Podcasts about Anesthesiology

Residents in a Room by American Society of Anesthesiologists

Play Episode Listen Later Jul 7, 2025 16:45

This series of talks hits upon one of the longstanding themes of TopMedTalk, opioids and opioid reduction in a perioperative setting. We discuss the opioid epidemic, the issue of persistent opioid use after surgery, and strategies for opioid reduction. Topics include historical usage, the dangers of high-dose opioids, and alternative pain management techniques such as opioid-free anesthesia and multimodal analgesia. The discussion also highlights the importance of ongoing research, patient education, and evidence-based practices to minimize the side effects of opioids while ensuring effective pain management. Presented by Tim Miller, Professor of Anesthesiology at Duke University Medical Center. Tim completed his training in Nottingham, UK followed by a fellowship in cardiothoracic anaesthesia at Glenfield Hospital, Leicester, UK. He is a fellow of the Royal College of Anaesthetists.

uk strategy professor epidemics opioids leicester nottingham reduction royal college pain management opioid epidemic tim miller anesthesiology duke university medical center perioperative anaesthetists topmedtalk

Navigating ANESTHESIOLOGY 2025

Play Episode Listen Later Jul 7, 2025 28:09

Resident host, Dr. Lauren Paul, along with fellow resident, Dr. Jacquelyn Ho, and medical student, Rebecca Tsai, welcome Dr. Elizabeth Rebello, Meeting Chair of ASA's Annual Meeting Oversight Committee. Dr. Rebello shares tips for navigating the meeting, discusses benefits of attending a meeting early in one's career, shares her early experiences, and more. Recorded June 2025.

navigating resident anesthesiology rebello lauren paul

Validated measurement tool assesses care team wellbeing through a system lens - K. Elliott Higgins III, MD

Caring Greatly

Play Episode Listen Later Jul 2, 2025 35:07

In this episode of Caring Greatly, K. Elliott Higgins III, MD, is Director of Health and Wellbeing for UCLA's Department of Anesthesiology and Perioperative Medicine, shares the origin of the Wellbeing Influencers Survey for Healthcare (WISH). The survey initiative began when Dr. Higgins and his team wanted more insight into specific drivers and barriers for wellbeing. He describes the process by which he and his team collaborated with an extended team of content experts to identify the eight critical drivers of team member wellbeing and then validate a set of questions that accurately assess these drivers and reliably predict key outcomes including burnout, intent to leave and professional fulfillment. Finally, Elliott shares the ways that the WISH survey is helping to facilitate culture change and team alignment by creating a shared lexicon and helping teams focus on changes that have the biggest impact on safety and wellbeing. He also outlines the team's efforts to test the survey's value in multi-center trials within anesthesia, as well as trials in other specialties, with hopes that the survey will help to improve cultures of care team safety and wellbeing across the healthcare ecosystem. The views and opinions expressed in this podcast are those of the speakers and do not necessarily reflect the views or positions of Stryker.

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Dr. Mike Guertin, Professor of Anesthesiology and Chief Perioperative Medical Director at Ohio State University Wexner Medical Center

Becker’s Healthcare Podcast

Play Episode Listen Later Jun 24, 2025 22:54

Dr. Mike Guertin, Professor of Anesthesiology and Chief Perioperative Medical Director at Ohio State University Wexner Medical Center, joins the podcast to reflect on the evolution of his career and the leadership lessons he's gained along the way. He discusses his experience in an MBA program and how it has shaped his approach to healthcare leadership. Dr. Guertin also sheds light on the ongoing anesthesia shortage and its implications for care delivery.

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Herpes Zoster & Post Herpetic Neuralgia- For the Pain Boards & your Patients!

The PainExam podcast

Play Episode Listen Later Jun 24, 2025 27:40

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023 Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more! Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call Brooklyn 718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Post Herpetic Neuralgias: Epidurals, Paravertebral Blocks and more!

AnesthesiaExam Podcast

Play Episode Listen Later Jun 24, 2025 27:40

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023 Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more! Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call Brooklyn 718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Post Herpetic Neuralgia- An Update

The PMRExam Podcast

Play Episode Listen Later Jun 24, 2025 27:40

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care. As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures. Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023 Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology. He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures. He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more! Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques. Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office. For an appointment go to AABPpain.com or call Brooklyn 718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

#39: Dr. Zain Hasan: Balancing Anesthesiology, Family, and Life

The Hoeflinger Podcast

Play Episode Listen Later Jun 23, 2025 50:38

In this episode, we spoke with Dr. Zain Hasan, a board-certified anesthesiologist, husband, father, and rising medical voice on social media, for an honest conversation about what life is really like behind the curtain of modern medicine. Dr. Hasan opens up about the realities of anesthesiology, how he navigates raising a family with a wife who is also in medicine, and the pressures of being calm and decisive when seconds can mean life or death.We also dive into the hidden toll medicine can take, why more physicians are speaking out online, and how Dr. Hasan reclaimed his own health, losing 50 pounds and rethinking everything from food to fitness. This episode is a look into the human side of medicine: the tradeoffs, the purpose, and the people behind the scrubs.Check out Dr. Hasan's social channels

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Global PARITY Study: Pediatric Critical Illness Insights by T. Kortz, A. Holloway | OPENPediatrics

OPENPediatrics

Play Episode Listen Later Jun 23, 2025 44:32

This World Shared Practice Forum reviews the Global PARITY study, a comprehensive research initiative aimed at understanding and addressing pediatric critical illness in resource-constrained settings. The discussion highlights the methodology, challenges, and key findings of the study, emphasizing the high prevalence of critical illnesses such as pneumonia, sepsis, and malaria among children in low socio-demographic index regions. The authors stress the importance of basic critical care interventions and the need for global health equity, advocating for the integration of critical care into health systems worldwide. LEARNING OBJECTIVES - Understand the methodology and challenges of conducting the Global Parity Study in resource-constrained settings. - Identify the most common pediatric critical illnesses and their prevalence in low socio-economic regions. - Recognize the importance of basic critical care interventions in improving health outcomes for critically ill children. - Appreciate the role of global health equity and the need for integrating critical care into health systems. - Explore the potential impact of research findings on policy decisions and resource allocation in healthcare. AUTHORS Teresa Kortz, MD, MS, PhD Associate Professor of Clinical Pediatrics University of California, San Francisco Adrian Holloway, MD Associate Professor Pediatrics University of Maryland School of Medicine, Department of Pediatrics Traci Wolbrink, MD, MPH‌ Senior Associate in Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Associate Professor of Anesthesia Harvard Medical School DATE Initial publication date: June 23, 2025. ARTICLE REFERENCED Kortz TB, Holloway A, Agulnik A, et al. Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study. Lancet Glob Health. 2025;13(2):e212-e221. doi:10.1016/S2214-109X(24)00450-9 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/as/sf6v5frcmb9j5pt3vrrss67/Kortz__Holloway_PWSP_June_2025_Transcript Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu Please note: OPENPediatrics does not support or control any related videos in the sidebar; these are placed by YouTube. We apologize for any inconvenience this may cause. CITATION Kortz TB, Holloway A, Wolbrink TA. Global PARITY Study: Pediatric Critical Illness Insights. 06/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/global-parity-study-pediatric-critical-illness-insights-by-t-kortz-a-holloway-openpediatrics.

