Clinical Anaesthesia Podcasts: Conversations with Keith and Courtney

Stay with us! In the final episode of this series, Keith and Courtney introduce Acid-Base Balance and Disturbances. It has taken years for both of them to get to grips on some of the basics of this topic, and they spend the next hour breaking down what is going on and how to interpret the values in front of you. During the second half of this episode, they discuss some case-based scenarios.  Even if you are not utilising blood gas analysis in practice, it doesn't mean something acute is not happening to our patients under anaesthesia just because we can't see it, so it is still useful to understand. Keep up to date with the Burtons Academy: Facebook - Burtons Veterinary Equipment | Facebook Instagram - Burtons Veterinary Equipment (@burtonsveterinaryequipment) Twitter - Burtons Veterinary Equipment (@Burtonsvet) LinkedIn - https://www.linkedin.com/company/burtons-medical-equipment/

Last episode, we talked about how carbon dioxide is formed in the body, and how it gets from the cells to the lungs. Now that it has arrived there – what next?! In this episode, Keith and Courtney talk about what happens when carbon dioxide diffuses from the pulmonary capillary into the alveoli to be exhaled.  They break down the Alveolar Ventilation Equation and the Alveolar Gas Equation into a more user-friendly concept you can apply to your everyday patient and how it is actually useful after the anaesthesia itself. Keith discusses the loss of one of his patients during the recovery period and Courtney shares ways you can continue to support and monitor those patients in this critical time of anaesthesia – after all, your pulse oximeter and capnograph can still be used after they are extubated!  Keep up to date with the Burtons Academy: Facebook - Burtons Veterinary Equipment | Facebook Instagram - Burtons Veterinary Equipment (@burtonsveterinaryequipment) Twitter - Burtons Veterinary Equipment (@Burtonsvet) LinkedIn - Burtons Medical Equipment Ltd | LinkedIn

In the first episode on carbon dioxide, Keith and Courtney will undoubtedly make you rethink the role of carbon dioxide in the blood – it isn't the “bad guy” we perhaps thought it was.   They start their conversation right down at the cellular level again and discuss how it gets from there to the lungs. How is carbon dioxide carried? At what point does it hitch a right on the haemoglobin (Hb) to return to the lungs to be breathed out? If only 25% of the carbon dioxide is carried in the blood – where is the rest? Why do we talk about bicarbonate when talking about carbon dioxide? There are so many questions!  Keep up to date with the Burtons Academy: Follow us on Facebook - Burtons Veterinary Equipment | Facebook Follow us on Instagram - Burtons Veterinary Equipment (@burtonsveterinaryequipment) Follow us on Twitter - Burtons Veterinary Equipment (@Burtonsvet) Follow us on LinkedIn - https://www.linkedin.com/company/burtons-medical-equipment/

In the last of the 3 episodes on oxygen, Keith and Courtney discuss how we can monitor the concentration of oxygen our patient is receiving and also how to monitor our patient's oxygenation levels – both manually and with a machine.  We can “flip the lip” (but human eyesight can't detect cyanosis for quite some time), use our pulse oximeter or run a blood gas analysis. Assuming the patient has normal haemoglobin levels. Anaemia, carbon monoxide poisoning from a house fire and even an overdose of certain everyday drugs can affect functional haemoglobin availability!    They finish this episode highlighting the importance of using an oxygen concentrator in a circle breathing system, and why we initially have high fresh gas flows to remove the nitrogen sitting in the tubing and carbon dioxide absorbing canister. 

In this second episode, Keith and Courtney discuss how oxygen gets from the lungs and down to the cellular level. This episode won't Bohr you! Listen out for Keith's fantastic explanation of how oxygen is carried in the blood to the tissues by using a “football fans and the London Underground network” analogy.   Also, after breaking down the Oxygen Dissociation Curve, you may want to get your pulse oximeter out and use it in the recovery phase of your patient's anaesthesia experience! They also throw in a few case base discussion points on tick-bite paralysis, geriatric pets and those animals who have perhaps been exposed to carbon monoxide in a house fire. This episode is relevant for all disciplines in veterinary medicine – not just anaesthesia!

