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Depth of Anesthesia is a podcast that critically explores dogmatic clinical practices in anesthesiology. Anesthesiology is full of claims. A claim is a practice decision that we either believe is true or is something we default to. We think that for every claim in anesthesiology, we should know what is supported or refuted by evidence and what claims have no evidence base but stand to reason.
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Depth of Anesthesia
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20: Do lower intraoperative tidal volumes reduce postoperative pulmonary complications?
39:14
39:14
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39:14
In this episode, we explore the evidence on whether lower intraoperative tidal volumes (e.g., 6 vs. 9 cc/kg) reduce postoperative pulmonary complications. Our guest is Dr. Avery Tung. Dr. Tung is Professor of Anesthesia & Critical Care at the University of Chicago and Section Editor for Critical Care & Resuscitation for Anesthesia & Analgesia. Than…
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Depth of Anesthesia
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19: Is hydrocortisone, ascorbic acid (Vitamin C), and thiamine therapy effective for treatment of sepsis?
25:18
25:18
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25:18
In this episode, we discuss the role of hydrocortisone, ascorbic acid (Vitamin C) and thiamine (HAT therapy) in the treatment of patients with septic shock. We discuss biological plausibility and comprehensively review the latest evidence. Our guest is Dr. Jonathan Charnin. Dr. Charnin is an assistant professor of anesthesiology in the Divisions of…
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Depth of Anesthesia
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18: Is mixing in lidocaine effective for preventing burning with propofol?
28:30
28:30
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28:30
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 Har…
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Depth of Anesthesia
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17: Is it important to reverse to a train-of-four target of 90%? - Part 2 of 2
41:04
41:04
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41:04
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. Our guest today is Dr. Daniel Saddawi-Konefka, residency program director at Mass General. Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for…
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Depth of Anesthesia
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16: Is emergence from sevoflurane substantially faster than from isoflurane?
23:12
23:12
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23:12
We investigate the claim that emergence from sevoflurane is substantially faster than from isoflurane. We explore rationales and discuss cost. Our guest today is Dr. Keith Baker, Vice Chair of Education at Massachusetts General Hospital. Connect with us @DepthAnesthesia on Twitter or email us at depthofanesthesia@gmail.com. Thanks for listening! Pl…
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Depth of Anesthesia
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15: Is dural puncture epidural (DPE) the optimal labor analgesia technique?
26:43
26:43
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26:43
In this episode, we investigate the following claims related to DPE: 1. Dural puncture epidural (DPE) technique improves analgesic quality versus traditional epidural 2. DPE technique has faster onset of analgesia versus traditional epidural 3. DPE has less adverse effects compared with combined spinal-epidural (CSE) Our guest today is Dr. Ronald G…
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Depth of Anesthesia
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14: What is the approach to post-extubation stridor in COVID-19?
25:41
25:41
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25:41
In this episode, we explore the evidence for various strategies to manage post-extubation stridor and the applications to COVID-19 patients. Our guest today is Dr. Tiara Calhoun (@tiaraforsyth), an internal medicine resident at the Massachusetts General Hospital. She is an active contributor to FLARE (Fast Literature Assessment and Review), a newsl…
Our guest today is Dr. Charles Hardin of the Division of Pulmonary and Critical Care Medicine at Massachusetts General Hospital. He is an active contributor to FLARE (Fast Literature Assessment and Review), a collaborative effort within the Pulmonary and Critical Care Division and the Department of Medicine. The mission of FLARE is to appraise rapi…
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Depth of Anesthesia
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12: Is COVID-19 spread by aerosols and aerosol-generating procedures?
1:00:12
1:00:12
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1:00:12
Our guest today is Dr. Justin Morgenstern (@First10EM). His website (First10EM) provides critical appraisals of important emergency medicine and critical care topics. 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 …
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Depth of Anesthesia
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11: Does cricoid pressure reduce the risk of pulmonary aspiration?