Permission to Be Bold

The Brave Enough Show

Play Episode Listen Later Jun 20, 2025 21:48

In this episode of The Brave Enough Show, Dr. Sasha Shillcutt discusses: Playing small serves no one Risk is inevitable Your boldness will inspire others to rise Comfort is the enemy of purpose Failure is just data collection “Comfort is the enemy of purpose.” - Sasha Shillcutt, MD Brave Enough CME Conference 2025 This conference will specifically address how to combat the isolation of women working in healthcare with strategies to foster deeper connections and promote accountability. The conference will cover specific topics to create allyship and peer mentorship by focusing on topics women in medicine face, in order to leave the conference with strong allies. We want every woman to leave with a group of friends that can be there for her all year through. Attendees will have time to connect with phenomenal speakers, ask questions, and experience live coaching in a protected, safe environment. Have Dr. Sasha Speak at your event! Dr. Sasha Shillcutt is a top empowerment keynote speaker and Vice Chair of Strategy in the Department of Anesthesiology at the UNMC. In 2016, Sasha was awarded the national American Medical Association's Women Physicians' Inspiring Physician Award by her peers. Sasha's greatest passion is empowering and encouraging others to achieve wellbeing in their professional and personal lives. She speaks frequently to executives and leaders on the topics of professional burnout, resilience, and gender equity. Follow Brave Enough: WEBSITE | INSTAGRAM | FACEBOOK | TWITTER | LINKEDIN Join The Table, Brave Enough's community. The ONLY professional membership group that meets both the professional and personal needs of high-achieving women.

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Medical Safety Principles -- Pediatric Anesthesiology Internet-Based Non-Technical Skills

internet safety md medical principles pediatric anesthesiology technical skills

Play Episode Listen Later Jun 16, 2025 14:44

Medical Safety Principles with Tyler P. Morrissey, MD and Megan Nash, DO

Department Conflict, Echos of Adventure, Good and Bad Decisions

anesthesiawiseguys's podcast

Play Episode Listen Later Jun 13, 2025 58:34

Shelly, Mawi, and David discuss a listener mail on interdepartmental conflict, cautionary tales of addressing valvular disease and anesthesia, and language barriers complicating care.

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Surgery as a window into brain resilience | Martin Angst

From Our Neurons to Yours

Play Episode Listen Later Jun 12, 2025 37:32 Transcription Available

We've all heard stories about someone who went in for surgery and came out...different. A grandmother who struggled with names after hip replacement, or an uncle who seemed foggy for months following cardiac bypass. But why does this happen to some people while others bounce right back?This week, we explore this question with Dr. Martin Angst, a professor of anesthesiology at Stanford who's studying the biological factors that determine cognitive outcomes after surgery. With support from the Knight Initiative for Brain Resilience, Martin and his team are following hundreds of cardiac surgery patients, tracking everything from blood biomarkers to cognitive performance both before and after their procedures.Their findings are revealing fascinating insights about what makes some brains more resilient than others when faced with the significant stress of major surgery - insights that could help physicians better advise patients and potentially lead to interventions that enhance resilience.Read MoreUnder the Lights: What Surgery Reveals About Brain Resilience (Knight Initiative for Brain Resilience, 2025)Infusion of young donor plasma components in older patients modifies the immune and inflammatory response to surgical tissue injury: a randomized clinical trial (Journal of Translational Medicine, 2025)Blood test predicts recovery after hip-replacement surgery, study finds (Stanford Medicine, 2021)Can major surgery increase risk for Alzheimer's disease? (Stanford Medicine, 2021)Plasma Biomarkers of Tau and Neurodegeneration During Major Cardiac and Noncardiac Surgery (JAMA Neurology, 2021)Episode CreditsThis episode was produced by Michael Osborne at 14th Street Studios, with sound design by Morgan Honaker. Our logo is by Aimee Garza. The show is hosted by Nicholas Weiler at Stanford's Wu Tsai Neurosciences Institute and supported in part by the Knight Iniative for Brain Resilience.Get in touchWe want to hear from your neurons! Email us at at neuronspodcast@stanford.eduSend us a text!Thanks for listening! If you're enjoying our show, please take a moment to give us a review on your podcast app of choice and share this episode with your friends. That's how we grow as a show and bring the stories of the frontiers of neuroscience to a wider audience. Learn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn.

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The Neurolytic Celiac Plexus Block for the Anesthesia Boards!

