Podcasts about br j anaesth

Send us a textDiese Woche geht es im Journal Club um das Thema Prämedikationsgespräch:D'Andria Ursoleo J, Bottussi A, Monaco F. Talk before they sleep: strategies for patient-centred communication in anaesthesiology. Br J Anaesth. 2024;133(5):934-939. doi:10.1016/j.bja.2024.08.013Im Studio diese Woche: Niemand ausser dem Host, Christopher Neuhaus, leider solo...

Send us a textDiese Woche im Journal Club: Hung KC, Chang LC, Ho CN, et al. Efficacy of intravenous iron supplementation in reducing transfusion risk following cardiac surgery: an updated meta-analysis of randomised controlled trials. Br J Anaesth. Published online September 26, 2024. doi:10.1016/j.bja.2024.08.030Wir besprechen die neueste Metaanalyse zu i.v.-Eisengabe und Transfusion in der Kardiochirurgie. Mit im Studio dabei - Mona Jung-König, wissenschaftliche Mitarbeiterin der Klinik für Anästhesie des UKHD.

Situational awareness and judgment are two of the most important ingredients to success in life and definitely medical school, especially the clinical years. Even if you don't know what you're doing on day 1 of a new rotation, or even where the bathrooms are, situational awareness will allow you to clue in to the dynamics around you, avoid mistakes and gaffes, and help you shine through fluid, seamless interactions with others. Dr. John Allen from the OSA sits down with Dr. Frayha to explore situational awareness in med school: what it means and how to cultivate it, along with specific scripting and strategies for different situations. Resources: AMA resource on how clinical clerkship students can hone situational awareness  What is situational awareness in healthcare? Feller S, et al. Situational Awareness in the Context of Clinical Practice. Healthcare (Basel). 2023 Dec 4;11(23):3098. PMID: 38063666. Weller JM, et al. Teamwork matters: team situation awareness to build high-performing healthcare teams, a narrative review. Br J Anaesth. 2024 Apr;132(4):771-778. Epub 2024 Feb 2. PMID: 38310070.  

Training as imagined?, sim for faster stroke treatment, simulation after key events, Implementing TALK for clinical debriefing.  Another great month on Simulcast.  The articles: -  Kerins, J., Ralston, K., Stirling, S.A. et al. Training as imagined? A critical realist analysis of Scotland's internal medicine simulation programme. Adv Simul 9, 27 (2024)  Ajmi SC, Kurz M, Lindner TW, et al. Does clinical experience influence the effects of team simulation training in stroke thrombolysis? A prospective cohort study. BMJ Open 2024;14:e086413  Diaz-Navarro, C., Jones, B., Pugh, G. et al. Improving quality through simulation; developing guidance to design simulation interventions following key events in healthcare. Adv Simul 9, 30 (2024).  Diaz-Navarro C, Enjo-Perez I, Leon-Castelao E, Hadfield A, Nicolas-Arfelis JM, Castro-Rebollo P. Implementation of the TALK© clinical self-debriefing tool in operating theatres: a single-centre interventional study. Br J Anaesth. 2024 Jul 29:S0007-0912(24)00413-6.    And also mentioned on the podcast   The Self Development Module on ‘Introduction to Quality Improvement'  Happy listening!    And… Date Claimers    The Victorian Translational SIMposium  6th September, Melbourne . Details and registration here     Simulation Reconnect is on again   Bond University, Wednesday 27th November. Registration here  

Send us a Text Message.In der aktuellen Folge des HAINS Journal Clubs geht es um das iPEGASUS-Trial von Funcke et al. aus dem BJA zur Cardiac Index-gesteuerten hämodynamischen Therapie:Funcke S, Schmidt G, Bergholz A, et al. Cardiac index-guided therapy to maintain optimised postinduction cardiac index in high-risk patients having major open abdominal surgery: the multicentre randomised iPEGASUS trial. Br J Anaesth. 2024;133(2):277-287. doi:10.1016/j.bja.2024.03.040Vorgestellt wird die Arbeit von Dr. Anja Schuh, wissenschaftliche Mitarbeiterin der Klinik für Anästhesiologie am UKHD. 

The first BTK THROW DOWN!  A spicy debate…a war of words…a battle of ideas!  This fiery episode features leaders in the field of trauma surgery discussing the optimal approach to vascular access in trauma patients.  A recent study titled “Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review” concluded that intraosseous access should be considered a first line therapy in hypotensive trauma patients.  Is this appropriate?  Crazy?  Just so crazy it might work?  Let's get ready to ruuuummmmbbbbbbllllllleeeee! Hosts:  Patrick Georgoff, MD (@georgoff) Nina Clark, MD (@clarkninam) Guests:  Ryan Dumas, MD – UT Southwestern (@RPDumasMD) Michael Vella, MD, MBA – University of Rochester (@MichaelVella32) Bellal Joseph, MD – University of Arizona (@TopKnife_B) Moving the Needle on Time to Resuscitation: An EAST Prospective multicenter study of vascular access in hypotensive injured patients using trauma video review. - Dumas RP, Vella MA, Maiga AW, Erickson CR, Dennis BM, da Luz LT, Pannell D, Quigley E, Velopulos CG, Hendzlik P, Marinica A, Bruce N, Margolick J, Butler DF, Estroff J, Zebley JA, Alexander A, Mitchell S, Grossman Verner HM, Truitt M, Berry S, Middlekauff J, Luce S, Leshikar D, Krowsoski L, Bukur M, Polite NM, McMann AH, Staszak R, Armen SB, Horrigan T, Moore FO, Bjordahl P, Guido J, Mathew S, Diaz BF, Mooney J, Hebeler K, Holena DN. Moving the needle on time to resuscitation: An EAST prospective multicenter study of vascular access in hypotensive injured patients using trauma video review. J Trauma Acute Care Surg. 2023 Jul 1;95(1):87-93. doi: 10.1097/TA.0000000000003958. Epub 2023 Apr 4. PMID: 37012624. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. - Deeb AP, Guyette FX, Daley BJ, Miller RS, Harbrecht BG, Claridge JA, Phelan HA, Eastridge BJ, Joseph B, Nirula R, Vercruysse GA, Sperry JL, Brown JB. Time to early resuscitative intervention association with mortality in trauma patients at risk for hemorrhage. J Trauma Acute Care Surg. 2023 Apr 1;94(4):504-512. doi: 10.1097/TA.0000000000003820. Epub 2023 Jan 11. PMID: 36728324; PMCID: PMC10038862. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis - van Loon FHJ, Buise MP, Claassen JJF, Dierick-van Daele ATM, Bouwman ARA. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth. 2018 Aug;121(2):358-366. doi: 10.1016/j.bja.2018.04.047. Epub 2018 Jul 2. PMID: 30032874. Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.   If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listen/

Emergency cricothyrotomy is a rare, but incredibly important procedure that can be lifesaving. A primary step when performing a cricothyrotomy is correct identification of the cricothyroid membrane (CTM).  In this episode Jeremy and Sass discuss the anatomy related to the CTM. They talk about palpation methods for finding the CTM, discuss current evidence for the use of ultrasound identification, and break down the ultrasound techniques that are useful in clinical practice. This is the podcast that will excite you to use POCUS for identification of the CTM!   Here are some of the things you'll learn on this show: Understanding and identifying the anatomy. 2:21 The two most effective ways to find the cricothyroid membrane. 8:32 A couple of relevant studies that provide good information. 12:45 The ultrasound procedure to help identify it. 17:19 The educational resources that Jeremy recommends. 21:48 The String of Pearls technique. 22:40   Show Notes & Resources: Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth. 2016 Sep;117 Suppl 1:i39-i48. doi: 10.1093/bja/aew176. Epub 2016 Jul 17. PMID: 27432055. Rai Y, You-Ten E, Zasso F, De Castro C, Ye XY, Siddiqui N. The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review. J Crit Care. 2020 Dec;60:161-168. doi: 10.1016/j.jcrc.2020.07.030. Epub 2020 Aug 13. PMID: 32836091. Journal of Anaesthesia, Volume 117, Issue suppl_1, September 2016, Pages i39–i48, https://doi.org/10.1093/bja/aew176 Hung KC, Chen IW, Lin CM, Sun CK. Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: a meta-analysis. Br J Anaesth. 2021 Jan;126(1):e9-e11. doi: 10.1016/j.bja.2020.08.012. Epub 2020 Sep 28. PMID: 32896429. Kristensen MS, Teoh WH. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access. Br J Anaesth. 2021 Jan;126(1):22-27. doi: 10.1016/j.bja.2020.10.004. Epub 2020 Oct 31. PMID: 33131758. Siddiqui N, Arzola C, Friedman Z, Guerina L, You-Ten KE. Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy: A Randomized Control Trial. Anesthesiology. 2015 Nov;123(5):1033-41. doi: 10.1097/ALN.0000000000000848. PMID: 26352376. Airway Management for Anaesthesiologists. Ultrasound guided marking of the cricothyroid membrane using: Transverse TACA Technique: https://airwaymanagement.dk/ultrasound_needle_cricothyrotomy Longitudinal “String of Pearls” Technique: airwaymanagement.dk/pearls     About our hosts: https://kpatprogram.org/about-the-school/faculty.html  Visit us online: http://beyondthemaskpodcast.com  Get the CE certificate here: https://beyondthemaskpodcast.com/wp-content/uploads/2020/04/Beyond-the-Mask-CE-Cert-FILLABLE.pdf

Doctor Jarrod Mosier is a bit of a polymath, and we were delighted he could squeeze us into his busy life. His day jobs include Intensive Care Medicine and Emergency medicine in Tucson, where he is a professor (at the other UofA: Arizona).He is an expert in all aspects of airway management, ranging from the physiologically difficult airway, through the importance of first pass success, including how to optimize for intubation, the roles of ultrasound and extracorporeal support, and all the way to safe extubation. This was the focus of our wide-ranging entertaining conversation. When away from work Jarrod throws a mean football, dotes on his two kids, and loves getting up into the mountains to snap superb nature photographs. Further reading: 1. Mosier JM, Sakles JC, Law JA, Brown CA 3rd, Brindley PG. Tracheal Intubation in the Critically Ill. Where We Came from and Where We Should Go. Am J Respir Crit Care Med. 2020;201(7):775-788. doi:10.1164/rccm.201908-1636CI 2. Mosier JM. Physiologically difficult airway in critically ill patients: winning the race between haemoglobin desaturation and tracheal intubation. Br J Anaesth. 2020;125(1):e1-e4. doi:10.1016/j.bja.2019.12.001

It's our first solo episode! We review the evidence around perioperative use of gabapentinoids (gabapentin and pregabalin) and discuss interesting concepts including trial sequential analysis and minimally important difference. If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues.  — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002 Sep;97(3):560-4. doi: 10.1097/00000542-200209000-00007. PMID: 12218520. Ian Gilron; Is Gabapentin a “Broad-spectrum” Analgesic?. Anesthesiology 2002; 97:537–539 doi: https://doi.org/10.1097/00000542-200209000-00004 Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015 Jan;114(1):10-31. doi: 10.1093/bja/aeu293. Epub 2014 Sep 10. PMID: 25209095.Fabritius ML, Geisler A, Petersen PL, Nikolajsen L, Hansen MS, Kontinen V, Hamunen K, Dahl JB, Wetterslev J, Mathiesen O. Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses. Acta Anaesthesiol Scand. 2016 Oct;60(9):1188-208. doi: 10.1111/aas.12766. Epub 2016 Jul 18. Erratum in: Acta Anaesthesiol Scand. 2017 Mar;61(3):357-359. PMID: 27426431. Chan JSK, Harky A. Trial sequential analysis in meta-analyses: A clinically oriented approach with real-world example. J Thorac Cardiovasc Surg. 2021 Jul;162(1):167-173. doi: 10.1016/j.jtcvs.2020.06.063. Epub 2020 Jun 27. PMID: 32868066. Clephas PRD, Kranke P, Heesen M. How to perform and write a trial sequential analysis. Anaesthesia. 2022 Jul 13. doi: 10.1111/anae.15811. Epub ahead of print. PMID: 35831946. Michael Verret, François Lauzier, Ryan Zarychanski, Caroline Perron, Xavier Savard, Anne-Marie Pinard, Guillaume Leblanc, Marie-Joëlle Cossi, Xavier Neveu, Alexis F. Turgeon, the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group; Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis. Anesthesiology 2020; 133:265–279 doi: https://doi.org/10.1097/ALN.0000000000003428 Deljou A, Hedrick SJ, Portner ER, Schroeder DR, Hooten WM, Sprung J, Weingarten TN. Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration. Br J Anaesth. 2018 Apr;120(4):798-806. doi: 10.1016/j.bja.2017.11.113. Epub 2018 Feb 10. PMID: 29576120. Kharasch ED, Clark JD, Kheterpal S. Perioperative Gabapentinoids: Deflating the Bubble. Anesthesiology. 2020 Aug;133(2):251-254. doi: 10.1097/ALN.0000000000003394. PMID: 32667153; PMCID: PMC7367437.

