation of the Response to Train-of-four Nerve Stimulation. Anesthesiology1985;63(4):440-442. Stephan R. Thilen, Bradley E. Hansen, Ramesh Ramaiah, Christopher D. Kent, Miriam M. Treggiari, Sanjay M. Bhananker; Intraoperative Neuromuscular Monitoring Site and Residual Paralysis. Anesthesiology 2012;117(5):964-972. doi: 10.1097/ALN.0b013e31826f8fdd. --
In this episode, we explore the claim that the sniffing position aligns the "axes" and is the optimal position for viewing the glottic opening. We welcome Dr. Keith Baker to the show. Dr. Baker is the Vice Chair for Education and a thoracic anesthesiologist in the Department of Anesthesiology, Critical Care, and Pain Medicine at the Massachusetts General Hospital. A list of references is also available at depthofanesthesia.com. We'd love to hear from you! Email us at email@example.com or tweet us @DepthAnesthesia. -- El-Orbany M.I., Getachew Y.B., Joseph N.J., Salem M.R., and Friedman M.: Head elevation improves laryngeal exposure with direct laryngoscopy. J Clin Anesth 2015; 27: pp. 153-158 Frédéric Adnet, Christophe Baillard, Stephen W. Borron, Christophe Denantes, Laurent Lefebvre, Michel Galinski, Carmen Martinez, Michel Cupa, Frédéric Lapostolle; Randomized Study Comparing the “Sniffing Position” with Simple Head Extension for Laryngoscopic View in Elective Surgery Patients. Anesthesiology 2001;95(4):836-841. Frédéric Adnet, Stephen W. Borron, Jean Luc Dumas, Frédéric Lapostolle, Michel Cupa, Claude Lapandry; Study of the “Sniffing Position” by Magnetic Resonance Imaging. Anesthesiology 2001;94(1):83-86. Hochman II, Zeitels SM, Heaton JT. Analysis of the forces and position required for direct laryngoscopic exposure of the anterior vocal cords. Ann Otol Rhino Laryngol 1999; 108 Levitan R.M., Mechem C.C., Ochroch E.A., et al: Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation. Ann Emerg Med 2003; 41: pp. 322-330
Dr. Matthew Vanneman, an attending cardiothoracic anesthesiologist at the Massachusetts General Hospital, returns for this episode. We explore pro and con positions on pre-operative anxiolytics. Pro claim: Preoperative anxiolytics improve patient satisfaction. Con claim: Preoperative anxiolytics delay recovery and discharge. We'd love to hear from you! Email us at firstname.lastname@example.org or tweet us @DepthAnesthesia. -- References C. Boncyk, A. S. Hess, A. Gaskell, J. Sleigh, R. D. Sanders, on behalf of the ConsCIOUS group, Does benzodiazepine administration affect patient satisfaction: a secondary analysis of the ConCIOUS study, BJA: British Journal of Anaesthesia, Volume 118, Issue 2, February 2017, Pages 266–267, https://doi.org/10.1093/bja/aew456 Kain ZN, Sevarino FB, Rinder C, et al. Preoperative anxiolysis and postoperative recovery in women undergoing abdominal hysterectomy. Anesthesiology 2001;94:415–22. Maurice-Szamburski A, Auquier P, Viarre-Oreal V, et al; for the PremedX Study Investigators. Effect of sedative premedication on patient experience after general anesthesia: a randomized clinical trial. JAMA. doi:10.1001/jama.2015.1108 Richardson MG, Wu CL, Hussain A. Midazolam premedication increases sedation but does not prolong discharge times after brief outpatient general anesthesia for laparoscopic tubal sterilization. Anesth Analg. 1997;85:301–5. van Vlymen JM, Sá Rêgo MM, White PF. Benzodiazepine premedication: can it improve outcome in patients undergoing breast biopsy procedures? Anesthesiology 1999; 90:740. Walker KJ, Smith AF. Premedication for anxiety in adult day surgery. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD002192. DOI: 10.1002/14651858.CD002192.pub2.
My guest this week is Dr. Matthew Vanneman, an attending adult cardiothoracic anesthesiologist at the Massachusetts General Hospital.
We explore the claim that an alternative antibiotic to cephalosporins (e.g., cefazolin) should be selected for penicillin-allergic patients in the perioperative setting.
A list of references is available at depthofanesthesia.com.
We'd love to hear from you! Email us at email@example.com or tweet us @DepthAnesthesia.
We explore the claim that morphine causes more nausea than hydromorphone.
Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital, is back for this discussion.
A list of references and show notes is available at depthofanesthesia.com.
Thank you to all our listeners! Leave a comment at depthofanesthesia.com or email us at firstname.lastname@example.org. You can also connect to us on Twitter @anespod.
My guest this week is Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital.
We explore the claim that mask ventilation should be "checked" or "confirmed" prior to administering a paralytic. We discuss some of the rationales and investigate the literature.
A list of references is available at depthofanesthesia.com.
We'd love to hear from you! Leave a comment at depthofanesthesia.com or email us at email@example.com.
This is a podcast exploring the depth of our critical thinking around clinical practices.
Anesthesia is full of claims. A claim is a practice decision that we either believe is true or is something we default to. We think that for every claim in anesthesia, we should know what is supported or refuted by evidence and what claims have no evidence base but “stand to reason”. We hope you start to see these claims and become less satisfied not knowing what you don’t know.