AnesthesiaExam Podcast

Play Episode Listen Later Jun 10, 2025 14:34

Summary In this Pain Exam Podcast episode, Dr. David Rosenblum discusses a journal club article on low volume neurolytic retrocrural celiac plexus blocks for visceral cancer pain. The study reviewed 507 patients with severe malignancy-related abdominal pain, with data retained for 455 patients at the 5-month mark. Dr. Rosenblum explains that the procedure involves injecting 3-5ml of 6% aqueous phenol at the T12-L1 level under fluoroscopic guidance, with an average procedure time of 16.3 minutes. The study found significant pain relief lasting up to six months, reduced opioid consumption, and improved quality of life for patients with primary abdominal cancer or metastatic disease. Dr. Rosenblum shares his personal experience with celiac plexus blocks, including the trans-aortic approach he trained on, and mentions his interest in ultrasound-guided approaches. He also announces upcoming teaching engagements at ASPN, Pain Week, and other conferences, as well as CME ultrasound courses available through nrappain.org. Additionally, he mentions a new community page on the website where users can share board preparation information, though he emphasizes that remembered board questions should not be posted as he is a board question writer himself. Pain Management Board Prep Ultrasound Training REGISTER TODAY! Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights Introduction and Upcoming Events Dr. David Rosenblum introduces the Pain Exam Podcast and shares information about upcoming events. He mentions teaching ultrasound at ASPN in July, attending Pain Week in September, and participating in the Latin American Pain Society conference. Dr. Rosenblum also promotes his CME ultrasound courses available at nrappain.org and mentions he's considering organizing another regenerative medicine course in fall or winter. He offers private training for those wanting more intensive ultrasound instruction. Board Prep Community Announcement Dr. Rosenblum announces a new community page on the nrappain.org website for board preparation. He explains that registered users can access free information and keywords relevant to board exams. He emphasizes that users should not post remembered questions as this would be inappropriate, noting that he himself is a board question writer for various pain boards. Dr. Rosenblum mentions that a post about phenol in this community inspired today's podcast topic. Journal Article Overview on Celiac Plexus Block Dr. Rosenblum introduces a journal article on low volume neurolytic retrocrural celiac plexus block for visceral cancer pain, a retrospective review of 507 patients with severe malignancy-related abdominal pain. He explains that the study assessed pain relief provided by this procedure, its duration, reduction in daily opioid consumption, and quality of life improvements. The patients received neurolytic blocks without previous diagnostic blocks due to multiple comorbidities, which Dr. Rosenblum acknowledges is sometimes necessary with very sick patients despite the typical preference for diagnostic blocks before neurolysis. Dr. Rosenblum's Personal Experience with Celiac Plexus Blocks Dr. Rosenblum shares his personal training experience with trans-aortic celiac plexus blocks, where a needle is inserted through the aorta after confirming no plaques or aneurysms are present. He describes it as a safe and effective procedure despite sounding intimidating. He mentions he's only performed a handful of these procedures and doesn't do many now as an outpatient pain doctor. Study Methods and Results Dr. Rosenblum details the study methods, noting that of 507 patients studied, data for 455 was retained at the end of the review. Patients were evaluated before and after the neurolytic retrocrural celiac plexus block under fluoroscopic guidance. Assessment included procedure duration, pain scores (0-10 scale), daily opioid consumption, and quality of life improvement. Follow-up was completed six months after the procedure, showing improved pain scores, reduced opioid consumption, and better quality of life throughout the study period. Some pain returned during months 4-6 due to disease progression and the anticipated duration of the neurolytic agent. The study noted a 6.7% initial vascular contrast uptake during the procedure while using digital subtraction angiography with fluoroscopy. Study Limitations and Conclusions Dr. Rosenblum discusses the study's limitations, including the need for a larger sample size and a prospective trial with a control group, though he acknowledges this is unrealistic given the patient population. He mentions that a proven quality of life questionnaire would be beneficial, and that comparing alcohol, phenol, and RF thermocoagulation would be interesting to evaluate duration effects and side effects. The study concluded that low volume neurolytic retrocrural celiac plexus block with phenol is safe, providing up to six months of pain relief for abdominal pain due to primary malignancy or metastatic spread. Detailed Procedure Technique Dr. Rosenblum explains the detailed procedure technique used in the study. The retrocrural celiac plexus was targeted at L1 level with aim towards T12. Anterior and posterior radiographic imaging aligning the spinous process of T12-L1 junction was used with 15-20 degree oblique rotation. Local anesthetic (1% lidocaine with sodium bicarbonate) was infiltrated along the injection path. A 22 or 25 gauge 3.5-7 inch curved spinal needle was used depending on patient body habitus. Dr. Rosenblum notes he typically uses a 6-inch Chiba needle or 25 gauge spinal needle for such procedures. Procedure Execution and Monitoring Dr. Rosenblum continues describing the procedure, noting that the needle was advanced to the anterior border of T12-L1 under multiple imaging views. Contrast dye studies verified spread and location, with digital subtraction angiography used to check for intravascular uptake. A test dose of 1ml of 0.5% bupivacaine with epinephrine per site was administered, which Dr. Rosenblum finds interesting as he typically doesn't mix bupivacaine with epinephrine. After confirming no vascular uptake, 3-5ml of 6% aqueous phenol was injected in 1ml aliquots while communicating with the patient. The average procedure time was 16.3 minutes with minimal or no sedation. Patients remained prone for 30 minutes afterward to avoid neuroforaminal spread, as phenol is heavier and more viscous than alcohol. Post-Procedure Care and Study Evaluation Dr. Rosenblum explains that patients were monitored in recovery for one hour for adverse events and their ability to eat and void easily. They were discharged once hospital post-anesthetic criteria were met and received a follow-up call 24 hours later. Dr. Rosenblum praises the study and notes that the procedure looks similar to a lumbar sympathetic plexus block, which is also a sympathetic block. Ultrasound Considerations and Alternative Approaches Dr. Rosenblum shares his interest in ultrasound-guided celiac plexus blocks but acknowledges concerns about bowel perforation. He mentions a conversation with an interventional radiology colleague who suggested a transhepatic approach. Dr. Rosenblum recalls scanning a very thin patient where the aorta was easily visible and close to the anterior abdominal wall, making the celiac plexus potentially accessible if bowel perforation, liver bleeding, or gallbladder perforation could be avoided. He shares an experience with a patient suffering from severe pancreatitis pain who received temporary relief from a paravertebral thoracic nerve block at T8-T10, noting that paravertebral blocks provide some sympathetic spread. Conclusion and Community Resource Reminder Dr. Rosenblum concludes by recommending the article, noting its well-written analysis and graphs showing morphine consumption dropping over months following the procedure. He suggests neurolytic procedures are underutilized because they sound intimidating. He again encourages listeners to check out the community he created with separate chat rooms for regenerative medicine, regional anesthesia, and pain boards, where users can share keywords but not specific board questions. Dr. Rosenblum reminds listeners about upcoming courses and his website resources, mentions an upcoming PRP lecture, and asks for five-star reviews if listeners enjoy the podcast. The episode ends with a standard medical disclaimer. Reference https://www.painphysicianjournal.com/current/pdf?article=NTQwOA%3D%3D&journal=113

Decarbonising healthcare With Dr Eugenie Kayak

FrequENTcy — AAO–HNS/F Otolaryngology Podcasts

Play Episode Listen Later Jun 7, 2025 28:19

---------Find us atInstagram: https://www.instagram.com/abcsofanaesthesia/Twitter: https://twitter.com/abcsofaWebsite: http://www.anaesthesiacollective.comPodcast: ABCs of AnaesthesiaPrimary Exam Podcast: Anaesthesia Coffee BreakFacebook Page: https://www.facebook.com/ABCsofAnaesthesiaFacebook Private Group: https://www.facebook.com/groups/2082807131964430---------Check out all of our online courses and zoom teaching sessions here!https://anaesthesia.thinkific.com/collectionshttps://www.anaesthesiacollective.com/courses/---------#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded ---------Please support me at my patreonhttps://www.patreon.com/ABCsofA---------Any questions please email abcsofanaesthesia@gmail.com---------Disclaimer: The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.

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Anesthesiology | Son of a Boy Dad #306

Son of a Boy Dad

Play Episode Listen Later Jun 3, 2025 63:33

Anesthesiology | Son of a Boy Dad #306 -- Very funny episode with Harry, Adam & Francis -- #Ad: Watch Tires season 2 on Netflix on June 5, 2025 -- #Ad: Download the Gametime app today and use code BOYDAD for $20 off your first purchase -- #Ad: STETSON SPIRIT COOLING MEN'S GROOMING COLLECTION: The full collection is now available EXCLUSIVELY at WALMART, in stores and online. https://www.walmart.com/brand/stetson/spirit-cologne/10033228 -- #Ad: GAMBLING PROBLEM? CALL 1-800-GAMBLER, (800) 327-5050 or visit gamblinghelplinema.org (MA). Call 877-8-HOPENY/text HOPENY (467369) (NY). Please Gamble Responsibly. 888-789-7777/visit ccpg.org (CT), or visit www.mdgamblinghelp.org (MD).21+ and present in most states. (18+ DC/KY/NH/WY). Void in ONT/OR/NH. Eligibility restrictions apply. On behalf of Boot Hill Casino & Resort (KS). 1 per new customer. Must register new account to receive reward Token. Must select Token BEFORE placing min. $5 bet to receive $300 in Bonus Bets if your bet wins. Min. -500 odds req. Token and Bonus Bets are single-use and non-withdrawable. Token expires 6/22. Bonus Bets expire in 7 days (168 hours). Stake removed from payout. Terms: sportsbook.draftkings.com/promos. Ends 6/22/25 at 11:59 PM ET. Sponsored by DK. -- Follow us on our socials: https://linktr.ee/sonofaboydad -- Merch: https://store.barstoolsports.com/collections/son-of-a-boy-dad -- SUBSCRIBE TO THE YOUTUBE #SonOfABoyDad #BarstoolSportsYou can find every episode of this show on Apple Podcasts, Spotify or YouTube. Prime Members can listen ad-free on Amazon Music. For more, visit barstool.link/sonofaboydad

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Beyond the Lecture Hall: Revolutionizing Medical Education Through Innovation

Play Episode Listen Later Jun 3, 2025 42:12

In this episode of Voices of Otolaryngology, Rahul K. Shah, MD, MBA, AAO-HNS/F EVP/CEO, talks with Vince Loffredo, EdD, Chief Learning Officer at the American Society for Anesthesiology, about the future of medical education, providing advice to lecturers on how to engage audiences. They discuss how technology has accelerated changes in medical learning, moving from traditional lectures toward micro-learning, interactive formats, and personalized education. Dr. Loffredo shares insights on engaging learners through gamification, virtual reality, social media platforms, and continuous educational experiences, emphasizing collaborative, team-based learning across specialties. Helpful Resources: Otolaryngology Core Curriculum (OCC): https://www.entnet.org/occ More Ways to Listen: Spotify: https://open.spotify.com/show/3UeVLtFdLHDnWnULUPoiin Apple Podcasts: https://podcasts.apple.com/us/podcast/voice-of-otolaryngology/id1506655333 Connect the AAO-HNS: Instagram: https://www.instagram.com/aaohns X (Twitter): https://x.com/AAOHNS Facebook: https://www.facebook.com/AAOHNS LinkedIn: https://www.linkedin.com/company/american-academy-of-otolaryngology/ Website: https://www.entnet.org Shop AAO-HNS Merchandise: https://www.otostore.org This episode is sponsored by Inspire Medical Systems - For more information and medical education resources, visit: https://bit.ly/InspireAAO Help Us Improve Future Episodes: Share your feedback and topic suggestions at https://forms.office.com/r/0XpA83XNBQ Subscribe to Voices of Otolaryngology for more insights from leading voices in ENT. New episodes released every Tuesday.