Welcome to the first episode in our third season of the Conversations with Keith and Courtney podcast. This season looks into Oxygen and Carbon Dioxide – from the moment oxygen leaves the cylinder until it gets to the mitochondria, and then how the waste product (carbon dioxide) gets from the tissue to the lungs so it can be exhaled.  In this episode, Keith and Courtney discuss methods we use to provide oxygen therapy to our patients before anaesthesia, such as through pre-oxygenation via flow-by or face mask delivery, and what type of oxygen concentration you're actually reaching! If it leaves the cylinder at 100%, it certainly doesn't mean that the patient gets that. And they will leave you with some frightening figures in regards to using insufficient fresh gas flows in an oxygen cage...  Much of what is discussed in this episode is also in our article “Are you providing effective Oxygen Therapy?” which you can check out here: https://bit.ly/3mNoQrw

In the last episode of our second series. Keith and Courtney discuss their bread & butter – mechanical ventilation. Whether you have a ventilator and don't use it or your practice is thinking about purchasing one – this episode aims to break down the fear of mechanical ventilation and goes through 3 key things you need to know so you can walk into a room and use any ventilator on any patient. It really is that easy. If you want more hands-on ventilation training – check out the dates and locations of our Respiratory Roadshow CPD events at www.burtonsveterinary.com/academy.

In this week's episode, Keith and Courtney discuss the long-awaited Podcast on ventilation across 2 parts, with this one focused on manual ventilation. During everyday anaesthesia, we may find ourselves needing to give our patients intermittent or regular positive pressure breaths to support their ventilation, for example, during long anaesthesia or due to thoracic surgery. Although closing the exhaust valve on the breathing system and squeezing the reservoir bag seems very straightforward, there are many factors to consider in regards to patient safety – what is the pressure we are delivering, is the tidal volume known and is this breathing system suitable? They discuss safe intrathoracic pressures to deliver these manual breaths and how to utilise equipment such as in-circuit manometers, IPPV button valves and how to use each breathing system correctly (even if you have been told the Lack is not suitable for IPPV!).

In this week's episode, Keith and Courtney follow on from the discussion of the last episode on blood pressure, but this time discussing Invasive Blood Pressure (IBP) monitoring and how to set up all the equipment, how to place an arterial catheter and how to troubleshoot a dampened IBP trace. With beat-to-beat information, there is so much more than blood pressure monitoring that can be achieved with an IBP set-up. Did you know positive pressure ventilation can affect the patient's cardiac output and blood pressure? Well, well IBP monitoring, you can actually see it happening! Also, you now have a direct line for arterial blood gas sampling! They hope by the end of the episode you will realise that IBP monitoring isn't an unachievable modality in general practice to aim for, and Courtney encourages RVNs to add this type of intensive monitoring to their skill set.

In this week's episode, Keith and Courtney discuss the equipment, technique and limitations of non-invasive blood pressure measurements (NIBP). Is the fluffy coat of a patient going to be like going to the doctor for your own blood pressure reading whilst wearing a puffer jacket? Yes! Is the reported number of an oscillometric machine gospel, or should we be looking at the trend? They hope to get your blood pumping with excitement when they discuss myths and controversies with NIBP machines. And hear about how Keith kills time in the airport...

In this week's episode, Keith and Courtney discuss how rebreathing systems actually work. They discuss gas flow and resistances to breathing, to the point you might actually consider putting adult cats and small dogs on a circle breathing system when they are set up correctly. Did you know not all rebreathing systems are the same? Some you cannot even provide flow-by oxygen with! They won't leave you running in circles, but instead, just a clear understanding of how these fascinating systems work.

In this week's episode, Keith and Courtney discuss the different non-rebreathing systems – the types we have available, the way gas flow moves through them and why some might be suitable for positive pressure ventilation. One common misconception is that they're all created equal, however, some non-rebreathing systems actually do allow for rebreathing of dead space gases if they are used correctly, which reduces the wasting of anaesthetic gases, but do you know which ones? Sit back, take a deep breath and let's go with the flow.