In this episode, Mo and Marc are joined by special guest Jason Busse (Professor in the Department of Anesthesia at McMaster University, Director of the National Pain Centre, and Associate Director of the Michael G. DeGroote Centre for Medicinal Cannabis Research), in a discussion on research into the relative effectiveness and harms associated with various types of opioids, cannabinoids, and psychedelics in the treatment of chronic pain. Links: Noori A, Sadeghirad B, Wang L, Siemieniuk RAC, Shokoohi M, Kum E, Jeddi M, Montoya L, Hong PJ, Zhou E, Couban RJ, Juurlink DN, Thabane L, Bhandari M, Guyatt GH, Busse JW. Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials. Br J Anaesth. 2022 Sep;129(3):394-406. doi: 10.1016/j.bja.2022.05.031. Epub 2022 Jul 9. PMID: 35817616. https://bit.ly/3KOtVat Kane RL, Bershadsky B, Rockwood T, Saleh K, Islam NC. Visual Analog Scale pain reporting was standardized. J Clin Epidemiol. 2005 Jun;58(6):618-23. doi: 10.1016/j.jclinepi.2004.11.017. PMID: 15878476. https://bit.ly/3BrSIyd Busse JW, Craigie S, Juurlink DN, Buckley DN, Wang L, Couban RJ, Agoritsas T, Akl EA, Carrasco-Labra A, Cooper L, Cull C, da Costa BR, Frank JW, Grant G, Iorio A, Persaud N, Stern S, Tugwell P, Vandvik PO, Guyatt GH. Guideline for opioid therapy and chronic noncancer pain. CMAJ. 2017 May 8;189(18):E659-E666. doi: 10.1503/cmaj.170363. PMID: 28483845; PMCID: PMC5422149. https://bit.ly/3QhqY3f Subspecialties: Basic Science Education and Training Ethics Foot & Ankle Hand & Wrist Hip Knee Oncology Orthopaedic Essentials Pain Management Rehabilitation Pediatrics Spine Shoulder Elbow Sports Medicine Trauma

Dr. Chris Di Capua and Dr. Bryan Glezerson (@BryanGlezerson) join the show to discuss the literature around the risk of aspiration with LMAs compared to ETTs. This is part I of a two-part series on LMAs. In part II, we discuss the safety of LMAs in specific patient populations including patients receiving positive pressure ventilation, patients undergoing laparoscopic surgery, obese patients, and pregnant patients. This is an episode produced from the Depth of Anesthesia Podcast Elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Barker P, Langton JA, Murphy PJ, Rowbotham DJ: Regurgitation of gastric contents during general anesthesia using the laryngeal mask airway. Br J Anaesth 1992; 69:314-5. Rabey PG, Murphy PJ, Langton JA, Barker P, Rowbotham DJ. Effect of the laryngeal mask airway on lower oesophage al sphincter pressure in patients during general anaesthesia. Br J Anaesth. 1992 Oct;69(4):346-8. doi: 10.1093/bja/69.4.346. PMID: 1419440. Owens TM, Robertson P, Twomey C, Doyle M, McDonald N, McShane AJ. The incidence of gastroesophageal reflux with the laryngeal mask: a comparison with the face mask using esophageal lumen pH electrodes. Anesth Analg. 1995 May;80(5):980-4. doi: 10.1097/00000539-199505000-00022. PMID: 7726443. Bercker S, Schmidbauer W, Volk T, Bogusch G, Bubser HP, Hensel M, Kerner T. A comparison of seal in seven supraglottic airway devices using a cadaver model of elevated esophageal pressure. Anesth Analg. 2008 Feb;106(2):445-8, table of contents. doi: 10.1213/ane.0b013e3181602ae1. PMID: 18227299. Brimacombe JR, Berry A. The incidence of aspiration associated with the laryngeal mask airway: a meta-analysis of published literature. J Clin Anesth. 1995 Jun;7(4):297-305. doi: 10.1016/0952-8180(95)00026-e. PMID: 7546756. Xu R, Lian Y, Li WX. Airway Complications during and after General Anesthesia: A Comparison, Systematic Review and Meta-Analysis of Using Flexible Laryngeal Mask Airways and Endotracheal Tubes. PLoS One. 2016 Jul 14;11(7):e0158137. doi: 10.1371/journal.pone.0158137. PMID: 27414807; PMCID: PMC4944923.

Dr. Bryan Glezerson (@BryanGlezerson), a neuroanesthesiologist in Montreal, Canada, joins the show to discuss the literature around BIS monitoring and awareness with recall under general anesthesia. Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode.  Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References American Society of Anesthesiologists Task Force on Intraoperative Awareness. Practice advisory for intraoperative awareness and brain function monitoring: a report by the american society of anesthesiologists task force on intraoperative awareness. Anesthesiology. 2006 Apr;104(4):847-64. doi: 10.1097/00000542-200604000-00031. PMID: 16571982. Avidan MS, Jacobsohn E, Glick D, Burnside BA, Zhang L, Villafranca A, Karl L, Kamal S, Torres B, O'Connor M, Evers AS, Gradwohl S, Lin N, Palanca BJ, Mashour GA; BAG-RECALL Research Group. Prevention of intraoperative awareness in a high-risk surgical population. N Engl J Med. 2011 Aug 18;365(7):591-600. doi: 10.1056/NEJMoa1100403. PMID: 21848460. Avidan MS, Mashour GA. Prevention of intraoperative awareness with explicit recall: making sense of the evidence. Anesthesiology. 2013 Feb;118(2):449-56. doi: 10.1097/ALN.0b013e31827ddd2c. PMID: 23263014. Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008 Mar 13;358(11):1097-108. doi: 10.1056/NEJMoa0707361. PMID: 18337600. HUTCHINSON R. Awareness during surgery. A study of its incidence. Br J Anaesth. 1961 Sep;33:463-9. doi: 10.1093/bja/33.9.463. PMID: 14450247. Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev. 2019;9(9):CD003843. Published 2019 Sep 26. doi:10.1002/14651858.CD003843.pub4 Mashour GA, Shanks A, Tremper KK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology. 2012;117(4):717-725. doi:10.1097/ALN.0b013e31826904a6 Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004 May 29;363(9423):1757-63. doi: 10.1016/S0140-6736(04)16300-9. PMID: 15172773. Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O'Connor K, O'Sullivan EP, Paul RG, Palmer JH, Plaat F, Radcliffe JJ, Sury MR, Torevell HE, Wang M, Cook TM; Royal College of Anaesthetists; Association of Anaesthetists of Great Britain and Ireland. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods, and analysis of data. Br J Anaesth. 2014 Oct;113(4):540-8. doi: 10.1093/bja/aeu312. Epub 2014 Sep 9. PMID: 25204695. Zhang C, Xu L, Ma YQ, Sun YX, Li YH, Zhang L, Feng CS, Luo B, Zhao ZL, Guo JR, Jin YJ, Wu G, Yuan W, Yuan ZG, Yue Y. Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial. Chin Med J (Engl). 2011 Nov;124(22):3664-9. PMID: 22340221.

In this episode, we talk about ketamine and how we have been using it in our department. Our experiences, some anecdotes, some evidence. We are not endorsing that you HAVE to use ketamine, but enlightening you that it can be used and the dogmas regarding it being unsafe are exactly those - DOGMAS. Following are the papers that you may read as references. They will guide you more about ketamine. Hope you enjoy the episode!. Have a Happy New Year! Reading material - 1. Domino EF, Chodoff P, Corssen G. Pharmacologic effects of CI-581, A new dissociative anesthetic, in man. Clin Pharmacol Ther. 1965 May-Jun;6:279-91. doi: 10.1002/cpt196563279. PMID: 14296024. 2. Godwin SA, Burton JH, Gerardo CJ, Hatten BW, Mace SE, Silvers SM, Fesmire FM; American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med. 2014 Feb;63(2):247-58.e18. doi: 10.1016/j.annemergmed.2013.10.015. Erratum in: Ann Emerg Med. 2017 Nov;70(5):758. PMID: 24438649. 3. Kiureghian E, Kowalski JM. Intravenous ketamine to facilitate noninvasive ventilation in a patient with a severe asthma exacerbation. Am J Emerg Med. 2015 Nov;33(11):1720.e1-2. doi: 10.1016/j.ajem.2015.03.066. Epub 2015 Apr 7. PMID: 25895715. 4. Green SM, Roback MG, Kennedy RM, Krauss B. Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med. 2011 May;57(5):449-61. doi: 10.1016/j.annemergmed.2010.11.030. Epub 2011 Jan 21. PMID: 21256625. 5. Godoy DA, Badenes R, Pelosi P, Robba C. Ketamine in acute phase of severe traumatic brain injury "an old drug for new uses?". Crit Care. 2021 Jan 6;25(1):19. doi: 10.1186/s13054-020-03452-x. PMID: 33407737; PMCID: PMC7788834. 6. Cohen L, Athaide V, Wickham ME, Doyle-Waters MM, Rose NG, Hohl CM. The effect of ketamine on intracranial and cerebral perfusion pressure and health outcomes: a systematic review. Ann Emerg Med. 2015 Jan;65(1):43-51.e2. doi: 10.1016/j.annemergmed.2014.06.018. Epub 2014 Jul 23. PMID: 25064742. 7. Verma A, Snehy A, Vishen A, Sheikh WR, Haldar M, Jaiswal S. Ketamine Use allows Noninvasive Ventilation in Distressed Patients with Acute Decompensated Heart Failure. Indian J Crit Care Med. 2019 Apr;23(4):191-192. doi: 10.5005/jp-journals-10071-23153. PMID: 31130793; PMCID: PMC6521817. 8. Shaprio HM, Wyte SR, Harris AB. Ketamine anaesthesia in patients with intracranial pathology. Br J Anaesth. 1972 Nov;44(11):1200-4. doi: 10.1093/bja/44.11.1200. PMID: 4647115. 9. Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed sequence intubation: a prospective observational study. Ann Emerg Med. 2015 Apr;65(4):349-55. doi: 10.1016/j.annemergmed.2014.09.025. Epub 2014 Oct 23. PMID: 25447559.

*The opinions are our own, and do not reflect the opinions of BSCOS, their working groups, committees or members.* Please follow BSCOS on twitter: @BSCOS_UK References Tolk JJ, Eastwood DM, Hashemi-Nejad A. Leg length discrepancy in patients with Perthes' disease: a note of caution for the arthroplasty surgeon. Bone Joint J. 2021 103-B(11): 1736-1741.PMID:34719271 Harris H, Bhutta MF, Rizan C. A survey of UK and Irish surgeons' attitudes, behaviours and barriers to change for environmental sustainability. Ann R Coll Surg Engl. 2021 Nov;103(10):725-729.PMID:34719956. Shi Y, Dykhoff HJ, Guevara LRH, Sangaralingham LR, Schroeder DR, Flick RP, Zaccariello MJ, Warner DO. Moderators of the association between attention-deficit/hyperactivity disorder and exposure to anaesthesia and surgery in children. Br J Anaesth. 2021 Nov;127(5):722-728. . Epub 2021 Sep 6.PMID:4503832. Woolford SJ, Sidell M, Li X, Else V, Young DR, Resnicow K, Koebnick C. Changes in Body Mass Index Among Children and Adolescents During the COVID-19 Pandemic. JAMA. 2021 Oct 12;326(14):1434-1436.PMID:34448817 Clever D, Thompson D, Gosselin M, Brouillet K, Guilak F, Luhmann SJ. Pilot Study Analysis of Serum Cytokines to Differentiate Pediatric Septic Arthritis and Transient Synovitis. J Pediatr Orthop. 2021 Nov-Dec 01;41(10):610-616.PMID:34483309. Baghdadi S, Nguyen JC, Arkader A. Nonossifying Fibroma of the Distal Tibia: Predictors of Fracture and Management Algorithm. J Pediatr Orthop. 2021 Sep 1;41(8):e671-e679.PMID:34138818. Birke O, George JS, Gibbons PJ, Little DG.The modified Dunn procedure can be performed safely in stable slipped capital femoral epiphysis but does not alter avascular necrosis rates in unstable cases: a large single-centre cohort study. J Child Orthop 2021 15(5): 479-87.PMID:34858535 Liyanarachi S, Hulleberg G, Foss OA. Is Gastrocnemius Tightness a Normal Finding in Children?: A Cross-Sectional Study of 204 Norwegian Schoolchildren. J Bone Joint Surg Am. 2021 Oct 20;103(20):1872-1879.PMID:34432740. Pennock AT, Heyworth BE, Bastrom T, Bae DS et al. Changes in superior displacement, angulation and shortening in the early phase of healing for completely displaced midshaft clavicle fractures in adolescents: results from a prospective, multicenter study. J Shoulder Elbow Surg 2021 Dec; 30(12): 2729-2737.PMID:34089880 Tahririan MA, Ramtin S, Taheri P. Functional and radiographic comparison of subtalar arthroereisis and lateral calcaneal lengthening in the surgical treatment of flexible flatfoot in children. Int Orthop 2021 Sep; 45(9): 2291-98.PMID:33796883 Mills H, Flowers MJ, Agrawal Y, Nicolaou N. Outcomes of distally un-threaded screw fixation of slipped capital femoral epiphysis at skeletal maturity: a matched cohort study. J Pediatr Orthop B 2021 Nov; 30(60: 540-548.PMID:32932415 Johnson MA, Gohel S, Mitchell SL, Lynn JJM, Baldwin KD. Entire-spine Magnetic Resonance Imaging findings and costs in children with presumed Adolescent Idiopathic Scoliosis. J Pediatr Orthop 2021 41(10): 585-590.PMID:34411047 Hancock GE, Baxter I, Balachander V, Flowers MJ, Evans OG. What can we learn from COVID-19 protocols with regard to management of nonoperative pediatric orthopaedic injuries? J Pediatr Orthop 2021 41(8): e600-e604.PMID:34138819 Cummins D, Kerr C, McConnell K, Perra O. Risk factors for intellectual disability in children with spastic cerebral palsy. Arch Dis Child 2021 106(10): 975-980.PMID:33727240 E17 Stay Another Day: https://www.youtube.com/watch?v=-wNhdjoF-6M BSCOS Podcast TEAM Host: Anish Sanghrajka, NNUH @AnishPSangh Co-Host: Alpesh Kothari, Oxford Producer: Pranai Buddhdev @Pranai_B