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The mission and vision at Euroanaesthesia 2025

Residents in a Room by American Society of Anesthesiologists

Play Episode Listen Later Jun 2, 2025 15:06

We're at Euroanaesthesia 2025 in Lisbon, Portugal. Here we discuss the European Society of Anaesthesiology and Intensive Care's initiatives, focusing on the innovations in the scientific program in anaesthesia and perioperative medicine, and the importance of inclusivity and diversity within the society. The episode also highlights the future direction of the society, the role of trainees, and offers insights into the upcoming Congress in Rotterdam. Listeners are encouraged to apply for roles and join the society for its educational resources and global networking opportunities. Presented by Kate Leslie with her guests, Michel Struys is Professor and Chair, Department of Anesthesiology, University of Groningen and University Medical Center Groningen, the Netherlands, and chair of the Scientific Committee of ESAIC, and Fabio Guarracino, Head of the Department of Cardiothoracic Anaesthesia and Intensive Care at Pisa University Hospital, Pisa, Italy, and incoming chair of the Scientific Committee of ESAIC.

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Critical Care Anesthesiology

Play Episode Listen Later Jun 2, 2025 41:46

Resident host, Dr. Laura Santa Cruz Mercado, interviews critical care anesthesiologists, Drs. Megan Hicks and Ashish Kumar Khanna. Learn what practicing the subspecialty looks like, what to expect from training, how this mentor and mentee find life balance, and more. Recorded May 2025.

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Final Exam Tips with Prize Winner Dr Meg

Play Episode Listen Later Jun 1, 2025 56:20

Thank you Dr Meg for sharing so many amazing practical tips for passing the Final Exam.And most importantly thank you for giving so generously to medical education and all the amazing teaching you do for ABCs of Anaesthesia!You're a legend!---------Find us atInstagram: https://www.instagram.com/abcsofanaesthesia/Twitter: https://twitter.com/abcsofaWebsite: http://www.anaesthesiacollective.comPodcast: ABCs of AnaesthesiaPrimary Exam Podcast: Anaesthesia Coffee BreakFacebook Page: https://www.facebook.com/ABCsofAnaesthesiaFacebook Private Group: https://www.facebook.com/groups/2082807131964430---------Check out all of our online courses and zoom teaching sessions here!https://anaesthesia.thinkific.com/collectionshttps://www.anaesthesiacollective.com/courses/---------#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded ---------Please support me at my patreonhttps://www.patreon.com/ABCsofA---------Any questions please email abcsofanaesthesia@gmail.com---------Disclaimer: The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.

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Patient Safety, Sustainability, and AI in Anaesthesiology

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Play Episode Listen Later May 31, 2025 14:33

Recorded at Euroanesthesia 2025 in Lisbon, Portugal, the annual meeting of the European Society of Anesthesiology and Intensive Care. The episode features an interview with Edoardo de Roberti, a former ESAIC president, who shares insights into the challenges and advancements in the field of anesthesiology. Key topics include patient safety, sustainability in medical practices, and the role of artificial intelligence in improving anesthesiology. Eduardo also discusses workforce shortages in Europe and the importance of maintaining a well-trained and happy workforce for optimal patient outcomes. Presented by Kate Leslie, with her guest Edoardo De Robertis, Professor and Director of Anaesthesiology and Intensive Care, Università degli Studi di Perugia, Italy, and former president of ESAIC. He currently serves on the National Anaesthesiologists Societies Committee (NASC).

Innovations in Monitoring Right Heart Failure with the Swan IQ Catheter

director germany innovation monitoring leipzig swan secretary general heart failure anesthesiology european association heart center catheter intensive care medicine german society lvads

Play Episode Listen Later May 31, 2025 22:00

In this piece we discuss the intricacies of right heart failure, the differences between the right and left ventricles, and the challenges of early detection and monitoring. With a focus upon research we discuss the Swan-Ganz IQ pulmonary artery catheter, with the FastCCO algorithm, from BD Advanced Patient Monitoring. We cover its innovative capabilities, explore its impact on patient care and look particularly at high-risk patients like those with pulmonary hypertension and LVADs. The episode highlights the importance of new monitoring techniques, future research directions, and the promise of continuous data in improving right ventricular function diagnosis and treatment. Presented by Kate Leslie with her guest Joerg Ender, Director of the Department for Anesthesiology and Intensive Care Medicine, Heart Center, Leipzig, Germany. He is second president of the German Society of Anesthesiology and Intensive Care Medicine and former Secretary General of the European Association of Cardiothoracic Anaesthesiologists (EACTA).

Pregnancy and epidurals - Junior Anaesthesia Vivas

Play Episode Listen Later May 31, 2025 40:38

Viva StemYou are called to assess 30yo G2P1. She is not progressing well and may need an epiduralNKA.What do you want to know on assessment---------Find us atInstagram: https://www.instagram.com/abcsofanaesthesia/Twitter: https://twitter.com/abcsofaWebsite: http://www.anaesthesiacollective.comPodcast: ABCs of AnaesthesiaPrimary Exam Podcast: Anaesthesia Coffee BreakFacebook Page: https://www.facebook.com/ABCsofAnaesthesiaFacebook Private Group: https://www.facebook.com/groups/2082807131964430---------Check out all of our online courses and zoom teaching sessions here!https://anaesthesia.thinkific.com/collectionshttps://www.anaesthesiacollective.com/courses/---------#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded ---------Please support me at my patreonhttps://www.patreon.com/ABCsofA---------Any questions please email abcsofanaesthesia@gmail.com---------Disclaimer: The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.

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Epidural PRP Injections...What's the deal?