In this week's episode, Keith and Courtney discuss what Dead Space means to our patients and how much of it is too much. All of our patients have anatomical dead space, but it is up to us anaesthetists to minimise the apparatus dead space. Does the apparatus dead space of a standard side stream capnograph connector affect an adult cat in the same way it affects an adult Labrador? Also, why are they talking about snorkels and thieves of Tidal Volumes? Check it out!

In this week's episode, Keith and Courtney discuss what Functional Residual Capacity (FRC) is, why we should understand this component of lung volume, and its role in patient ventilation and oxygenation. Have you considered that there is usually about one breath to every 4 or so heartbeats? This is exactly why understanding the FRC is so important. So take a deep breath, sit back and enjoy!

In this week's episode, Keith and Courtney discuss temperature monitoring in our patients under anaesthesia. Anaesthesia-related hypothermia is both extremely common and also avoidable through effective monitoring and management – so what can you do for your patients? They start by revising some of the pathophysiology of how hypothermia occurs, ways you can monitor temperature trends, and then when and how you can act on those. After all, there's nothing cool about cold cats!

In this week's episode, Keith and Courtney discuss the best way to utilise your ECG machine in everyday anaesthesia. We often hear that the ECG machine gets dusted off and bought out for critical cases and is not used routinely. But if you're not using it every day, how will you become comfortable in setting it up and interpreting the waveforms? Using your ECG machine is more than connecting the cables to the patient and hoping for the best! We revise a little bit of the cardiac anatomy and physiology before diving in and looking at what type of electrodes can be used on different patients, the different Leads that our ECG reads (like a TV channel, you can flick through them!) and also why having the cables arranged uniformly around your patient will improve the signal. After all, the P wave shouldn't stand for Panic!

In this week's episode, Keith and Courtney discuss the concepts of Capnography while clarifying some of the terminologies used when we discuss carbon dioxide (CO2) in the blood and body. One common misconception is that CO2 is the “bad guy” and we must get rid of it, but actually, too much or too little CO2 creates pH imbalances which disturb normal homeostatic processes in the body. So when we monitor our patients for hypocapnia or hypercapnia, we're not only assessing the patient's ability to ventilate effectively, but we use this information to ensure the levels of end-tidal CO2are normal, which is similar to the levels of CO2 in the blood, which has a role in maintaining optimal pH. Capnography is so much more than waveforms!

To start our first series, we spend this week's episode getting to know Keith and Courtney, who make up the Clinical Team at Burtons Academy. They talk about their journey, how they got to where they are now and then the educational plans they have lined up to bring to you! In this episode Keith covers, how his journey began when studying for his veterinary degree, working in a small animal practice to then how the idea of creating a small business focused on veterinary equipment all began. Once he gave up practice and worked out of his garage to make ventilators, his small business grew into the need to hire staff and move into new premises, allowing them to build all of the well-known ventilators like the SAV, Merlin and Tafonius. After running a successful business, Keith wanted to get back to the research and design of new pieces of equipment alongside teaching the veterinary industry about practical and relevant ventilation and monitoring techniques – which is how Burtons Academy was born. Courtney shares her journey of becoming a veterinary nurse, and how she has to jump over a few hurdles when she fainted at the sight of surgery, to then find her passion in anaesthesia! She then talks about how she found a hospital in Australia to learn more about anaesthesia (and of course, enjoy the Sunshine State), and eventually got a job there. Moving to the UK and making her dream a reality by working at the Royal Veterinary College is discussed too! Follow us on our socials to stay up to date with the latest Clinical News and Content: Facebook - Burtons Veterinary Equipment | Facebook Twitter - Burtons Veterinary Equipment (@Burtonsvet) / Twitter Instagram - Burtons Veterinary Equipment (@burtonsveterinaryequipment) • Instagram photos and videos LinkedIn - https://www.linkedin.com/company/burtons-medical-equipment/mycompany/ YouTube - (110) Burtons Veterinary Equipment - YouTube