For paramedics, click here for CE credits.  Brought to you by Urgent Admin which is an intuitive one-touch solution that connects in-field clinicians and medical directors in real-time, this episode covers the challenge of the prehospital airway. The But Why team covers unique ways to secure the airway that include  "Ghosting the Airway" and "Romantic Hands."   Hear the But Why EMS Podcast team discuss this situation with:   Dr. Robert Stephens Emergency Medicine Resident at Washington University Click here to check it out today! Thank you for listening! Hawnwan Philip Moy MD  Gina Pellerito EMT-P John Reagan EMT-P Noah Bernhardson MD   References: 1. Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20(1):71-78. 2. Sakles JC, Mosier J, Stolz U. In reply. Acad Emerg Med 2013;20(9):966. 3. Limkakeng A, Broder JS, Theiling BJ. Chicken or egg? Risks of misattribution of cause-effect relationships in studies of association. Acad Emerg Med 2013;20(9):965. 4. Kajino K, Iwami T, Kitamura T, et al. Comparison of supraglottic airway versus endotracheal intubation for the pre-hospital treatment of out-of-hospital cardiac arrest. Crit Care 2011;15(5):R236. 5. Clemency BM, Roginski M, Lindstrom HA, et al. Paramedic intubation: patient position might matter. Prehosp Emerg Care 2014;18(2):239-243. 6. Murphy DL, Rea TD, McCoy AM, et al. Inclined position is associated with improved first pass success and laryngoscopic view in prehospital endotracheal intubations. Am J Emerg Med 2019;37(5):937-941. 7. Turner JS, Ellender TJ, Okonkwo ER, et al. Feasibility of upright patient positioning and intubation success rates At two academic EDs. Am J Emerg Med 2017;35(7):986-992. 8. Levitan RM, Kinkle WC, Levin WJ, et al. Laryngeal view during laryngoscopy: a randomized trial comparing cricoid pressure, backward-upward-rightward pressure, and bimanual laryngoscopy. Ann Emerg Med 2006;47(6):548-555. 9. Snider DD, Clarke D, Finucane BT. The "BURP" maneuver worsens the glottic view when applied in combination with cricoid pressure. Can J Anaesth 2005;52(1):100-104. 10. Tournadre JP, Chassard D, Berrada KR, et al. Cricoid cartilage pressure decreases lower esophageal sphincter tone. Anesthesiology 1997;86(1):7-9. 11. Chassard D, Tournadre JP, Berrada KR, et al. Cricoid pressure decreases lower oesophageal sphincter tone in anaesthetized pigs. Can J Anaesth 1996;43(4):414-417. 12. Garrard A, Campbell AE, Turley A, et al. The effect of mechanically-induced cricoid force on lower oesophageal sphincter pressure in anaesthetised patients. Anaesthesia 2004;59(5):435-439. 13. Heath KJ, Palmer M, Fletcher SJ. Fracture of the cricoid cartilage after Sellick's manoeuvre. Br J Anaesth 1996;76(6):877-878. 14. Notcutt W. Oesophageal rupture and cricoid pressure. Anaesthesia 1991;46(5):424-425. 15. Savino PB, Reichelderfer S, Mercer MP, et al. Direct Versus Video Laryngoscopy for Prehospital Intubation: A Systematic Review and Meta-analysis. Acad Emerg Med 2017;24(8):1018-1026. 16. Messa MJ, Kupas DF, Dunham DL. Comparison of bougie-assisted intubation with traditional endotracheal intubation in a simulated difficult airway. Prehosp Emerg Care 2011;15(1):30-33. 17. Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA 2018;319(21):2179-2189. 18. Driver B, Dodd K, Klein LR, et al. The Bougie and First-Pass Success in the Emergency Department. Ann Emerg Med 2017;70(4):473-478 e471. 19. Latimer AJ, Harrington B, Counts CR, et al. Routine Use of a Bougie Improves First-Attempt Intubation Success in the Out-of-Hospital Setting. Ann Emerg Med 2021;77(3):296-304. 20. Braude D, Richards M. Rapid Sequence Airway (RSA)--a novel approach to prehospital airway management. Prehosp Emerg Care 2007;11(2):250-252. 21. Braude D, Southard A, Bajema T, et al. Rapid sequence airway using the LMA-Supreme as a primary airway for 9 h in a multi-system trauma patient. Resuscitation 2010;81(9):1217. 22. Moss R, Porter K, Greaves I, et al. Pharmacologically assisted laryngeal mask insertion: a consensus statement. Emerg Med J 2013;30(12):1073-1075.  

Dr. Tony Anderson, an anesthesiologist at the Stanford University School of Medicine, joins us to discuss the evolving literature and evidence around perioperative management of buprenorphine. Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode.  Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Anderson TA, Quaye ANA, Ward EN, Wilens TE, Hilliard PE, Brummett CM. To Stop or Not, That Is the Question: Acute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology. 2017 Jun;126(6):1180-1186. doi: 10.1097/ALN.0000000000001633. PMID: 28511196; PMCID: PMC7041233. Goel A, Azargive S, Lamba W, Bordman J, Englesakis M, Srikandarajah S, Ladha K, Di Renna T, Shanthanna H, Duggan S, Peng P, Hanlon J, Clarke H. The perioperative patient on buprenorphine: a systematic review of perioperative management strategies and patient outcomes. Can J Anaesth. 2019 Feb;66(2):201-217. English. doi: 10.1007/s12630-018-1255-3. Epub 2018 Nov 27. PMID: 30484167. Goel A, Azargive S, Weissman JS, Shanthanna H, Hanlon JG, Samman B, Dominicis M, Ladha KS, Lamba W, Duggan S, Di Renna T, Peng P, Wong C, Sinha A, Eipe N, Martell D, Intrater H, MacDougall P, Kwofie K, St-Jean M, Rashiq S, Van Camp K, Flamer D, Satok-Wolman M, Clarke H. Perioperative Pain and Addiction Interdisciplinary Network (PAIN) clinical practice advisory for perioperative management of buprenorphine: results of a modified Delphi process. Br J Anaesth. 2019 Aug;123(2):e333-e342. doi: 10.1016/j.bja.2019.03.044. Epub 2019 May 29. PMID: 31153631; PMCID: PMC6676043. Hansen LE, Stone GE, Matson CA, Tybor DJ, Pevear ME, Smith EL. Total joint arthroplasty in patients taking methadone or buprenorphine/naloxone preoperatively for prior heroin addiction: a prospective matched cohort study. J Arthroplasty 2016; 31: 1698-701. (29) Höflich AS, Langer M, Jagsch R, Bäwert A, Winklbaur B, Fischer G, Unger A. Peripartum pain management in opioid dependent women. Eur J Pain. 2012 Apr;16(4):574-84. doi: 10.1016/j.ejpain.2011.08.008. PMID: 22396085; PMCID: PMC3290684. Li A, Schmiesing C, Aggarwal AK.Evidence for Continuing Buprenorphine in the Perioperative Period. Clin J Pain. 2020 Oct; 36(10): 764-774.doi: 10.1097/AJP.0000000000000858. PMID: 32520814 Macintyre PE, Russel RA, Usher KA, Gaughwin M, Huxtable CA. Pain relief and opioid requirements in the first 24 hours after surgery in patients taking buprenorphine and methadone opioid substitution therapy. Anaesth Intensive Care 2013; 41: 222-30 (27) Meyer M, Paranya G, Keefer Norris A, Howard D. Intrapartum and postpartum analgesia for women maintained on buprenorphine during pregnancy. Eur J Pain. 2010 Oct;14(9):939-43. doi: 10.1016/j.ejpain.2010.03.002. Epub 2010 May 4. PMID: 20444630. Quaye A, Potter K, Roth S, Acampora G, Mao J, Zhang Y. Perioperative Continuation of Buprenorphine at Low-Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation. Pain Med. 2020 Sep 1;21(9):1955-1960. doi: 10.1093/pm/pnaa020. PMID: 32167541.

Welcome to Episode 007 (cue the James Bond music please) of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 7 of “The 2 View” A Wolf in Sheep's Clothing Birnbaumer, Diane MD. A Wolf in Sheep's Clothing: Serious Causes of Common Complaints. Advanced Emergency Medicine Boot Camp. September 2019. Las Vegas. Accessed June 29, 2021. Subarachnoid Hemorrhage Carpenter CR, Hussain AM, Ward MJ, et al. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and Lumbar Puncture with an Exploration of Test Thresholds. Acad Emerg Med. PubMed.gov. Published September 6, 2016. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/27306497/ Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. Published 2012. Accessed June 29, 2021. https://www.ahajournals.org/doi/full/10.1161/str.0b013e3182587839 Headache. Acep.org. Published June 2019. Accessed June 29, 2021. https://www.acep.org/patient-care/clinical-policies/headache/ Hine, J MD, Marcolini, E MD. Aneurysmal Subarachnoid Hemorrhage. EM:RAP CorePendium. Emrap.org. Published September 17, 2020. Accessed June 29, 2021. https://www.emrap.org/corependium/chapter/recTI59VW0TPBpesx/Aneurysmal-Subarachnoid-Hemorrhage Kim YW, Neal D, Hoh BL. Cerebral aneurysms in pregnancy and delivery: pregnancy and delivery do not increase the risk of aneurysm rupture. Neurosurgery. PubMed.gov. Published February 2013. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/23147786/ Marcolini E, Hine J. Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. West J Emerg Med. NCBI. Published February 28, 2019. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404699/ Ogilvy, C MD, Rordorf, G MD, Singer, R MD. Aneurysmal subarachnoid hemorrhage: Clinical manifestations and diagnosis. UpToDate. Uptodate.com. Updated February 25, 2020. Accessed June 29, 2021. https://www.uptodate.com/contents/aneurysmal-subarachnoid-hemorrhage-clinical-manifestations-and-diagnosis?search=subarachnoid%20hemorrhage&source=searchresult&selectedTitle=1~150&usagetype=default&display_rank=1 Ottawa Subarachnoid Hemorrhage (SAH) Rule for Headache Evaluation. Mdcalc.com. Accessed June 29, 2021. https://www.mdcalc.com/ottawa-subarachnoid-hemorrhage-sah-rule-headache-evaluation Subarachnoid Hemorrhage, no LP. EM:RAP. Emrap.org. Published May 2020. Accessed June 29, 2021. https://www.emrap.org/episode/emrap2020may/subarachnoid Gonococcal Arthritis Klausner, J MD, MPH. Disseminated gonococcal infection. UpToDate. Uptodate.com. Updated January 7, 2021. Accessed June 29, 2021. https://www.uptodate.com/contents/disseminated-gonococcal-infection Li R, Hatcher JD. Gonococcal Arthritis. In: StatPearls. StatPearls Publishing. Published July 26, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/books/NBK470439/ Milne, Wm. MD. SGEM#335: Sisters Are Doin' It for Themselves…Self-Obtained Vaginal Swabs for STIs. Thesgem.com. Published June 26, 2021. Accessed June 29, 2021. https://www.thesgem.com/2021/06/sgem335-all-by-myselfself-obtained-vaginal-swabs-for-stis/ Ventura, Y MD, Waseem, M MD, MS. Disseminated Gonococcal Infection: Emergency Department Evaluation and Treatment. Emdocs.net. Published May 17, 2021. Accessed June 29, 2021. http://www.emdocs.net/disseminated-gonococcal-infection-emergency-department-evaluation-and-treatment/ Epiglottitis Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. Published July-September 2012. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498669/ Ames WA, Ward VM, Tranter RM, Street M. Adult epiglottitis: an under-recognized, life-threatening condition. Br J Anaesth. Oxford Academic. Published November 1, 2000. Accessed June 29, 2021. https://academic.oup.com/bja/article/85/5/795/273886 Dowdy RAE, Cornelius BW. Medical Management of Epiglottitis. Anesth Prog. Published July 6, 2020. Accessed June 29, 2021. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342809/ Farkas, J. Epiglottitis. Emcrit.org. Published December 18, 2016. Accessed June 29, 2021. https://emcrit.org/ibcc/epiglottitis/ Mayo-Smith M. Fatal respiratory arrest in adult epiglottitis in the intensive care unit. Implications for airway management. Chest. PubMed.gov. Published September 1993. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/8365325/ Roberts, J MD, Roberts, M ACNP, PNP. Nasal Endoscopy for Urgent and Complex ED Cases. Lww.com. Published October 28, 2020. Accessed June 29, 2021. https://journals.lww.com/em-news/blog/theproceduralpause/pages/post.aspx?PostID=110 Wolf M, Strauss B, Kronenberg J, Leventon G. Conservative management of adult epiglottitis. Laryngoscope. PubMed.gov. Published February 1990. Accessed June 29, 2021. https://pubmed.ncbi.nlm.nih.gov/2299960/ Wellens Syndrome Wellens Syndrom EKG Sign: See full show notes here: https://bit.ly/3eSyzp0 Cadogan M, Buttner R. Wellens Syndrome. Life in the Fastlane. Litfl.com. Published June 4, 2021. Accessed June 29, 2021. https://litfl.com/wellens-syndrome-ecg-library/ Smith S. Wellens' missed. Then returns with Wellens' with dynamic T-wave inversion. Dr. Smith's ECG Blog. Blogspot.com. Published May 4, 2011. Accessed June 29, 2021. http://hqmeded-ecg.blogspot.com/2011/05/wellens-missed-then-returns-with.html?m=1 Wellens Syndrome ECG Recommended Book Resources for the Month Merck. The Merck Manual of Patient Symptoms. (Porter RS, ed.). Merck; 2008. Schaider JJ, Barkin RM, Hayden SR, et al., eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 4th ed. Lippincott Williams and Wilkins; 2010. Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Last month we asked you a trivia question regarding the very first NP program – who was the duo that began the program and what was the first NP specialty program? The correct answer was Dr. Loretta Ford and Dr. Henry Silver. The first NP specialty program was pediatrics. We'll be sending Lindsey Harvey, MSN, FNP-BC to the November Original EM Boot Camp Gratis for providing that answer! We can't wait to see you and all of the other registrants in November in Las Vegas! Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to.