AnesthesiaExam Podcast

Play Episode Listen Later May 28, 2025 15:31

PRP in the Epidural Space for Radiculopathy Brooklyn Based Pain Physician, David Rosenblum, MD known for his work publishing and teaching Regenerative Pain Medicine and Ultrasound Guided Pain Procedures hosts this podcast covering the latest and most advanced concepts in Pain Medicine. Summary Dr. David Rosenblum delivered a comprehensive lecture covering several key topics in pain management. He discussed his upcoming speaking engagements at PainWeek, ASPN and great upcoming meetings like the Latin American Pain Society, and other conferences. Dr. Rosenblum shared his extensive experience with PRP (Platelet-Rich Plasma) epidural injections, reviewing multiple research studies that support their efficacy. He highlighted three significant studies: a randomized control trial comparing PRP epidural injections to traditional treatments, a CT-guided epidural PRP study, and a 2025 meta-analysis comparing PRP to steroids. Dr. Rosenblum emphasized that PRP treatments are showing comparable or better results than traditional steroid injections, with potentially fewer required treatments and longer-lasting relief. He noted that while PRP is currently not covered by insurance, it represents a growing trend in 'natural' treatment approaches that patients increasingly prefer. Chapters Introduction and Upcoming Events Dr. Rosenblum announced his upcoming lectures at Pain Week focusing on ultrasound and regenerative medicine, followed by presentations at the Latin American Pain Society in Chile and the New York, New Jersey Pain Conference. He mentioned the SoMeDocs online pain conference accessible through nrappain.org, and upcoming ultrasound training sessions in New York City. PRP Epidural Research Review Dr. Rosenblum discussed a randomized control trial involving 30 patients receiving transforaminal epidural injections. The study showed that PRP patients demonstrated significant improvements in leg pain scores at 6, 12, and 24 weeks. He noted that while the study didn't use contrast, he personally prefers using contrast diluted with saline for better visualization. CT-Guided Epidural Study Analysis Dr. Rosenblum reviewed a study comparing CT-guided epidural PRP versus steroid injections, questioning the necessity of CT guidance. The study included 60 patients and showed similar results between PRP and steroid groups at six weeks, though he criticized the short follow-up period, noting that PRP typically takes months to show full effects. Meta-Analysis Discussion Dr. Rosenblum presented a 2025 meta-analysis comparing PRP to steroids in epidural injections. The analysis included 310 patients across five RCTs, demonstrating comparable efficacy between PRP and steroid injections without increased adverse events. He emphasized that his clinical experience shows patients typically require fewer PRP injections compared to steroid treatments. Register for Next Weeks SoMeDocs Pain Conference References Wongjarupong, Asarn, et al. "“Platelet-Rich Plasma” epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial." BMC Musculoskeletal Disorders 24.1 (2023): 335. Bise, Sylvain, et al. "Comparison of interlaminar CT-guided epidural platelet-rich plasma versus steroid injection in patients with lumbar radicular pain." European radiology 30 (2020): 3152-3160. Muthu S, Viswanathan VK, Gangadaran P. Is platelet-rich plasma better than steroids as epidural drug of choice in lumbar disc disease with radiculopathy? Meta-analysis of randomized controlled trials. Exp Biol Med (Maywood). 2025 Feb 4;250:10390. doi: 10.3389/ebm.2025.10390. PMID: 39968415; PMCID: PMC11832311.

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Building Global Pediatric Research Networks by L. Schlapbach, P. Ramnarayan | OPENPediatrics

OPENPediatrics

Play Episode Listen Later May 26, 2025 34:07

This World Shared Practice Forum Podcast episode features a discussion on the article "Building Global Collaborative Research Networks in Pediatric Critical Care: A Roadmap," published in Lancet Child and Adolescent Health in February 2025. The conversation, led by Dr. Jeff Burns with guests Professor Luregn Schlapbach and Professor Padmanabhan Ramnarayan, explores the challenges and strategies for creating effective global research networks in pediatric critical care. The speakers highlight the importance of collaboration, the need for a robust evidence base, and the potential of large data models to drive the future of precision medicine and improve patient outcomes. LEARNING OBJECTIVES - Understand the current landscape and challenges of pediatric critical care research - Identify the key components and benefits of global collaborative research networks - Learn about the action plans and goals for advancing global pediatric critical care research AUTHORS Luregn Schlapbach, MD, PhD, Prof, FCICM Head, Department of Intensive Care and Neonatology University Children's Hospital in Zurich, Switzerland Padmanabhan "Ram" Ramnarayan, MBBS, MD, FRCPCH, FFICM Professor of Paediatric Critical Care Imperial College London Jeffrey Burns, MD, MPH Emeritus Chief Division of Critical Care Medicine Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Professor of Anesthesia Harvard Medical School DATE Initial publication date: May 26, 2025. ARTICLE REFERENCED Schlapbach LJ, Ramnarayan P, Gibbons KS, et al. Building global collaborative research networks in paediatric critical care: a roadmap. Lancet Child Adolesc Health. 2025;9(2):138-150. doi:10.1016/S2352-4642(24)00303-1 TRANSCRIPT https://cdn.bfldr.com/D6LGWP8S/at/7hptjhbmtkv8sqx7m86934/202505_WSP_Schlapbach_and_Ramnarayan_Transcript-3864x5000-258ba60.pdf Please visit: http://www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu CITATION Schlapbach LJ, Ramnarayan P, Burns JP. Building Global Pediatric Research Networks. 05/2025. OPENPediatrics. Online Podcast. https://soundcloud.com/openpediatrics/building-global-pediatric-research-networks-by-l-schlapbach-p-ramnarayan-openpediatrics.

Junior Anaesthesia Viva - Basics, assessment, intubation, hypoxaemia, pain management

west professor innovation breakthrough bench bytes bedside anesthesiology rosenblatt

Play Episode Listen Later May 26, 2025 46:29

Viva StemYou meet a 60yo male for a laparoscopic cholecystectomy.PMx: IHD, T2DM, HTN. Neuropathic foot painMedications:MetoprololMetforminACEiStatinPregabalin---------Find us atInstagram: https://www.instagram.com/abcsofanaesthesia/Twitter: https://twitter.com/abcsofaWebsite: http://www.anaesthesiacollective.comPodcast: ABCs of AnaesthesiaPrimary Exam Podcast: Anaesthesia Coffee BreakFacebook Page: https://www.facebook.com/ABCsofAnaesthesiaFacebook Private Group: https://www.facebook.com/groups/2082807131964430---------Check out all of our online courses and zoom teaching sessions here!https://anaesthesia.thinkific.com/collectionshttps://www.anaesthesiacollective.com/courses/---------#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded ---------Please support me at my patreonhttps://www.patreon.com/ABCsofA---------Any questions please email abcsofanaesthesia@gmail.com---------Disclaimer: The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.

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Bio Bytes 41: From Bedside to Breakthrough: Dr. Rosenblatt on Innovation and Impact in Anesthesiology

CU Bio Bytes

Play Episode Listen Later May 23, 2025 40:42

In this episode of Bio Bytes and our ongoing Bench to Bedside series, we learn about Dr. Meg Rosenblatt, Chair of the Department of Anesthesiology at Mount Sinai Morningside and West and Professor of Anesthesiology. She is recognized as the first person to deliver 20% intralipid therapy to treat local anesthetic systemic toxicity in a patient. We explore how she became a leader in anesthesiology, what it means to turn a case report into a career-defining moment, and how she balances clinical work, education, and leadership. Dr. Rosenblatt also reflects on the evolving challenges in the U.S. healthcare system, the importance of mentorship, moments that have most profoundly shaped her career, and offers practical advice. Whether you're an undergraduate student, medical student, practicing physician, or just curious about the people behind life-saving innovations, this episode offers a rare glimpse into the mind and heart of a physician-leader committed to excellence in care and education. Feel free to contact Dr. Rosenblatt with any specific questions at meg.rosenblatt@mountsinai.org. Hosted by: Celine Cotran

Episode 39: Beyond the block: a canvas for well-being and conversation in anesthesiology and pain medicine