35:33
35:33
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35:33
For our first episode of 2020, we investigate claims related to the application of cricoid pressure. Claim 1. Cricoid pressure reduces the risk of pulmonary aspiration. Claim 2. Landmark technique is able to accurately identify the cricoid cartilage. Claim 3. Cricoid pressure should be routinely applied in all rapid-sequence intubations. Our guest …
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Depth of Anesthesia
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10: Is a subjective assessment of functional capacity predictive of perioperative complications?
28:50
28:50
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28:50
We investigate the claim that a subjective assessment is an accurate way to measure functional capacity. We also explore whether self-reported ability to climb two flights of stairs is the best subjective method to assess functional capacity and whether exercise tolerance greater than or equal to 4 metabolic equivalents predicts the risk of periope…
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Depth of Anesthesia
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9: Is it safe to peripherally administer norepinephrine?
45:39
45:39
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45:39
We investigate the claim that norepinephrine is not safe for peripheral administration. Our guests today are Dr. Katarina Ruscic and Dr. Jamie Sparling of the Critical Care Division of the Massachusetts General Hospital. Full show notes available at depthofanesthesia.com. Connect with us @DepthAnesthesia on Twitter or depthofanesthesia@gmail.com. T…
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Depth of Anesthesia
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8: Does ketorolac increase the risk of bleeding?
35:03
35:03
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35:03
We investigate the claim that administering ketorolac (Toradol) increases bleeding and should be avoided in surgeries for which there is concern for bleeding. Claim 1. Administration of intraoperative ketorolac increases the bleeding time due to platelet inhibition Claim 2. Increased bleeding time translates to higher rate of surgical bleeding Clai…
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Depth of Anesthesia
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7: How do you reverse neuromuscular blockade? - Part 1 of 2
30:21
30:21
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30:21
We investigate claims about reversal of neuromuscular blockade. Claim 1. Location of train-of-four assessment matters Claim 2. Train-of-four is unnecessary with "sufficient" time from the last dose Claim 3. Fade can be discriminated by tactile assessment Our guest today is Dr. Daniel Saddawi-Konefka of the Massachusetts General Hospital. Full show …
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Depth of Anesthesia
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6: Is the sniffing position optimal for viewing the glottic opening?
30:56
30:56
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30:56
We investigate the claim that the sniffing position aligns the "axes" and is the optimal position for viewing the glottic opening. Our guest is Dr. Keith Baker, Vice Chair for Education and a thoracic anesthesiologist at the Massachusetts General Hospital. Full show notes available at depthofanesthesia.com. Connect with us @DepthAnesthesia on Twitt…
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Depth of Anesthesia
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5: Do preoperative anxiolytics improve patient satisfaction?
32:20
32:20
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32:20
We investigate pro and con positions on preoperative anxiolytics. Pro claim: Preoperative anxiolytics improve patient satisfaction. Con claim: Preoperative anxiolytics delay recovery and discharge. My guest is Dr. Matthew Vanneman, an attending cardiothoracic anesthesiologist at the Massachusetts General Hospital. Full show notes available at depth…
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Depth of Anesthesia
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4: Is it safe to administer cefazolin in penicillin-allergic patients?
54:31
54:31
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54:31
We investigate the claim that an alternative antibiotic to cephalosporins (e.g., cefazolin) should be selected for penicillin-allergic patients in the perioperative setting. Claim 1. Alternative antibiotics may be as efficacious in preventing surgical site infections Claim 2. Cephalosporins (e.g., cefazolin) may be unsafe due to cross-reactivity. C…
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Depth of Anesthesia
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3: Does morphine cause more nausea than hydromorphone?
24:25
24:25
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24:25
We investigate the claim that morphine causes more nausea than hydromorphone. 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 liste…
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Depth of Anesthesia
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2: Is it necessary to confirm mask ventilation before paralyzing?
35:45
35:45
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35:45
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 depthofa…
This is a podcast exploring the depth of our critical thinking around clinical practices. Anesthesia is full of claims. A claim is a practice decision that we either believe is true or is something we default to. We think that for every claim in anesthesia, we should know what is supported or refuted by evidence and what claims have no evidence bas…