In this episode, Dr. Jonathan Charnin and Dr. Daniel Saddawi-Konefka join us to explore the evidence around perioperative stress dose steroids and adrenal insufficiency. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and consider helping us offset the costs of production by donating through our Patreon at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Axelrod L. Perioperative management of patients treated with glucocorticoids. Endocrinol Metab Clin North Am. 2003 Jun;32(2):367-83. doi: 10.1016/s0889-8529(03)00008-2. PMID: 12800537. Bromberg JS, Baliga P, Cofer JB, et al. Stress steroids are not required for patients receiving a renal allograft and undergoing operation. J Am Coll Surg 1995;180:532–536. Christy NP. Corticosteroid withdrawal. In: Current Therapy in Endocrinology and Metabolism, 3rd Ed, Bardin CW (Ed), BC Decker, New York 1988. P.113. Glowniak JV, Loriaux DL. A double-blind study of perioperative steroid requirements in secondary adrenal insufficiency. Surgery. 1997 Feb;121(2):123-9. doi: 10.1016/s0039-6060(97)90280-4. PMID: 9037222. Kehlet H, Binder C. Adrenocortical function and clinical course during and after surgery in unsupplemented glucocorticoid-treated patients. Br J Anaesth. 1973 Oct;45(10):1043-8. doi: 10.1093/bja/45.10.1043. PMID: 4772640. LEWIS L, ROBINSON RF, YEE J, HACKER LA, EISEN G. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med. 1953 Jul;39(1):116-26. doi: 10.7326/0003-4819-39-1-116. PMID: 13065993. Melanie M. Liu, Andrea B. Reidy, Siavosh Saatee, Charles D. Collard; Perioperative Steroid Management: Approaches Based on Current Evidence. Anesthesiology 2017; 127:166–172 doi: https://doi.org/10.1097/ALN.0000000000001659 Prete A, Yan Q, Al-Tarrah K, Akturk HK, Prokop LJ, Alahdab F, Foster MA, Lord JM, Karavitaki N, Wass JA, Murad MH, Arlt W, Bancos I. The cortisol stress response induced by surgery: A systematic review and meta-analysis. Clin Endocrinol (Oxf). 2018 Nov;89(5):554-567. doi: 10.1111/cen.13820. Epub 2018 Aug 23. PMID: 30047158. Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019 Aug 29;381(9):852-861. doi: 10.1056/NEJMra1807486. PMID: 31461595. Salem M, Tainsh RE Jr, Bromberg J, Loriaux DL, Chernow B. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg. 1994;219(4):416-425. doi:10.1097/00000658-199404000-00013 Thomason JM, Girdler NM, Kendall-Taylor P, Wastell H, Weddel A, Seymour RA. An investigation into the need for supplementary steroids in organ transplant patients undergoing gingival surgery. A double-blind, split-mouth, cross-over study. J Clin Periodontol. 1999 Sep;26(9):577-82. doi: 10.1034/j.1600-051x.1999.260903.x. PMID: 10487307. Woodcock T, Barker P, Daniel S, Fletcher S, Wass JAH, Tomlinson JW, Misra U, Dattani M, Arlt W, Vercueil A. Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency: Guidelines from the Association of Anaesthetists, the Royal College of Physicians and the Society for Endocrinology UK. Anaesthesia. 2020 May;75(5):654-663. doi: 10.1111/anae.14963. Epub 2020 Feb 3. Erratum in: Anaesthesia. 2020 Sep;75(9):1252. PMID: 32017012. Zaghiyan K, Melmed G, Murrell Z, Fleshner P. Are high-dose perioperative steroids necessary in patients undergoing colorectal surgery treated with steroid therapy within the past 12 months? Am Surg. 2011 Oct;77(10):1295-9. PMID: 22127073.

SummarySpace is a hostile environment. Microgravity, radiation, temperature extremes, vacuums, isolation, and forces related to takeoff and landing are just a few of the hazards faced by astronauts and other space voyagers. Humans have been capable of leaving planet earth for just 60 years. Since that time, we have learned a lot about how to keep humans safe and healthy in space. However, our knowledge remains primitive. To become multiplanetary, physicians, scientists, engineers, and other disciplines will need to take space medicine to the next level. This will be the greatest preventative medicine challenge ever undertaken. Morbidity and MortalitySpace can kill you in 1000 different ways. Explosions, lethal radiation doses, and environmental control failures can all result in fatality. Those who spend long amounts of time in space can have long term vision issues, higher rates of cancer, and back problems. Longer space flight missions, and those outside of the earth’s magnetosphere will pose much higher risks to human in space. StoryGetting things into space is getting cheaper. Adjusted for inflation (to year 2000), the price to put 1 kg into low earth orbit was about $85,000 in 1981. In 2019 that number had fallen to $951/kg or 1% of the cost from 40 years prior. Prices continue to get cheaper and space continues to become more accessible. Key Points1. Microgravity has a number of adverse effects including motion sickness, muscle and bone loss, and cardiovascular changes.2. Ionizing radiation is a huge problem is space that we have no idea how to solve3. The psychological and human factor components can never be understated, even when picking the best humans available.4. Humans need to become multiplanetary in order to assure the long-term survival of our species. We also need to bring the rest of life on earth with us. Space medicine is booming as a result of the booming space industry. References-       Green et al. Handbood of Aviation and Space Medicine. 2019-       Hodkinson PD, Anderton RA, Posselt BN, Fong KJ. An overview of space medicine. Br J Anaesth. 2017 -       Wikipedia- Karman Line, Armstrong limit, Space Medicine, Ionizing Radiation, Geocorona, etc.-       https://www.nasa.gov/feature/nasa-station-astronaut-record-holders-       https://www.futuretimeline.net/data-trends/6.htm-       Belavy et al. Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?. Eur Spine J 25, 144–154 (2016)

SummarySpace is a hostile environment. Microgravity, radiation, temperature extremes, vacuums, isolation, and forces related to takeoff and landing are just a few of the hazards faced by astronauts and other space voyagers. Humans have been capable of leaving planet earth for just 60 years. Since that time, we have learned a lot about how to keep humans safe and healthy in space. However, our knowledge remains primitive. To become multi-planetary, physicians, scientists, engineers, and other disciplines will need to take space medicine to the next level. This will be the greatest preventative medicine challenge ever undertaken. Morbidity and MortalitySpace can kill you in 1000 different ways. Explosions, lethal radiation doses, and environmental control failures can all result in fatality. Those who spend long amounts of time in space can have long term vision issues, higher rates of cancer, and back problems. Longer space flight missions, and those outside of the earth’s magnetosphere will pose much higher risks to human in space. StoryGetting things into space is getting cheaper. Adjusted for inflation (to year 2000), the price to put 1 kg into low earth orbit was about $85,000 in 1981. In 2019 that number had fallen to $951/kg or 1% of the cost from 40 years prior. Prices continue to get cheaper and space continues to become more accessible. Key Points1. Microgravity has a number of adverse effects including motion sickness, muscle and bone loss, and cardiovascular changes.2. Ionizing radiation is a huge problem is space that we have no idea how to solve3. The psychological and human factor components can never be understated, even when picking the best humans available.4. Humans need to become multiplanetary in order to assure the long-term survival of our species. We also need to bring the rest of life on earth with us. Space medicine is booming as a result of the booming space industry. References-       Green et al. Handbood of Aviation and Space Medicine. 2019-       Hodkinson PD, Anderton RA, Posselt BN, Fong KJ. An overview of space medicine. Br J Anaesth. 2017 -       Wikipedia- Karman Line, Armstrong limit, Space Medicine, Ionizing Radiation, Geocorona, etc.-       https://www.nasa.gov/feature/nasa-station-astronaut-record-holders-       https://www.futuretimeline.net/data-trends/6.htm-       Belavy et al. Disc herniations in astronauts: What causes them, and what does it tell us about herniation on earth?. Eur Spine J 25, 144–154 (2016)