RAPM Focus

Play Episode Listen Later May 23, 2025 27:14

In this episode of RAPM Focus, Alopi Patel, MD, speaks with K. Elliott Higgins III, MD, and Courtney Burns, MD, about their powerful pain palette essay, “Beyond the block: a canvas for well-being and conversation in anesthesiology and pain medicine.” This essay accompanies Healing Emotional Wounds—a community-engaged art piece by medical and scientific illustrator Morgan Granzow. Dr. Higgins is the director of health and well-being for UCLA's department of anesthesiology and perioperative medicine, a physician health officer for UCLA Health, and a practicing anesthesiologist with subspecialty expertise in regional anesthesia and acute pain medicine. His research focuses on measuring and understanding health care professional well-being through a systems lens. As founding leader of the Well-Being Influencers Survey for Healthcare (WISH) research consortium, he led the development of WISH, a validated tool designed to assess perceptions of organizational conditions that shape well-being rather than individual states like burnout. He also co-chairs the American Society of Anesthesiologists' well-being research working group and serves as both a member and change maker coach for the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience. Dr. Burns is an anesthesiology resident physician at Vanderbilt University Medical Center and member of the BH Robbins Scholars Physician-Scientist Development Program. Her research interests include clinician well-being among the anesthesiology workforce, psychological sequelae of adverse clinical events, and the association of clinician occupational well-being challenges with health care quality and patient outcomes. She is experienced in the medical humanities and has leveraged both visual art and narrative medicine in promoting well-being among students and clinicians. She also serves as a member of the American Society of Anesthesiologists' Committee on Physician Well-Being and the Society for Education in Anesthesia's Committee on Well-Being. Inviting reflection and dialogue within the RAPM community and beyond, this artwork isn't just visual—it's a conversation starter. By incorporating language that emerged from guided reflection, it aims to create safer, more compassionate clinical environments. Whether displayed in break rooms, pain clinics, or perioperative spaces, it offers clinicians a moment to pause, see themselves in others' words, and feel less alone. This discussion explores how this project seeks to destigmatize emotional struggles in medicine, promote well-being, and serve as a catalyst for further research—whether through focus groups, interviews, or broader institutional efforts. Most importantly, this piece reminds us that healing isn't just for our patients—it's for us, too. View more of Morgan Granzow's medical and scientific illustrations here.

Writing an Effective Research Abstract: A Step-by-Step Guide -- Pediatric Anesthesiology Internet-Based Non-Technical Skills

internet research writing resolutions acc pediatric abstract step by step guide anesthesiology conflict management faap technical skills

Play Episode Listen Later May 21, 2025 16:09

Conflict Management and Resolution with Destiny F. Chau MD, FAAP, MSLOD, ACC

Conflict Management and Resolution: Pediatric Anesthesiology Internet-Based Non-Technical Skills

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Play Episode Listen Later May 21, 2025 16:00

Conflict Management and Resolution with Destiny F. Chau MD, FAAP, MSLOD, ACC

When Mistakes Happen: Error Reporting and Breaking Bad News -- Pediatric Anesthesiology Internet-Based Non-Technical Skills

Play Episode Listen Later May 21, 2025 20:08

When Mistakes Happen: Error Reporting and Breaking Bad News with Casey Quinlan, MD; Matthew Goodmanson, MD; and Katherine R. Gentry, MD, MA

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TopMedTalks to Manu Malbrain; the patient experience

Play Episode Listen Later May 19, 2025 17:16

This piece follows on from the previous interview with Manu Malbrian, but works as a standalone podcast. It is presented from the annual conference of the Society of Critical Care Medicine (SCCM), the largest non-profit medical organization dedicated to promoting excellence and consistency in the practice of critical care. Here our guest very kindly shares his personal experience of critical care, before the conversation moves into the patient experience in general. Presented by Desiree Chappell and Monty Mythen with their guest Manu Malbrain, CMO of Medaman, an initiative that seeks to optimize the use of data in hospitals, combined with a position as professor of Critical Care Research at the First Department of Anesthesiology and Intensive Therapy of the Medical University of Lublin in Poland. He is a co-founder and president of the International Fluid Academy (IFAD), the co-founder, past president, and current treasurer of the Abdominal Compartment Society (WSACS), author and co-author of more than 386 peer-reviewed articles, reviews, comments, editorials, book chapters, and books on abdominal compartment syndrome (ACS) and rational fluid use. His cumulative h-index is 63 on Scopus and 85 on GoogleScholar (with a total of 37000 citations). We mention WSACS | WSACS - and recommend it again here. You can find him here: https://twitter.com/manu_malbrain https://www.linkedin.com/in/manu-malbrain-53574313 The previous podcast, from which this piece follows on, is here: https://topmedtalk.libsyn.com/topmedtalks-to-manu-malbrain

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Episode 33: Brave Boundaries - Radical Strategies to Take Back Your Time with Dr. Sasha Shillcutt

I AM Well, MD

Play Episode Listen Later May 17, 2025 38:27

Send us a textIn this empowering episode, Dr. Sasha Shillcutt joins us to unpack the transformative power of setting boundaries, especially for women in demanding roles. With wisdom rooted in her own journey and extensive work with thousands of professionals, Sasha reveals how we can reclaim our time, protect our energy, and live more authentically.We discuss:What sparked her passion for coaching women on boundariesHow to know when and where boundaries are neededPractical strategies for setting and sustaining boundariesThe common internal and external roadblocks we faceHow to identify what's truly controlling your timeGenerational healing through bold boundary-settingWhether you're a busy professional, a caregiver, or someone trying to find balance in a chaotic world, this episode is your blueprint for drawing the line with courage and clarity.About our guest:Dr. Sasha K. Shillcutt is a tenured and endowed Professor and Vice Chair of Strategy in the Department of Anesthesiology at the University of Nebraska Medical Center. She is a double-boarded cardiac anesthesiologist, international speaker, best-selling author, and the CEO & Founder of Brave Enough, a global community that empowers women leaders through coaching, courses, and conferences.Her TEDx talk "Resilience: The Art of Failing Forward" and best-selling books Brave Boundaries and Between Grit and Grace continue to inspire women around the world to lead boldly, protect their peace, and live without apology.Connect with Sasha:Website: www.becomebraveenough.comInstagram: @becomebraveenoughFacebook: facebook.com/becomebraveenoughLinkedIn: linkedin.com/company/becomebraveenoughPodcast: The Brave Enough ShowEmail: info@becomebraveenough.comTune in now and learn how to say "no" to what drains you and "yes" to the life you truly want.Dr. Tanikella practices General Pediatrics, Integrative Medicine, and is an expert in Mind-Body medicine. She has traveled the world to learn more about the intersection where mind, body, personal beliefs, and motivation meet. She is founder and CEO of Integrative Approaches to Mastering Wellness, where she brings the wisdom of mind body medicine and the power of life coaching together to help her clients break through their glass ceilings. Want to learn more? Visit Dr. Tanikella at iamwellmd.com. You can also join our email list or drop us a message by going to iamwellmd.com/contact. You may just get a shout out in the next episode! Follow I AM Well MD on Instagram | LinkedIn | FacebookWelcome home!Disclaimer: While I am a practicing physician, in this space, I function as a life coach and wellness advocate. The information provided here is for educational purposes only and does not necessarily reflect that of my employers. If you need medical or psychological services, I strongly recommend that you contact your physician. If you are having an emergency, please call 911 and proceed to the ER.

