Anesthesia Clerkship Podcast

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 Considerations: https://www.anesthesiaconsiderations.com/ References: 1. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013. 2. https://www.anesthesiaconsiderations.com/ 3. Lerman J., Coté C.J., Steward D.J. (2016) Foundations of Pediatric Anesthesia. In: Manual of Pediatric Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-30684-1_1 Have questions, comments, corrections, or concerns? Please reach out via email: anesthesiaclerkship@gmail.com All research, scriptwriting and recording was by Sandy Wu UBC MSI3 and Blake Birnie, UBC Anesthesiology R1

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. Capdevila X, Aveline C, Delaunay L, et. al. Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of a Multicenter Observational Study. Adv Ther. 2020 Jan;37(1):527-540. doi: 10.1007/s12325-019-01171-6. Epub 2019 Dec 11. PMID: 31828612; PMCID: PMC6979445. 6. Broadbent CR, Maxwell WB, Ferrie R, et al. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 2000;55:1122–6. 7. Schlotterbeck H, Toure Y, Schaeffer R, et al. Is assessment of lumbar interspace as inaccurate in the clinical setting of obstetrical regional anesthesia as it is in experimental studies? Anesthesiology 2003;99:A1189. 8. Jespersen MS, Jæger PT, Ægidius KL, et al. Sphenopalatine ganglion block for treatment of post-dural puncture headache. Ugeskr Laeger. 2019 May 6;181(19):V12180846. Danish. PMID: 31120017. 9. https://www.openanesthesia.org/differential_spinal_block/ Have questions, comments, corrections, or concerns? Please reach out via email: anesthesiaclerkship@gmail.com All research, scriptwriting and recording was by Blake Birnie, UBC Anesthesiology R1 + Sandy Wu UBC MSI3

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 endplate. Big thanks to Suzanne George MD 2022 Candidate from the University of Calgary for editing the episode script! References: 1. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013. 2. https://www.openanesthesia.org/aba_phase_ii_depolarizing_blockade/ 3. Zhang Z, Guo Q, Wang E. Hyperventilation in neurological patients: from physiology to outcome evidence. Curr Opin Anaesthesiol. 2019;32(5):568-573. doi:10.1097/ACO.0000000000000764

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. For rescue therapy within 6 hours post-op, use a different agent. References: 1. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013. 2. Gan TJ, Belani KG, Bergese S, et al. Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting. Anesth Analg. 2020;131(2):411-448. doi:10.1213/ANE.0000000000004833 3. Barash P, Cullen B, Stoelting R. Clinical Anesthesia. 8th ed. Wolters Kluwer Have questions, comments, corrections, or concerns? Please reach out via email: anesthesiaclerkship@gmail.com All research, scriptwriting and recording was by Blake Birnie, MD 2021 candidate at UBC's Southern Medical School Program

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. Sharma S, Patel R, Hashmi MF, Friede R. 3-3-2 Rule. In: StatPearls. StatPearls Publishing; 2020. Accessed June 8, 2020. http://www.ncbi.nlm.nih.gov/books/NBK493235/ 2. Safavi M, Honarmand A, Amoushahi M. Prediction of difficult laryngoscopy: Extended mallampati score versus the MMT, ULBT and RHTMD. Adv Biomed Res. 2014;3. doi:10.4103/2277-9175.133270 3. Mahmoodpoor A, Soleimanpour H, Nia KS, et al. Sensitivity of Palm Print, Modified Mallampati Score and 3-3-2 Rule in Prediction of Difficult Intubation. Int J Prev Med. 2013;4(9):1063-1069. 4. Sullivan P. Ottawa Anesthesia Primer. ECHO BOOK PUBLISHING; 2012. 5. Butterworth J, Mackey D, Wasnick J. Morgan & Mikhail's Clinical Anesthesiology. 5th ed. McGraw-Hill Education; 2013. Have questions, comments, corrections, or concerns? Please reach out via email: anesthesiaclerkship@gmail.com All research, scriptwriting and recording was by Blake Birnie, MD 2021 candidate at UBC's Southern Medical School Program

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 Anesthesiology. 5th ed. McGraw-Hill Education; 2013. 3. Weinstein AS, Sigurdsson MI, Bader AM. Comparison of Preoperative Assessment of Patient's Metabolic Equivalents (METs) Estimated from History versus Measured by Exercise Cardiac Stress Testing. Anesthesiology Research and Practice. doi:https://doi.org/10.1155/2018/5912726 4. Warner ME, Benenfeld SM, Warner MA, Schroeder DR, Maxson PM. Perianesthetic dental injuries: frequency, outcomes, and risk factors. Anesthesiology. 1999;90(5):1302-1305. doi:10.1097/00000542-199905000-00013 Have questions, comments, corrections, or concerns? Please reach out via email: anesthesiaclerkship@gmail.com All research, scriptwriting and recording was by Blake Birnie, MD 2021 candidate at UBC's Southern Medical School Program