In this episode, we explore the evidence on whether smaller endotracheal tubes are... 1. Less likely to maintain a secure patent airway 2. Less reliable in facilitating positive pressure ventilation 3. Less able to seal the trachea and protect the lungs from aspiration We also discuss the potential harms associated with larger endotracheal tubes.  Our guests are Dr. Shamir Karmali and Dr. Peter Rose from the Department of Anesthesiology at Vancouver General Hospital. Thanks for listening! If you enjoy our content, consider supporting our mission at https://bit.ly/3n0sklh. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia. Email us at depthofanesthesia@gmail.com. Music by Stephen Campbell, MD. — References Coordes A, Rademacher G, Knopke S, Todt I, Ernst A, Estel B, Seidl RO. Selection and placement of oral ventilation tubes based on tracheal morphometry. Laryngoscope. 2011 Jun;121(6):1225-30. doi: 10.1002/lary.21752. Epub 2011 May 6. PMID: 21557233. Dominelli PB, Ripoll JG, Cross TJ, Baker SE, Wiggins CC, Welch BT, Joyner MJ. Sex differences in large conducting airway anatomy. J Appl Physiol (1985). 2018 Sep 1;125(3):960-965. doi: 10.1152/japplphysiol.00440.2018. Epub 2018 Jul 19. PMID: 30024341; PMCID: PMC6335094. El-Boghdadly K, Bailey CR, Wiles MD. Postoperative sore throat: a systematic review. Anaesthesia. 2016 Jun;71(6):706-17. doi: 10.1111/anae.13438. Epub 2016 Mar 28. PMID: 27158989. Ellis SF, Pollak AC, Hanson DG, Jiang JJ. Videolaryngoscopic evaluation of laryngeal intubation injury: incidence and predictive factors. Otolaryngol Head Neck Surg. 1996 Jun;114(6):729-31. doi: 10.1016/s0194-5998(96)70093-1. PMID: 8643294. Fiastro JF, Habib MP, Quan SF. Pressure support compensation for inspiratory work due to endotracheal tubes and demand continuous positive airway pressure. Chest. 1988 Mar;93(3):499-505. doi: 10.1378/chest.93.3.499. PMID: 3277803. Futagawa K, Takasugi Y, Kobayashi T, Morishita S, Okuda T. Role of tube size and intranasal compression of the nasotracheal tube in respiratory pressure loss during nasotracheal intubation: a laboratory study. BMC Anesthesiol. 2017 Oct 17;17(1):141. doi: 10.1186/s12871-017-0432-1. PMID: 29041911; PMCID: PMC5645985. Hu B, Bao R, Wang X, Liu S, Tao T, Xie Q, Yu X, Li J, Bo L, Deng X. The size of endotracheal tube and sore throat after surgery: a systematic review and meta-analysis. PLoS One. 2013 Oct 4;8(10):e74467. doi: 10.1371/journal.pone.0074467. PMID: 24124452; PMCID: PMC3790787. Hwang JY, Park SH, Han SH, Park SJ, Park SK, Kim JH. The effect of tracheal tube size on air leak around the cuffs. Korean J Anesthesiol. 2011 Jul;61(1):24-9. doi: 10.4097/kjae.2011.61.1.24. Epub 2011 Jul 21. PMID: 21860747; PMCID: PMC3155132. Karmali S, Rose P. Tracheal tube size in adults undergoing elective surgery - a narrative review. Anaesthesia. 2020 Nov;75(11):1529-1539. doi: 10.1111/anae.15041. Epub 2020 May 16. PMID: 32415788. Koh KF, Hare JD, Calder I. Small tubes revisited. Anaesthesia. 1998 Jan;53(1):46-50. doi: 10.1111/j.1365-2044.1998.00290.x. PMID: 9505742. Pavlin EG, VanNimwegan D, Hornbein TF. Failure of a high-compliance low-pressure cuff to prevent aspiration. Anesthesiology. 1975 Feb;42(2):216-9. doi: 10.1097/00000542-197502000-00019. PMID: 1115375. Randestad A, Lindholm CE, Fabian P. Dimensions of the cricoid cartilage and the trachea. Laryngoscope. 2000 Nov;110(11):1957-61. doi: 10.1097/00005537-200011000-00036. PMID: 11081618. Shah C, Kollef MH. Endotracheal tube intraluminal volume loss among mechanically ventilated patients. Crit Care Med. 2004 Jan;32(1):120-5. doi: 10.1097/01.CCM.0000104205.96219.D6. PMID: 14707569. Stenqvist O, Sonander H, Nilsson K. Small endotracheal tubes: ventilator and intratracheal pressures during controlled ventilation. Br J Anaesth. 1979 Apr;51(4):375-81. doi: 10.1093/bja/51.4.375. PMID: 465261. Tanaka A, Isono S, Ishikawa T, Sato J, Nishino T. Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway. Anesthesiology. 2003 Aug;99(2):252-8. doi: 10.1097/00000542-200308000-00005. PMID: 12883396. Tonnesen AS, Vereen L, Arens JF. Endotracheal tube cuff residual volume and lateral wall pressure in a model trachea. Anesthesiology. 1981 Dec;55(6):680-3. doi: 10.1097/00000542-198155060-00013. PMID: 7305056. Walker EMK, Bell M, Cook TM, Grocott MPW, Moonesinghe SR; Central SNAP-1 Organisation; National Study Groups. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth. 2016 Jun 12;117(6):758-766. doi: 10.1093/bja/aew381. Erratum in: Br J Anaesth. 2017 Sep 1;119(3):552. PMID: 27956674. Wilson AM, Gray DM, Thomas JG. Increases in endotracheal tube resistance are unpredictable relative to duration of intubation. Chest. 2009 Oct;136(4):1006-1013. doi: 10.1378/chest.08-1938. Epub 2009 May 1. PMID: 19411293. Young PJ, Rollinson M, Downward G, Henderson S. Leakage of fluid past the tracheal tube cuff in a benchtop model. Br J Anaesth. 1997 May;78(5):557-62. doi: 10.1093/bja/78.5.557. PMID: 9175972. __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital.

In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss how pain medicine has been affected by COVID-19. This pandemic has caused so much devastation for our patients, including some who directly experienced COVID-19 infection and those who have had to weigh seeking medical care against risking infection. It has also impacted our practice as we work to create a safe environment for patients and accommodate their needs. More and more research is emerging on a persistent syndrome following acute COVID-19 infection. Although we don't understand its entire clinical picture, it appears most patients with post-COVID-19 syndrome (over 50%) have significant fatigue, and a significant percentage of patients (about 20%) have persistent pain. We can anticipate this syndrome presenting a growing challenge to the broader medical community, given both the vast number of COVID-19 patients worldwide and the historical difficulty of treating similar post-viral syndromes. Multiple risk factors associated with acute COVID-19 infection could increase the chance of developing a post-infectious syndrome. For instance, the virus enters cells through the ACE-2 receptor which is present throughout the body, making it possible to spread beyond the respiratory system to the vasculature, neural, and muscle tissues. At the individual and community level, many patients are experiencing isolation, barriers to health care, and worsening of mental health conditions which can exacerbate symptoms such as chronic pain. Listen as the doctors discuss the evidence behind the emerging entity of post-COVID-19 syndrome, as well as the challenges and necessity of delivering multi-disciplinary treatment in this COVID-19 era. As always, we greatly appreciate the effort of all involved in the management of this challenging pandemic, and our thoughts and prayers are with all who have been affected. This podcast is for information and educational purposes only, it is not meant to be medical or career advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, the may not represent the views of Spine & Nerve. References: 1. Kemp HI, Corner E, Colvin LA. Chronic pain after COVID-19: implications for rehabilitation. Br J Anaesth. 2020;125(4):436-440. 2. Characteristics, Symptom Management, and Outcomes of 101 Patients With COVID-19 Referred for Hospital Palliative Care. Journal of Pain and Symptom Management. 2020. 3. Persistent Symptoms in Patients After Acute COVID-19. JAMA. August 2020.

3 ปีที่แล้วพี่ปุ๋มเป็นคนหนึ่งที่เชื่อสุดใจกับ Carbohydrate-Insulin Obesity Model (CIM) ที่กล่าวว่า “สาเหตุหลักของความอ้วนเกิดจาก ความสามารถของคาร์โบไฮเดรตที่กระตุ้นการหลั่งอินซูลินเพิ่ม ซึ่งทำให้เพิ่มการสะสมกลูโคสไปเป็นไขมันในเนื้อเยื่อไขมัน และทำให้มีกลูโคสและกรดไขมันไหลเวียนในกระแสเลือดน้อยลง ทำให้เราขาดแคลนวัตถุดิบในการสร้างพลังงาน เราจึงหิวบ่อย”

In this episode, we discuss the mechanisms of burning with propofol infusion and explore the evidence behind strategies like mixing lidocaine with propofol.  Our guest today is Dr. Stu Forman, Professor of Anesthesiology at Massachusetts General Hospital. He is an investigator on several NIH-sponsored basic research grants and co-director of the Harvard Anesthesia Research Training Fellowship. Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Bengalorkar GM, Bhuvana K, Sarala N, Kumar T. Fospropofol: clinical pharmacology. J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):79-83. PMID: 21804712; PMCID: PMC3146164. Dajun Song, Mohamed A. Hamza, Paul F. White, Stephanie I. Byerly, Stephanie B. Jones, Amy D. Macaluso; Comparison of a Lower-lipid Propofol Emulsion with the Standard Emulsion for Sedation during Monitored Anesthesia Care. Anesthesiology 2004; 100:1072–1075 doi: https://doi.org/10.1097/00000542-200405000-00007 Euasobhon P, Dej-Arkom S, Siriussawakul A, Muangman S, Sriraj W, Pattanittum P, Lumbiganon P. Lidocaine for reducing propofol-induced pain on induction of anaesthesia in adults. Cochrane Database Syst Rev. 2016 Feb 18;2(2):CD007874. doi: 10.1002/14651858.CD007874.pub2. PMID: 26888026; PMCID: PMC6463799. Fischer MJ, Leffler A, Niedermirtl F, Kistner K, Eberhardt M, Reeh PW, Nau C. The general anesthetic propofol excites nociceptors by activating TRPV1 and TRPA1 rather than GABAA receptors. J Biol Chem. 2010 Nov 5;285(45):34781-92. doi: 10.1074/jbc.M110.143958. Epub 2010 Sep 7. PMID: 20826794; PMCID: PMC2966094. Jalota L, Kalira V, George E, Shi YY, Hornuss C, Radke O, Pace NL, Apfel CC; Perioperative Clinical Research Core. Prevention of pain on injection of propofol: systematic review and meta-analysis. BMJ. 2011 Mar 15;342:d1110. doi: 10.1136/bmj.d1110. PMID: 21406529. Klement W, Arndt JO. Pain on i.v. injection of some anaesthetic agents is evoked by the unphysiological osmolality or pH of their formulations. Br J Anaesth. 1991 Feb;66(2):189-95. doi: 10.1093/bja/66.2.189. PMID: 1817619. Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clin Pharmacokinet. 2018;57(12):1539-1558. doi:10.1007/s40262-018-0672-3 Scott RP, Saunders DA, Norman J. Propofol: clinical strategies for preventing the pain of injection. Anaesthesia. 1988 Jun;43(6):492-4. doi: 10.1111/j.1365-2044.1988.tb06641.x. PMID: 3261547.

Our guest today is Dr. Daniel Saddawi-Konefka, residency program director at Mass General. In this part II or II series on neuromuscular blockade, we investigate the claim that a train-of-four target of 90% is important to achieve prior to extubation. Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Naguib M, Kopman AF, Lien CA, Hunter JM, Lopez A, Brull SJ. A survey of current management of neuromuscular block in the United States and Europe. Anesth Analg. 2010;111(1):110-119. doi:10.1213/ANE.0b013e3181c07428 Ali HH, Kitz RJ. Evaluation of recovery from nondepolarizing neuromuscular block, using a digital neuromuscular transmission analyzer: preliminary report. Anesth Analg. 1973;52(5):740-745. Ali HH, Wilson RS, Savarese JJ, Kitz RJ. The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans. Br J Anaesth. 1975;47(5):570-574. doi:10.1093/bja/47.5.570 Sundman E, Witt H, Olsson R, Ekberg O, Kuylenstierna R, Eriksson LI. The incidence and mechanisms of pharyngeal and upper esophageal dysfunction in partially paralyzed humans: pharyngeal videoradiography and simultaneous manometry after atracurium. Anesthesiology. 2000;92(4):977-984. doi:10.1097/00000542-200004000-00014 Eikermann M, Groeben H, Hüsing J, Peters J. Accelerometry of adductor pollicis muscle predicts recovery of respiratory function from neuromuscular blockade. Anesthesiology. 2003;98(6):1333-1337. doi:10.1097/00000542-200306000-00006 Gopalaiah Venkatesh Kumar, Anita Pramod Nair, Hanuman Srinivasa Murthy, Koppa Ramegowda Jalaja, Karnate Ramachandra, Gundappa Parameshwara; Residual Neuromuscular Blockade Affects Postoperative Pulmonary Function. Anesthesiology 2012; 117:1234–1244 doi: https://doi.org/10.1097/ALN.0b013e3182715b80 Eriksson LI, Lennmarken C, Wyon N, Johnson A. Attenuated ventilatory response to hypoxaemia at vecuronium-induced partial neuromuscular block. Acta Anaesthesiol Scand. 1992;36(7):710-715. doi:10.1111/j.1399-6576.1992.tb03550.x Suzanne J. L. Broens, Martijn Boon, Chris H. Martini, Marieke Niesters, Monique van Velzen, Leon P. H. J. Aarts, Albert Dahan; Reversal of Partial Neuromuscular Block and the Ventilatory Response to Hypoxia: A Randomized Controlled Trial in Healthy Volunteers. Anesthesiology 2019; 131:467–476 doi: https://doi.org/10.1097/ALN.0000000000002711 Kopman AF, Yee PS, Neuman GG. Relationship of the train-of-four fade ratio to clinical signs and symptoms of residual paralysis in awake volunteers. Anesthesiology. 1997;86(4):765-771. doi:10.1097/00000542-199704000-00005 Glenn S. Murphy, Joseph W. Szokol, Jesse H. Marymont, Steven B. Greenberg, Michael J. Avram, Jeffery S. Vender, Margarita Nisman; Intraoperative Acceleromyographic Monitoring Reduces the Risk of Residual Meeting Abstracts and Adverse Respiratory Events in the Postanesthesia Care Unit. Anesthesiology 2008; 109:389–398 doi: https://doi.org/10.1097/ALN.0b013e318182af3b Butterly A, Bittner EA, George E, et al. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. BJA: British Journal of Anaesthesia. 2010 Sep;105(3):304-309. DOI: 10.1093/bja/aeq157. Section Editor(s): Brull, Sorin J.Murphy, Glenn S. MD; Szokol, Joseph W. MD; Marymont, Jesse H. MD; Greenberg, Steven B. MD; Avram, Michael J. PhD; Vender, Jeffery S. MD Residual Neuromuscular Blockade and Critical Respiratory Events in the Postanesthesia Care Unit, Anesthesia & Analgesia: July 2008 - Volume 107 - Issue 1 - p 130-137 doi: 10.1213/ane.0b013e31816d1268 Kirmeier E, Eriksson LI, Lewald H, et al. Post-anaesthesia pulmonary complications after use of muscle relaxants (POPULAR): a multicentre, prospective observational study [published correction appears in Lancet Respir Med. 2018 Nov 6;:]. Lancet Respir Med. 2019;7(2):129-140. doi:10.1016/S2213-2600(18)30294-7