Revolutionizing Anesthesia: The Jaw Elevation Device (JED) - A Deep Dive with Inventor April King

The Strategy Skills Podcast: Management Consulting | Strategy, Operations & Implementation | Critical Thinking

Play Episode Listen Later May 12, 2025 22:08

This piece focuses upon an innovative device that has transformed patient care in Anesthesia; the Jaw Elevation Device (JED), a non-invasive tool designed to keep patients' airways open during moderate anesthesia care (MAC). The conversation explores the challenges of MAC, the device's adaptability across different patient demographics, and its impact on improving patient safety and practitioner efficiency. Learn more about the evolution of JED, its clinical applications, and where to find this groundbreaking device. Presented by Desiree Chappell with April King, Co-Founder, Director, President and CEO of Hypnoz Therapeutic Devices, creator of the JED and Irene Osborn, Director, Non-Operating Room Anesthesia and Professor, Anesthesiology at Montefiore Einstein.at

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Technology & Innovation in Pediatric ICUs: A Progressive Look at North America

OPENPediatrics

Play Episode Listen Later May 8, 2025 31:43

The World Federation of Pediatric Intensive & Critical Care Societies (WFPICCS), in collaboration with OPENPediatrics, recognizes World PICU Awareness Week 2025. This initiative aims to raise global awareness about the importance of PICUs and critical care wards worldwide, emphasizing how healthcare professionals in these units, regardless of resource setting, are driving change. From predictive analytics to AI-driven teamwork, this episode explores how pediatric intensive care units across North America are blending technology and human insight to transform care. Hear experts from leading children's hospitals in the U.S. discuss how innovation, frontline collaboration, and a focus on people, not just machines, are shaping the future of critical care for children. HOST Maya Dewan, MD, MPH Division Director, Division of Critical Care Attending Physician, Pediatric Intensive Care Unit & Associate Professor UC Department of Pediatrics Cincinnati Children's Hospital United States of America GUESTS Matthew Zackoff MD, Med Director, Critical Care Fellowship Program Co-Lead Digital Simulation, Center for Simulation and Research Attending Physician, Pediatric Intensive Care Unit Assistant Professor, UC Department of Pediatrics Cincinnati Children's Hospital United States of America Sanjiv Mehta, MD, MBE Sanjiv D Mehta, MD, MBE, MSCE Assistant Professor of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine Attending Physician, Division of Pediatric Critical Care Medicine, Children's Hospital of Philadelphia Associate Medical Director for Analytics - ICU United States of America Jean Anne Cieplinski-Robertson, MSN, RN Senior Director of Nursing, Critical Care Children's Hospital of Philadelphia United States of America DATE Initial publication date: May 8, 2025. TRANSCRIPTS English - https://cdn.bfldr.com/D6LGWP8S/at/b73v7gmf79nzjt9bt3vg3w/WPAW-25_North_America_Final_English.pdf Spanish - https://cdn.bfldr.com/D6LGWP8S/at/2xjfmjbwfcw739f6f68tj4q/WPAW-25_North_America_Final_Spanish.pdf French - https://cdn.bfldr.com/D6LGWP8S/at/9b4xsp88j7m3t438rpxrc62t/WPAW-25_North_America_Final_French.pdf Portuguese - https://cdn.bfldr.com/D6LGWP8S/at/5bqn4q6fnw8b5gnr6swvvbx/WPAW-25_North_America_Final_Portuguese.pdf Italian - https://cdn.bfldr.com/D6LGWP8S/at/3n2xjk7tvrqgmtwwhx3mb8nb/WPAW-25_North_America_Final_Italian.pdf German - https://cdn.bfldr.com/D6LGWP8S/at/2q58jgjq7p99nxsgmbqp887/WPAW-25_North_America_Final_German.pdf Arabic - https://cdn.bfldr.com/D6LGWP8S/at/ntsn8qpntsfkm65krzs6hqc/WPAW-25_North_America_Final_Arabic.pdf Please visit: www.openpediatrics.org OPENPediatrics™ is an interactive digital learning platform for healthcare clinicians sponsored by Boston Children's Hospital and in collaboration with the World Federation of Pediatric Intensive and Critical Care Societies. It is designed to promote the exchange of knowledge between healthcare providers around the world caring for critically ill children in all resource settings. The content includes internationally recognized experts teaching the full range of topics on the care of critically ill children. All content is peer-reviewed and open-access, thus at no expense to the user. For further information on how to enroll, please email: openpediatrics@childrens.harvard.edu

549: Anesthesiologist and Reality TV Star on How to Stop Chasing Perfection and Embrace Connection

Play Episode Listen Later May 7, 2025 52:49

Dr. Tiffany Moon isn't just breaking stereotypes — she's rewriting the script. In this episode, Dr. Tiffany Moon — board-certified anesthesiologist, founder of Aromasthesia, and former cast member of Bravo's Real Housewives — opens up about what it really takes to balance ambition, motherhood, entrepreneurship, and public scrutiny. From immigrating to the U.S. at age 6 to graduating from college at 19 and medical school at 23, where she finished in the top ten percent of her class, to launching a wellness brand rooted in science and self-care, Tiffany's story is as raw and relatable as it is inspiring. We cover: The culture of overachievement and how it can become an emotional cage The silent weight of perfectionism in high-achieving women How childhood trauma shaped her relentless drive and how she's healing from it Why asking for help isn't a weakness — it's a strategy The behind-the-scenes reality of being a doctor and a reality TV personality Why she's choosing presence over perfection in parenting, career, and business Plus: Why even the most “put-together” people struggle with self-worth How Tiffany balances a medical career with being a mother, wife, and founder Why her social media presence is as real as it gets and why that matters Tiffany also shares the surprising impact of being on reality TV, not on her brand, but on her identity, and why she now uses her platform to champion authenticity, self-care, and breaking generational cycles. This is an honest, unfiltered conversation about legacy, self-awareness, and the courage to define success on your own terms. Tiffany Moon, MD, is a board-certified anesthesiologist, entrepreneur, keynote speaker, mother of twins, and author of Joy Prescriptions: How I Learned to Stop Chasing Perfection and Embrace Connection. She is also the founder and CEO of Aromasthesia Candles, Three Moons Wine, and LeadHer Summit. Tiffany has published over fifty peer-reviewed articles, is one of D Magazine's “Best Doctors,” and serves as an Oral Board Examiner for the American Board of Anesthesiology. She was the first medical doctor and Chinese American cast member on Bravo's Real Housewives. Her story has been featured in Forbes, Variety, Harper's Bazaar, USA Today, and more. She lives with her family in Dallas, TX. Get Tiffany's book here: https://rb.gy/5fvfl5 Joy Prescriptions: How I Learned to Stop Chasing Perfection and Embrace Connection Here are some free gifts for you: Overall Approach Used in Well-Managed Strategy Studies free download: www.firmsconsulting.com/OverallApproach McKinsey & BCG winning resume free download: www.firmsconsulting.com/resumepdf Enjoying this episode? Get access to sample advanced training episodes here: www.firmsconsulting.com/promo

#37: Andy Nguyen (ND MD) - Navigating Anesthesiology Residency

The Hoeflinger Podcast

Play Episode Listen Later May 6, 2025 67:14

In this episode, we're joined by Andy Nguyen, MD, a PGY1 anesthesiology resident at Yale and YouTube creator (ND MD - Dr. Nguyen's YouTube channel)Dr. Nguyen shares his journey from medical school to residency, offering insights into the structure of his intern year and the emotional and professional challenges that come with it. We also discuss how he uses photography, videography, and storytelling as a creative outlet and to share the stories of others. We reflect on medical specialty selection, the weight of responsibility in medicine, and the importance of long-term vision. Other topics discussed include, the role of social media in medicine, the delicate balance between professionalism and personal expression, the increased competitiveness of medical school and residency, and much more!Whether you're a future physician or simply curious about the modern medical journey, this episode offers honest, thoughtful reflections on what it means to grow, as both a doctor and a person, in today's digital age.Check out My Free Newsletter: pages.doctorhoeflinger.comEach week, I simplify the world of health, medicine, and fitness using my 25 years of experience as a board-certified neurosurgeon. Tune in every week for new episodes of The Hoeflinger Podcast with Dr. Brian Hoeflinger and Kevin Hoeflinger.All Dr. Hoeflinger's linksClick here for all links for Dr. HoeflingerKevin Hoeflinger's linksClick here for all links for Kevin HoeflingerContact Us brian.hoeflinger1@gmail.comThank you all for watching and listening to our content and we hope you continue to follow along on our journey!