This is part 2 of a 2 part discussion with Dr. Andrew Herring on the use of Buprenorphine after an opiate overdose, primarily in the ED. Guest: Andrew Herring MD. Associate Director of Research, Highland Hospital, Alameda Health System Medical Director, Substance Use Disorder Treatment Program Assistant Clinical Professor, University of California San Francisco Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.com/equal References: 1. Weiner, Scott, et al. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019. doi.org/10.1016/j.annemergmed.2019.04.020 2. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569-580. doi.org/10.1038/clpt.1994.71 3. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627-632. doi.org/10.1093/bja/ael051 4. Ciraulo DA, Hitzemann RJ, Somoza E, et al. Pharmacokinetics and pharmacodynamics of multiple sublingual buprenorphine tablets in dose-escalation trials. J Clin Pharmacol. 2006;46(2):179-192. doi.org/10.1177/0091270005284192 5. Ang-Lee K, Oreskovich MR, Saxon AJ, et al. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006;38(4):505-512. doi.org/10.1080/02791072.2006.10400589 6. Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321(2):544-552. doi.org/10.1124/jpet.106.118810 7. Boysen K, Hertel S, Chraemmer-Jørgensen B, Risbo A, Poulsen NJ. Buprenorphine antagonism of ventilatory depression following fentanyl anaesthesia. Acta Anaesthesiol Scand. 1988;32(6):490-492. doi.org/10.1111/j.1399-6576.1988.tb02772.x 8. Zamani N, Buckley NA, Hassanian-Moghaddam H. Buprenorphine to reverse respiratory depression from methadone overdose in opioid-dependent patients: a prospective randomized trial. Crit Care. 2020;24(1):44. Published 2020 Feb 7. doi.org/10.1186/s13054-020-2740-y 9. Phillips RH, Salzman M, Haroz R, Rafeq R, Mazzarelli AJ, Pelletier-Bui A. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. Ann Emerg Med. 2019;74(3):430-432. doi.org/10.1016/j.annemergmed.2019.01.006 10. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1-2):154-159. doi.org/10.1016/j.drugalcdep.2009.07.001 11. Carroll GG, Wasserman DD, Shah AA, et al. Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series [published online ahead of print, 2020 May 4]. Prehosp Emerg Care. 2020;1-5. 10.1080/10903127.2020.1747579

This is part 1 of a 2 part discussion with Dr. Andrew Herring on the use of Buprenorphine after an opiate overdose, primarily in the ED. Guest: Andrew Herring MD. Associate Director of Research, Highland Hospital, Alameda Health System Medical Director, Substance Use Disorder Treatment Program Assistant Clinical Professor, University of California San Francisco Host: Jason Woods, MD Audio Editor: Kellen Vu www.acep.com/equal References: 1. Weiner, Scott, et al. One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose. Annals of Emergency Medicine. April 2, 2019. https://doi.org/10.1016/j.annemergmed.2019.04.020 2. Walsh SL, Preston KL, Stitzer ML, Cone EJ, Bigelow GE. Clinical pharmacology of buprenorphine: ceiling effects at high doses. Clin Pharmacol Ther. 1994;55(5):569-580. https://doi.org/10.1038/clpt.1994.71 3. Dahan A, Yassen A, Romberg R, et al. Buprenorphine induces ceiling in respiratory depression but not in analgesia. Br J Anaesth. 2006;96(5):627-632. https://doi.org/10.1093/bja/ael051 4. Ciraulo DA, Hitzemann RJ, Somoza E, et al. Pharmacokinetics and pharmacodynamics of multiple sublingual buprenorphine tablets in dose-escalation trials. J Clin Pharmacol. 2006;46(2):179-192. https://doi.org/10.1177/0091270005284192 5. Ang-Lee K, Oreskovich MR, Saxon AJ, et al. Single dose of 24 milligrams of buprenorphine for heroin detoxification: an open-label study of five inpatients. J Psychoactive Drugs. 2006;38(4):505-512. https://doi.org/10.1080/02791072.2006.10400589 6. Wang D, Sun X, Sadee W. Different effects of opioid antagonists on mu-, delta-, and kappa-opioid receptors with and without agonist pretreatment. J Pharmacol Exp Ther. 2007;321(2):544-552. https://doi.org/10.1124/jpet.106.118810 7. Boysen K, Hertel S, Chraemmer-Jørgensen B, Risbo A, Poulsen NJ. Buprenorphine antagonism of ventilatory depression following fentanyl anaesthesia. Acta Anaesthesiol Scand. 1988;32(6):490-492. https://doi.org/10.1111/j.1399-6576.1988.tb02772.x 8. Zamani N, Buckley NA, Hassanian-Moghaddam H. Buprenorphine to reverse respiratory depression from methadone overdose in opioid-dependent patients: a prospective randomized trial. Crit Care. 2020;24(1):44. Published 2020 Feb 7. https://doi.org/10.1186/s13054-020-2740-y 9. Phillips RH, Salzman M, Haroz R, Rafeq R, Mazzarelli AJ, Pelletier-Bui A. Elective Naloxone-Induced Opioid Withdrawal for Rapid Initiation of Medication-Assisted Treatment of Opioid Use Disorder. Ann Emerg Med. 2019;74(3):430-432. https://doi.org/10.1016/j.annemergmed.2019.01.006 10. Tompkins DA, Bigelow GE, Harrison JA, Johnson RE, Fudala PJ, Strain EC. Concurrent validation of the Clinical Opiate Withdrawal Scale (COWS) and single-item indices against the Clinical Institute Narcotic Assessment (CINA) opioid withdrawal instrument. Drug Alcohol Depend. 2009;105(1-2):154-159. https://doi.org/10.1016/j.drugalcdep.2009.07.001 11. Carroll GG, Wasserman DD, Shah AA, et al. Buprenorphine Field Initiation of ReScue Treatment by Emergency Medical Services (Bupe FIRST EMS): A Case Series [published online ahead of print, 2020 May 4]. Prehosp Emerg Care. 2020;1-5. 10.1080/10903127.2020.1747579

Bom dia, boa tarde, boa noite! Esse é mais um podcast do Medicina do Conhecimento. Ciência e informação a qualquer momento, em todo lugar. Eu sou Pablo Gusman, o Anestesiador. E como compartilhar é multiplicar segue uma pílula, dica rápida para aumentar seu conhecimento. Antes eu gostaria de avisar que você usuário de smartphones androides pode baixar o app Medicina do Conhecimento na sua loja Google Play para ouvir a nossa rádio web e interagir conosco no seu momento. Basta procurar por medicinadoconhecimento. Digite todas as palavras juntas! Vamos lá aumentando nosso mundo do conhecimento. A clonidina tem sido usada como droga adjuvante de anestésicos locais em várias técnicas regionais para prolongar a duração dos bloqueios moter e sensitivo. Uma revisão sistemática de Elia e colaboradores no jornal Regional Anesthesia Pain Medicine mostrou que a duração do bloqueio motor e sensitivo foi prolongada por 47 minutos em média quando a clonidina foi adicionada a anestésicos locais intratecais. Contudo, o estudo não divulgou uma dose ideal e incluiu uma faixa de dosagem ampla de 15 a 150 μg. Na publicação de Rhee no Acta Anaesthesiologica Scandinavica, uma dose de 3 μg/kg de clonidina endovenosa administrada imediatamente após o bloqueio espinhal mostrou o prolongamento do bloqueio por aproximadamente 60 minutos sem efeitos colaterais adversos perceptíveis. Além disso, deve-se notar que, embora conheçamos o mecanismo de ação da clonidina na técnica neuroaxial, não há um mecanismo de ação estabelecido da clonidina no bloqueio de nervo periférico. Um ensaio clínico randomizado duplo-cego de Duma no British Journal of Anaesthesia investigou os efeitos da clonidina no prolongamento da duração do bloqueio do plexo braquial e axilar e mostrou que não houve diferença na duração do bloqueio com ou sem clonidina. Baixe os arquivos no nosso canal do Telegram Medicina do Conhecimento! O link é t.me/medconhecimento ou abra seu telegram e busque por Medicina do Conhecimento. A qualquer momento e em todo lugar, escute a rádioweb no www.medicinaconhecimento.com.br Escolha sua plataforma e ouça mais podcasts. Siga pelo Spotify, Deezer, Itunes, Google Podcasts, Soundcloud, Youtube e mais uma dezena de agregadores de podcast. Na medicina do conhecimento, você escolhe o player da sua preferência. É muito importante seu feedback. Compartilhe nas suas redes e deixe seu like. Isso aumenta a divulgação do projeto. Além disso, você pode entrar em contato conosco e sugerir o próximo tema! Fique ligado nas redes sociais Twitter, Facebook e Instagram Medicina do Conhecimento, afinal compartilhar é multiplicar! Murphy DB, McCartney CJ, Chan VW. Novel analgesic adjuncts for brachial plexus block: a systematic review. Anesthes Analg. 2000;90(5):1122-1128. Elia N, Culebras X, Mazza C, Schiffer E, Tramer MR. Clonidine as an adjuvant to intrathecal local anesthetics for surgery: systematic review of randomized trials. Reg Anesth Pain Med. 2008;33(2):159-167. Rhee K, Kang K, Kim J, Jeon Y. Intravenous clonidine prolongs bupivacaine spinal anesthesia. Acta Anaesthesiol Scand. 2003;47(8):1001-1005. Duma A, Urbanek B, Sitzwohl C, Kreiger A, Zimpfer M, Kapral S. Clonidine as an adjuvant to local anesthetic axillary brachial plexus block: a randomized, controlled study. Br J Anaesth. 2005;94(1):112-116.

Kontakt: ivajuntan@gmail.com       Musik: Blind Love Dub by Jeris (c) copyright 2017 Licensed under a Creative Commons Attribution (3.0) license. http://dig.ccmixter.org/files/VJ_Memes/55416 Ft: Kara Square (mindmapthat)       Om du gillar du det vi gör - stöd Life Support Foundation! www.lifesupportfoundation.org     Bli månadsgivare eller använd Swish: 1234610804        Dagens artikel: Outbreak of a new coronavirus: what anaesthetists should know. Peng PWH, et al. Br J Anaesth. 2020.

References:Adriana Sarah Nica, Adela Caramoci, Mirela Vasilescu, Anca Mirela Ionescu, Denis Paduraru, Virgil Mazilu.  Magnesium supplementation in top athletes - effects and recommendations. Medicina Sportiva (2015), vol. XI, no 1, 2482-2494 Journal of the Romanian Sports Medicine SocietyAikawa JW. Magnesium: its biological significance. Boca Raton, FL: CRC Press, 1981:21–38.Abbasi B, Kimiagar M, Sadeghnijat K, Shirazi MM, Hedayati M, Rashidkhani B. “The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial.”  J Res Med Sci. 2012 Dec 17 (12): 1161-9.PubMed PMID: 23853635. Arnaud MJ: Update on the assessment of magnesium status. Br J Nutr 2008;99(suppl 3):S24–S36 Brilla LR, Haley TF. Effect of magnesium supplementation on strength training in humans. J Am Coll Nutr 1992;11:326​​​​​​​Chandrasekaran NC, Weir C, Alfraji S, Grice J, Roberts MS, Barnard RT. Effects of magnesium deficiency--more than skin deep. Exp Biol Med (Maywood). 2014 Oct;239(10):1280-91. doi: 10.1177/1535370214537745. Epub 2014 Jun 13.Ebel H, Gunther T. Magnesium metabolism: a review. J Clin Chem Biochem 1980;18:257–70.Emelyanov A, Fedoseev G, Barnes PJ: Re- duced intracellular magnesium concentra- tions in asthmatic patients. Eur Respir J 1999;13:38–40.Fawcett WJ, Haxby EJ, Male DA: Magnesium: physiology and pharmacology. Br J Anaesth 1999;83:302–320.Institute of Medicine, Food and Nutrition Board. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy Press, 1997.Guerrero-Romero F, Rodríguez-Morán M. Relationship between serum magnesium levels and C-reactive protein concentration, in non-diabetic, non-hypertensive obese subjects. Int J Obes Relat Metab Disord. 2002;26:469–74.Hosty´nek JJ, Hinz RS, Lorence CR, Price M, Guy RH. Metals and the skin. Crit Rev Toxicol 1993;23:171–235Jahnen-Dechent W, Ketteler M. Magnesium basics. Clin Kidney J 2012;5:i3–i14Kupetsky-Rincon EA1, Uitto J. Magnesium: novel applications in cardiovascular disease--a review of the literature. Ann Nutr Metb. 2012;61(2):102-10.Lansdown AB. Physiological and toxicological changes in the skin resulting from the action and interaction of metal ions. Crit Rev Toxicol1995;25:397–462.Mochizuki M, Akagi K, Inoue K, Shimamura K.[A single dose toxicity study of magnesium sulfate in rats and dogs]. J Toxicol Sci. 1998 May;23 Suppl 1:31-5Navarrete-Cortes A, Ble-Castillo JL, Guerrero-Romero F, Cordova-Uscanga R, Juárez-Rojop IE, Aguilar-Mariscal H, Tovilla-Zarate CA, Lopez-Guevara Mdel R. No effect of magnesium supplementation on metabolic control and insulin sensitivity in type 2 diabetic patients with normomagnesemia. Magnes Res. 2014 Apr-Jun;27(2):48-56. doi: 10.1684/mrh.2014.0361.Nedeltcheva AV, Kilkus JM, Imperial J, Schoeller DA, Peney PD. “Insufficient sleep undermines dietary efforts to reduce adiposity.”  ANN Intern Med. 2010 Oct 5:153(7):435-41. PubMed PMID: 20921542.Nowacki W, Daveau M, Malpuech-Bruge C. Inflammatory responsefollowing acute magnesium deficiency in the rat. Biochim Biophys Acta 2000;1501:91–8Nielsen FH, Johnson LK, Zeng H.  Magnesium supplementation improves indicators of low magnesium status and inflammatory stress in adults older than 51 years with poor quality sleep.  Magnes Res. 2010 Dec;23(4):158-68. doi: 10.1684/mrh.2010.0220. Epub 2011 Jan 4.Malon A, Brockmann C, Fijalkowska- Morawska J, Rob P, Maj-Zurawska M: Ionized magnesium in erythrocytes – the best magnesium parameter to observe hypo- or hypermagnesemia. Clin Chim Acta 2004; 349:67–73.Martin K, Jackson CF, Levy RG, Cooper PN. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2016 Feb 9;2:CD001903. doi: 10.1002/14651858.CD001903.pub3.Meolie AL, Rosen C, Kristo D, Kohrman M, Gooneratne N, Aguillard RN, Fayle R, Troell R, Townsend D, Claman D, Hoban T, Mahowald M. Oral nonprescription treatment for insomnia: an evaluation of products with limited evidence; Clinical Practice Review Committee; American Academy of Sleep Medicine.J Clin Sleep Med. 2005 Apr 15;1(2):173-87.Rodríguez-Morán M, Guerrero-Romero F. Serum magnesium and C-reactive protein levels. Arch Dis Child. 2008;93:676–80University of Maryland Medical Center “Magnesium” access May 8. 2016 http://umm.edu/ health/medical/altmed/supplement/magnesiumShils ME. Magnesium. In: Shils ME, Olson JA, Shike M, eds. Modern nutrition in health and disease. 8th ed. Philadelphia: Lea & Febiger, 1993:164–84.Simsek E, Karabay M, Kocabay K: Assess- ment of magnesium status in newly diag- nosed diabetic children: measurement of erythrocyte magnesium level and magne- sium tolerance testing. Turk J Pediatr 2005; 47:132–137.Waring, RH  Report on Absorption of magnesium sulfate (Epsom salts) across the skin.  School of Biosciences, University of Birmingham. B15 2TT, U.K. r.h.waring@bham.ac.uk   URL http://www.epsomsaltcouncil.org/wpcontent/uploads/2015/10/report_on_absorption_of_magnesium_sulfate.pdfWinkelmann RK. The relationship of the structure of the epidermis to percutaneous absorption. Br J Dermatol 1969;81:11–22Witkowski M, Hubert J, Mazur A. Methods of assessment of magnesium status in humans: a systematic review. Magnes Res. 2011 Dec;24(4):163-80. doi: 10.1684/mrh.2011.0292.

Raj Gupta (@dr_rajgupta) and Eric Schwenk (@eschwenkmd) talk with our guests about the need for, implementation of, and results of creating a Transitional Pain Service to help patients with persistent post surgical pain. This episode is sponsored by the ASRA Persistent Perioperative Pain Special Interest Group! Recorded 07/21/2019.Guests:- Hesham El-Sharkawy (@kaohesham)- Padma Gulur (@doctorgulur)Articles:Richebe P, Capdevila X, Rivat C: Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology 2018; 129:590–607McGreevy K, Bottros MM, Raja SN: Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and their Efficacy. Eur J Pain Suppl 2011; 5:365–72Katz J: The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res 2015; 8:695–702Macrae WA: Chronic post-surgical pain: 10 years on. Br J Anaesth 2008; 101:77–86_______Thanks to The Preps from Philadelphia, PA for the music: “Hindsight" and “Left Behind". The band features Steve Breslin on vocals/guitars, Bryan Schwenk on guitars/vocals, Jeff Frederick on bass, and Eric Schwenk on drums.

We investigate the claim that mask ventilation should be "checked" or "confirmed" before administering paralytics.  My guest is Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital.  Full show notes available at depthofanesthesia.com.  Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Chingmuh Lee, Jonathan S. Jahr, Keith A. Candiotti, Brian Warriner, Mark H. Zornow, Mohamed Naguib; Reversal of Profound Neuromuscular Block by Sugammadex Administered Three Minutes after Rocuronium: A Comparison with Spontaneous Recovery from Succinylcholine. Anesthesiology 2009;110(5):1020-1025. doi: 10.1097/ALN.0b013e31819dabb0. Drummond GB, Park GR. Arterial oxygen saturation before intubation of the trachea. An assessment of oxygenation techniques. Br J Anaesth 1984; 56:987. Benjamin J. Dixon, John B. Dixon, Jennifer R. Carden, Anthony J. Burn, Linda M. Schachter, Julie M. Playfair, Cheryl P. Laurie, Paul E. O’Brien; Preoxygenation Is More Effective in the 25° Head-up Position Than in the Supine Position in Severely Obese Patients: A Randomized Controlled Study. Anesthesiology 2005;102(6):1110-1115. Jense HG, Dubin SA, Silverstein PI, O’Leary-Escolas U. Effect of obesity on duration of apnea in anesthetized humans. Anesth Analg 1991; 72: 89–93. Min, Se-Hee & Im, Hyunjae & Rim Kim, Bo & Yoon, Susie & Bahk, Jae-Hyon & Seo, Jeong-Hwa. (2019). Randomized Trial Comparing Early and Late Administration of Rocuronium Before and After Checking Mask Ventilation in Patients With Normal Airways. Anesthesia & Analgesia. 1. 10.1213/ANE.0000000000004060. R. Sirian, Jonathan Wills, Physiology of apnoea and the benefits of preoxygenation, Continuing Education in Anaesthesia Critical Care & Pain, Volume 9, Issue 4, August 2009, Pages 105–108, https://doi.org/10.1093/bjaceaccp/mkp018 Roland Amathieu, Xavier Combes, Widad Abdi, Loutfi El Housseini, Ahmed Rezzoug, Andrei Dinca, Velislav Slavov, Sébastien Bloc, Gilles Dhonneur; An Algorithm for Difficult Airway Management, Modified for Modern Optical Devices (Airtraq Laryngoscope; LMA CTrach  ™): A 2-Year Prospective Validation in Patients for Elective Abdominal, Gynecologic, and Thyroid Surgery. Anesthesiology 2011;114(1):25-33. doi: 10.1097/ALN.0b013e318201c44f. Sachin Kheterpal, Richard Han, Kevin K. Tremper, Amy Shanks, Alan R. Tait, Michael O’Reilly, Thomas A. Ludwig; Incidence and Predictors of Difficult and Impossible Mask Ventilation. Anesthesiology 2006;105(5):885-891. Sachdeva R Kannan TR Mendonca C Patteril M. Evaluation of changes in tidal volume during mask ventilation following administration of neuromuscular blocking drugs. Anaesthesia  2014; 69: 826–31

Välkommen till februariavsnittet av AKUTBOKEN podcast. Här är ämnena och artiklarna i detta avsnitt: Nervblockader vid höftfraktur Steenberg & Møller (2018) Systematic review of the effects of fascia iliaca compartment block on hip fracture patients before operation. Br J Anaesth 120(6):1368-1380. PMID: 29793602 Guay et al. (2017) Peripheral nerve blocks for hip fractures. Cochrane 11;5:CD001159. […]

With bonfire night approaching we thought it would be a good time to have a think about burns. However burns are a significant issue at all times of year with around 130,000 presentations to UK EDs annually, 10,000 cases are admitted to hospital, 500 of these have severe burns and 200 of these will die. But most importantly intervention that we make can make a big difference to both morbidity and mortality, really affecting outcomes.  Throughout this episode we'll be covering the essential first responder management, all the way through to the critical care that maybe required for the sickest of burns patients.  In the podcast we cover Burn type and burn severity The importance of history Assessing burn extent Assessing burn depth The A-E assessment and specifics regarding the burns patient NAI, antibiotics, tetanus cover, analgesia, special circumstances eyes & chemicals Conveyance and destination As always we'd love to hear any thoughts or comments you have on the website and via twitter, we look forward to hearing from you. Enjoy! Simon, Rob & James    References British Burn Association First Aid Clinical Practice Guidelines BBA Clinical Practice Guideline for Management of Burn Blisters BBA Clinical Practice Guideline for Deroofing Burn Blisters RCEMLearning; Major Trauma, Burns National Burn Care Referral Guidance WHO; fact sheet on burns NHS Standard Contract for Specialised Burns Care (All Ages) Schedule 2- The Services A. Service Specification LITFL; burns Clinical review: The critical care management of the burn patient. Jane A Snell. Crit Care 2013 Fluid resuscitation in major burns. Mitra B ANZ J Surg. 2006 How well does the Parkland formula estimate actual fluid resuscitation volumes? Cartotto RC. J Burn Care Rehabil. 2002 Fluid resuscitation management in patients with burns: update. Guilabert P. Br J Anaesth. 2016 ISBI Practice Guidelines for Burn Care 2016  

Professor Monty Mythen presents Journal Club Express. Postoperative delirium in total knee and hip arthroplasty patients: a study of perioperative modifiable risk factors DOI: 10.1016/j.bja.2017.12.046 -- S. M. Weinstein et al. Br J Anaesth 2018; 120(5): 999-1008 This is an American single center retrospective study with 41,766 patients undergoing hip and knee arthroplasties over a seven year period.  They showed that 22.1% patients developed post operative delirium according to the ICD 9 definition of delirium.  Delirium occurs more in patients with multiple co-morbidities, older age, higher baseline creatinine, lower haemoglobins and longer patients stays. They looked at the type of anaesthetic as well as the use of opioids, ketamine and benzodiazepines.  They found the rates of delirium were higher in the knee arthroplasty group compared with the hip arthroplasty group. Those that received a neuroaxial block had a lower rate of delirium; Spinal:  OR 0.55 (CI 0.37-0.83), Epidural:  OR 0.59 (CI  0.38-0.93), CSE:  OR0.56 (CI 0.40-0.80).  There was a high risk with the use of postoperative benzodiazepines (OR 2.47 CI 2.04-2.97) and ketamine infusion ()R 10.59 CI 5.26-19.91) as well as intraoperative ketamine (OR 1.27 CI 1.01-1.59)  and opioids (OR 10.59 CI 5.26-19.91). 

Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles. Br J Anaesth. 2018 Apr;120(4):679-692. See full article here: https://doi.org/10.1016/j.bja.2017.11.104

When you give only after you're asked, you've waited too long. – John Mason First, learn to bag Place a towel roll under the scapulae to align oral, pharyngeal, and tracheal axes: Karsli C. Can J Anesth. 2015. Use airway adjuncts such as the oropharyngeal airway or a nasal trumpet. Use the two-hand ventilation technique whenever possible:   (See Adventures in RSI for more)     Supraglottic Airways: for difficult bag-valve-mask ventilation or a difficult airway (details in audio) LMA Classic Pros: Best studied; sizes for all ages Cons: Cannot intubate through aperture   LMA Supreme Pros: Better ergonomics with updated design; bite bloc; port for decompression Cons: Cannot pass appropriate-sized ETT through tube   King Laryngeal Tube Pros: Little training needed; high success rate; single inflation port Cons: Flexion of tube can impede ventilation or cause leaks; only sized down to 12 kg (not for infants and most toddlers)   Air-Q Pros: Easy to place; can intubate through aperture Cons: Not for neonates less than 4 kg   iGel Pros: Molds more accurately to supraglottis; no need to inflate; good seal pressures Cons: Cannot intubate through (without fiberoscopy)   Summary • If you can bag the patient, you're winning. • If you have difficulty bagging, or anticipate or encounter a difficult airway, then don't forget your friend the supraglottic airway (SGA). • Ego is the enemy of safety: SGAs are simple, fast, and reliable. • Just do it.   References Ahn EJ et al. Comparative Efficacy of the Air-Q Intubating Laryngeal Airway during General Anesthesia in Pediatric Patients: A Systematic Review and Meta-Analysis. Biomed Res Int. 2016;2016:6406391. Black AE, Flynn PE, Smith HL, Thomas ML, Wilkinson KA; Association of Pediatric Anaesthetists of Great Britain and Ireland. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth. 2015 Apr;25(4):346-62. Byars DV et al. Comparison of direct laryngoscopy to Pediatric King LT-D in simulated airways. Pediatr Emerg Care. 2012 Aug;28(8):750-2.  Carlson JN, Mayrose J, Wang HE. How much force is required to dislodge an alternate airway? Prehosp Emerg Care. 2010 Jan-Mar;14(1):31-5. Diggs LA, Yusuf JE, De Leo G. An update on out-of-hospital airway management practices in the United States. Resuscitation. 2014 Jul;85(7):885-92. Ehrlich PF et al. Endotracheal intubations in rural pediatric trauma patients. J Pediatr Surg. 2004 Sep;39(9):1376-80. Hernandez MR, Klock PA Jr, Ovassapian A. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg. 2012 Feb;114(2):349-68.  Huang AS, Hajduk J, Jagannathan N. Advances in supraglottic airway devices for the management of difficult airways in children. Expert Rev Med Devices. 2016;13(2):157-69. Jagannathan N, Wong DT. Successful tracheal intubation through an intubating laryngeal airway in pediatric patients with airway hemorrhage. J Emerg Med. 2011 Oct;41(4):369-73.  Jagannathan N et al. Elective use of supraglottic airway devices for primary airway management in children with difficult airways. Br J Anaesth. 2014 Apr;112(4):742-8. Jagannathan N, Ramsey MA, White MC, Sohn L. An update on newer pediatric supraglottic airways with recommendations for clinical use. Paediatr Anaesth. 2015 Apr;25(4):334-45. Karsli C. Managing the challenging pediatric airway: Continuing Professional Development. Can J Anaesth. 2015 Sep;62(9):1000-16. Luce V et al. Supraglottic Airway Devices vs Tracheal Intubation in Children: A Quantitative Meta-Analysis of Respiratory Complications. Paediatr Anaesth 24 (10), 1088-1098. Nicholson A et al. Supraglottic airway devices versus tracheal intubation for airway management during general anaesthesia in obese patients. Cochrane Database Syst Rev. 2013 Sep 9;(9):CD010105. Ostermayer DG, Gausche-Hill M. Supraglottic airways: the history and current state of prehospital airway adjuncts. Prehosp Emerg Care. 2014 Jan-Mar;18(1):106-15.  Rosenberg MB, Phero JC, Becker DE. Essentials of airway management, oxygenation, and ventilation: part 2: advanced airway devices: supraglottic airways. Anesth Prog. 2014 Fall;61(3):113-8.  Schmölzer GM, Agarwal M, Kamlin CO, Davis PG. Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation. 2013 Jun;84(6):722-30. Sinha R, Chandralekha, Ray BR. Evaluation of air-Q™ intubating laryngeal airway as a conduit for tracheal intubation in infants--a pilot study. Paediatr Anaesth. 2012 Feb;22(2):156-60. Timmermann A. Supraglottic airways in difficult airway management: successes, failures, use and misuse. Anaesthesia. 2011 Dec;66 Suppl 2:45-56. Timmermann A, Bergner UA, Russo SG. Laryngeal mask airway indications: new frontiers for second-generation supraglottic airways. Curr Opin Anaesthesiol. 2015 Dec;28(6):717-26.   Supraglottic Airway on WikEM   This post and podcast are dedicated to Tim Leeuwenburg, MBBS FRACGP FACRRM DRANZCOG DipANAES and Rich Levitan, MD, FACEP for keeping our minds and our patients' airways -- open.  You make us better doctors.  Thank you. Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP Pediatric; Emergency Medicine; Pediatric Emergency Medicine; Podcast; Pediatric Podcast; Emergency Medicine Podcast; Horeczko; Harbor-UCLA; Presentation Skills; #FOAMed #FOAMped #MedEd

Ep #21 Ketamine Induced Rapid Sequence Intubation with Faizan H. Arshad, MD @emscritcare Happy #EMSWeek #EMSStrong #EMSNation   SKEPTIC = Safety & Efficacy of Ketamine in Emergent Prehospital Tracheal Intubation – a Case Series   Brand new paper from Sydney HEMS on Ketamine and Shock Index in Annals of EM! http://www.annemergmed.com/article/S0196-0644(16)30002-6/abstract   Additional References: Carlson JN, Karns C, Mann NC, et al. Procedures performed by emergency medical services in the united states.Prehosp Emerg Care. 2015. Jacobs PE, Grabinsky A. Advances in prehospital airway management.International Journal of Critical Illness & Injury Science. 2014;4:57-64. Prekker ME, Kwok H, Shin J, Carlbom D, Grabinsky A, Rea TD. The process of prehospital airway management: Challenges and solutions during paramedic endotracheal intubation.Crit Care Med. 2014;42:1372-1378. Wang HE, Kupas DF, Greenwood MJ, et al. An algorithmic approach to prehospital airway management.Prehospital Emergency Care. 2005;9:145-155. Mace SE. Challenges and advances in intubation: Airway evaluation and controversies with intubation.Emerg Med Clin North Am. 2008;26:977-1000. Combes X, Jabre P, Jbeili C, et al. Prehospital standardization of medical airway management: Incidence and risk factors of difficult airway.Acad Emerg Med. 2006;13:828-834. Drummond GB. Comparison of sedation with midazolam and ketamine: effects on airway muscle activity. Br J Anaesth. 1996;76:663-667. Jackson APF, Dhadphale PR, callaghan ML, Alseri S. Haemodynamic studies during induction of anaesthesia for open-heart surgery using diazepam and ketamine. Br J Anaesth. 1978;50:375-378. Price B, Arthur AO, Brunko M, et al. Hemodynamic consequences of ketamine vs etomidate for endotracheal intubation in the air medical setting. Am J Emerg Med. 2013;31:1124-1132. Scherzer D, Leder M, Tobias JD. Pro-Con Debate: Etomidate or Ketamine for Rapid Sequence Intubation in Pediatric Patients. J Pediatr Pharmacol Ther. 2012;17:142-149. Bruder Eric A, Ball Ian M, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients.Cochrane Database of Systematic Reviews. 2015 Thompson Bastin ML, Baker SN, Weant KA. Effects of Etomidate on Adrenal Suppression: A Review of Intubated Septic Patients.Hospital Pharmacy. 2014;49:177-183. Arnold C. The promise and perils of ketamine research Ketamine began its life as an anaesthetic , but has enjoyed a recent renaissance as a potential. Lancet Neurol. 2013;12:940-941. Craven R. Ketamine. Anaesthesia. 2007;62:48-53. Perkins ZB, Gunning M, Crilly J, Lockey D, O’Brien B. The haemodynamic response to pre-hospital RSI in injured patients. Injury. 2013;44:618-623. Aroni F, Iacovidou N, Dontas I, Pourzitaki C, Xanthos T. Pharmacological Aspects and Potential New Clinical Applications of Ketamine: Reevaluation of an Old Drug. J Clin Pharmacol. 2009;49:957-964. Manthous CA. Avoiding circulatory complications during endotracheal intubation and initiation of positive pressure ventilation.J Emerg Med. 2010;38:622-631. Kohrs R, Durieux ME. Ketamine. Anesth Analg. 1998;87:1186-1193. Moy RJ, Clerc S Le. Trends in Anaesthesia and Critical Care Ketamine in prehospital analgesia and anaesthesia. Trends Anaesth Crit Care. 2011;1:243-245. Reich DL, Silvay G. Ketamine: an update on the first twenty-five years of clinical experience. Can J Anaesth. 1989;36(2):186-197. Porter K. Ketamine in prehospital care. Emerg Med J. 2004;21:351-354. Svenson JE, Abernathy MK. Ketamine for prehospital use: new look at an old drug. Am J Emerg Med. 2007;25:977-980. Johansson J, Sjöberg J, Nordgren M, Sandström E, Sjöberg F, Zetterström H. Prehospital analgesia using nasal administration of S-ketamine--a case series. Scand J Trauma Resusc Emerg Med. 2013;21:38. Filanovsky Y, Miller P, Kao J. Myth: Ketamine should not be used as an induction agent for intubation in patients with head injury. Can J Emerg Med. 2010;12:154-201. Himmelseher S, Durieux ME. Revising a Dogma: Ketamine for Patients with Neurological Injury? Anesth Analg. 2005;101:524-534. Kropf J a., Grossman MD, Genzlinger M a., Stoltzfus J, Stehly CD. 328 Ketamine versus Etomidate for Rapid Sequence Intubation in Traumatically Injured Patients: An Exploratory Study. Ann Emerg Med. 2012;60:S117. Angus DC, van dP. Severe sepsis and septic shock.N Engl J Med. 2013;369:840-851. Jabre P, Avenel A, Combes X, et al. Morbidity related to emergency endotracheal intubation-A substudy of the KETAmine SEDation trial. Resuscitation. 2011;82:517-522. Shafi S, Gentilello L. Pre-Hospital Endotracheal Intubation and Positive Pressure Ventilation Is Associated with Hypotension and Decreased Survival in Hypovolemic Trauma Patients: An Analysis of the National Trauma Data Bank. The Journal of Trauma: Injury, Infection, and Critical Care. 2005;59:1140–1147. Seymour CW, Band RA, Cooke CR, et al. Out-of-hospital characteristics and care of patients with severe sepsis: A cohort study.J Crit Care. 2010;25:553-562. Williams E, Arthur a., Price B, Banister NJ, Goodloe JM, Thomas SH. 175 Ketamine versus Etomidate for Use in Helicopter Emergency Medical Services Endotracheal Intubation. Ann Emerg Med. 2012;60:S63-S64 Bruns, B, Gentilello, L, Elliott, A, Shafi, S. Prehospital Hypotension Redefined. The Journal of Trauma: Injury, Infection, and Critical Care. 2008;65:1217–1221. Seymour, CW, Cooke, CR, Heckbert, SR, et al. Prehospital Systolic Blood Pressure Thresholds: A Community-based Outcomes Study. Acad Emerg Med Academic Emergency Medicine. 2013;20:597–604. Kristensen AKB, Holler JG, Mikkelsen S, Hallas J, Lassen A. Systolic blood pressure and short-term mortality in the emergency department and prehospital setting: a hospital-based cohort study.Critical Care. 2015;1:158. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84:1500-1504. Salt PJ, Baranes PK, Beswick FJ. Inhibition of neuronal and extraneuronal uptake of noradrenaline by ketamine in the isolated perfused rat heart. Br J Anaesth. 1979;51:835-838. Sprung J, Schuetz SM, Stewart RW, Moravec CS. Effects of Ketamine on the Contractility of Failing and Nonfailing Human Heart Muscles in Vitro. Surv Anesthesiol. 1999;43:230-231. Kunst G, Martin E, Graf BM, Hagl S, Vahl CF. Actions of Ketamine and Its Isomers on Contractility and Calcium Transients in Human Myocardium. Anesthesiology. 1999;90:1363-1371. Lundy PM, Lockwood PA, Thompson G, Frew R. Differential Effects of Ketamine Isomers on Neuronal and Extraneuronal Catecholamine Uptake Mechanisms. Anesthesiology. 1986;64:359-363. Selde W. Push dose epinephrine. A temporizing measure for drugs that have the side-effect of hypotension.JEMS. 2014;39:62-63.   Sponsored by @PerfectCPR Apple Watch App with Audio and Haptic Feedback to Optimize Cardiac Arrest Training and Improve Quality of CPR Delivery PerfectCPR.com     Query us on Twitter: www.twitter.com/EMS_Nation Like us on Facebook: www.facebook.com/prehospitalnation   Wishing Everyone a safe tour! ~Faizan H. Arshad, MD @emscritcare www.emsnation.org