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Unconscious bias, bullying, harassment, and discrimination

Play Episode Listen Later May 5, 2025 29:12

In this piece we discuss perioperative medicine with Alana Flexman, an anaesthetist and researcher from Vancouver, Canada, and Maryanne Balkin, an anaesthetist and law graduate from Melbourne, Australia. We explore our guests' career journeys, and gender and equity issues, including unconscious bias and bullying, harassment, and discrimination, in the workplace. Finally we talk about the craziness and joy of continued learning and enquiry. Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guests, Dr Alana Flexman, Clinical Associate Professor, Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, and St. Paul's Hospital/Providence Health Care, Vancouver, Canada, and Dr Maryanne Balkin, Consultant Anaesthetist, Alfred Health, Melbourne, Australia.

Journals in focus, The BJA and Anesthesiology

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Play Episode Listen Later May 5, 2025 29:02

In this piece we discuss the latest news in medical publishing with Hugh Hemmings, editor-in-chief of the British Journal of Anaesthesia and Laszlo Vutskits, editor of Anesthesiology. We discuss the increasing volume of manuscripts being received by journals; the challenges of peer review, and initiatives to find and support new reviewers. Then we delve into the use of AI by authors and journals, and how this might influence publishing in the future. Presented by Andy Cumpstey and Kate Leslie on location at the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in Cairns, Australia, with their guests, Dr Hugh Hemmings, Joseph F. Artusio Jr. Professor and Chair, Department of Anesthesiology, Weill-Cornell Medicine, New York, USA, and Dr Laszlo Vutskits, Head of Pediatric Anesthesia at the Department of Anesthesiology, Pharmacology and Intensive Care at the University Hospital of Geneva, Switzerland.

Dr. Tiffany Moon, The Real Housewives of Dallas Star & Author of JOY PRESCRIPTIONS

For You From Eve

Play Episode Listen Later May 2, 2025 72:35

What an amazing guest episode… meet Dr. Tiffany Moon; a trailblazer known as the first doctor and first-generation Asian American to star on The Real Housewives of Dallas. She made headlines for speaking out against racial bullying, which sparked her advocacy for Asian American issues. We had so many different conversation topics today such as… Women's Empowerment & Entrepreneurship: Transitioning from a successful medical career to a multi-faceted businesswoman and reality TV star. Discovering Inner Joy: How she embraced risks, creativity, and self-care to live a more fulfilling life. Perfectionist Burnout: Overcoming the emotional toll of societal expectations and perfectionism. Leadership as an Asian American: Confronting anti-AAPI hate and exploring racial diversity challenges. Balancing Family & Career: How she successfully manages motherhood while growing professionally. About Tiffany: TIFFANY MOON, MD, is a board-certified anesthesiologist, entrepreneur, and mother of twins. She is the founder and CEO of Aromasthesia Candles, Three Moons Wine, and LeadHer Summit. She has published over fifty peer-reviewed publications, is one of D Magazine's “Best Doctors,” and serves as an Oral Board Examiner for the American Board of Anesthesiology. Tiffany was the first medical doctor and Chinese American cast member on Bravo's Real Housewives and her story has been featured in Forbes, Variety, Harper's Bazaar, USA Today, and more. She lives with her family in Dallas, TX Find Tiffany Here! : Tiktok: 1.7M followers Instagram: 830K followers Facebook: 66K followers LinkedIn: 500+ connections Main website: https://www.tiffanymoonmd.com/ Book website: https://joyprescriptions.com/ Thank you so much for the constant love & support! LinkTree (all links) : ⁠https://linktr.ee/foryoufromeve⁠ Website + Services: ⁠https://www.foryoufromeve.org⁠ Instagram: ⁠https://www.instagram.com/foryoufromeve⁠ Tiktok: ⁠https://www.tiktok.com/@foryoufromeve⁠ Amazon Storefront: ⁠https://www.amazon.com/shop/influencer-e333d6b9?utm_source=hoobe&utm_medium=social⁠ LTK: ⁠https://www.shopltk.com/explore/Olivia_Eve_Shabo⁠ Sponsors: Head on over to ⁠Rula.com/fromeve⁠ to get started today. After you sign up they ask you where you heard about them. PLEASE support our show and tell them our show sent you. Learn more about your ad choices. Visit megaphone.fm/adchoices

How to Overcome Perfectionism, Reclaim Joy, & Find Fulfillment | Dr. Tiffany Moon

I Dare You

Play Episode Listen Later May 2, 2025 47:50

Are you feeling the weight of perfectionism and the constant need to achieve? Dr. Tiffany Moon's journey is a testament to how the pressure to be perfect can hinder personal fulfillment. As a successful physician, reality TV star, and author, she realized that her life was driven by external accomplishments rather than internal joy. In this episode, Dr. Tiffany shares how she stopped living for external validation and began to align her actions with her authentic self. From moving away from toxic friendships to learning the art of saying no, she highlights the importance of setting boundaries and prioritizing well-being over societal expectations. Her book, Joy Prescriptions, explores this journey and how Dr. Tiffany applied her doctor's mindset to prescribe joy in everyday life. It's not just about removing the negative but creating space for what truly brings happiness. Ready to start your own journey of self-rediscovery? Join us as we explore how you can overcome perfectionism, prioritize joy, and live a life that feels as good on the inside as it looks on the outside. "To stop filling your bucket with the wrong things is a mindset shift. First, you change your mindset, and then you start doing things that fall in line with the new mindset." ~ Dr. Tiffany Moon In this Episode: - Meet Dr. Tiffany Moon - Behind the scenes of the Real Housewives of Dallas - Jen's Real Housewives experience - Dr. Tiffany's upbringing, academic achievements, and career - Escaping the trap of perfectionism and reconstructing Life - Finding healing: therapy, self-help books, and a "friends" audit - Tiffany's Real Housewives experience - Dr. Tiffany's life and career after her awakening - How to pre-order the Joy Prescriptions book About Dr. Tiffany Moon: Dr. Tiffany Moon is a board-certified anesthesiologist, entrepreneur, and author. She is a proud mother of twins and a dynamic television and social media personality. Dr. Tiffany graduated from Cornell University at 19, earned her medical degree with Alpha Omega Alpha Honors from UT Southwestern, and completed her anesthesiology residency at UCSF. She has been named one of D Magazine's Best Doctors, authored over 50 peer-reviewed publications, been recognized as a Distinguished Educator by the American Society of Anesthesiologists, and serves as an Oral Board Examiner for the American Board of Anesthesiology. She is the founder and CEO of Aromasthesia Candle Company, Three Moons Wine, and LeadHer Summit. Her debut book, Joy Prescriptions—a powerful exploration of overcoming perfectionism and finding joy through gratitude, self-compassion, and connection—will be published in May 2025. Pre-order Joy Prescriptions: https://www.joyprescriptions.com/ Website: https://www.tiffanymoonmd.com/ Instagram: https://www.instagram.com/tiffanymoonmd/ Facebook: https://www.facebook.com/tiffanymoonmd Where to find me: IG: https://www.instagram.com/jen_gottlieb/ TikTok: https://www.tiktok.com/@jen_gottlieb Facebook: https://www.facebook.com/Jenleahgottlieb Website: https://jengottlieb.com/ My business: https://www.superconnectormedia.com/ YouTube: https://www.youtube.com/@jen_gottlieb

Patient Advocacy in the Hospital and Society, May 2025: Pediatric Anesthesiology Internet-Based Non-Technical Skills