Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast

In this 282nd episode I welcome Dr. Tricia Pendergrast to the show to discuss how to navigate the process of applying for residency in anesthesiology. We discuss how to set yourself up for success, how to figure out how competitive you are, when to consider an away rotation, when to consider dual applying, and how to figure out how to best use your signals.

In this 281st episode I welcome our SICU pharmacist, Traci Grucz, to the show to discuss glycemic management of critical ill patients. 

In this 280th episode I share the shocking and tragic news that Dr. Gillian Isaac died suddenly and unexpectedly a few weeks ago. She was an incredible human being, teacher, doctor, wife and mother. She will be missed more than I can say by more people than we can possibly count. I know that she would want us to continue with these keyword episodes that she loved doing and so I am going to try. I know they will never be the same, but they will be dedicated to her memory. Today I address the keyword of shock states and discuss the 4 types of shock and how they may be covered on your exams. I miss you, Gillian.

In this 279th episode I welcome Dr. Phil Carullo back to the show to discuss what, exactly, an anesthesiologist does and how we fit into the perioperative experience for patients.

In this 278th episode I discuss what you need to know about liver physiology for your exams.

In this 277th episode I welcome Dr. Gillian Isaac back for another ABA keyword episode. We discuss Adrenal Diseases and the questions you're likely to see about them on your exams. 

In this 276th episode I welcome pediatric anesthesiologist Dr. rita Saynhalath to the show to discuss how to manage kids presenting for surgery with a recent URI. We discuss the evidence for proceeding versus postponing, whether the type of virus matters, and how to handle COVID infections. 

In this 275th episode I welcome Chef Myles Snider to the show to discuss how busy professionals can cook tasty, healthy meals for themselves and their families. 

In this 274th episode I welcome Dr. Jonathan Kay (JK) to the show to discuss perioperative hypersensitivity reactions. We focus on the diagnosis and treatment of anaphylaxis and also discuss antibiotic allergies and how to deal with the ever present allergy to PCN. 

In this 273rd episode I welcome Dr. Caitlin Sutton to the show to discuss Anesthesia for fetal surgical procedures. We discuss some common procedures, how the anesthesia is done and why, what can go wrong and how to prepare, and what the future holds.

In this 272nd episode I welcome Dr. Kinza Berical to the show to discuss her work developing support systems for mothers who practice anesthesiology. We discuss navigating pregnancy and prenatal care, breastfeeding, mentorship around pregnancy loss, IVF and childcare. 

In this 271st episode I welcome Dr. Gillian Isaac back to the show for another ABA keyword episode. We discuss lower extremity nerve blocks.

In this 270th episode I welcome Drs. Michael Douglas and Leonard Soloniuk to the show to discuss the use of dexmedetomidine in spinals, epidurals and nerve blocks.

In this 269th episode I welcome Dr. Jeanna Blitz to the show to discuss the newest, most evidence based approach to preoperative assessment and optimization of patients. We discuss the use of biomarkers, alternatives to RCRI and using METS alone and assessment and optimization of frailty, nutritional status, anemia, psychological status and functional status. 

In this 268th episode I welcome Drs. Carullo, Kostibas, Isaac, Banks and Segna to the show. They are our peds, cardiac, OB, critical care and regional fellowship directors and we discuss the state of fellowships in anesthesiology.

In this 267th episode I welcome Dr. Alli Bechtel to the show to discuss the Anesthesia Patient Safety Foundation where she works as their podcast host. We discuss the APSF top 10 priorities, what they include and what guidance clinicians can get from them. 

This special 266th episode was recorded before a live audience at the Anesthesiology 2023 Annual Meeting in San Francisco. I interviewed Dr. Deb Culley about post-op delirium and Dr. John Eichorn about the history and future of patient monitoring.

In this 265th episode I welcome Dr. Gillian Isaac back to the show to do another ABA Keyword episode. We follow up on the last one by discussing Nitroprusside, Nitroyglycerin and their effect on hemoglobin

In this 264th episode I welcome Dr. Mimi Wynn to the show to discuss anesthesia for TAAA repair. We discuss preoperative concerns, intraoperative management, postoperative concerns especially spinal cord ischemia, and how to reduce the risk of that dreaded complication. 

In this 263rd episode I welcome Dr. Mahesh to the show to discuss radiation safety for anesthesia providers in the OR and procedure suites.  

In this 262nd episode I welcome Dr. Evan Kharash to the show to discuss the use of methadone perioperatively instead of more commonly used opioids such as fentanyl and dilaudid. We discuss the safety of methadone, how it works, and the evidence for superiority in terms of pain control, total opioid use, and patient satisfaction.

In this 261st episode I welcome professional commercial pilot and safety expert Matt Renz to the show to discuss aviation safety and how it can apply to medicine. 

In this 260th episode I welcome Dr. Dave Berman back to the show to discuss malignant hyperthermia. Dr. Berman is a volunteer with the MH hotline and he discussed the history, epidemiology, genetics, testing, prevention and management of MH and then we discuss some cases.

In this 259th episode I welcome Dr. Gillian Isaac back to the show to discuss another set of ABA key words. We discuss the pulse oximeter and some hemoglobinopathies that can affect its readings. 

In this 258th episode I welcome Dr Emily Sharpe and Dr. Mike Hofkamp back to the show to have a pro-con debate about what to do when a woman in labor with an epidural in place has to go unexpectedly for c-section. Dr. Hofkamp argues for removing the epidural and doing a second neuraxial technique while Dr. Sharpe argues for using the existing epidural. 

In this 257th episode I welcome Dr. Cara Esser back to the show to discuss the ins and outs of transsphenoidal pituitary surgery and what to keep in mind preoperatively, intraoperatively and postoperatively. 

In this 256th episode I welcome Dr. Cara Esser to the show to discuss neuromuscular diseases that are important to know for Anesthesia and Critical Care. 

In this 255th episode I welcome Drs. Dutoit and Teeter to the show to discuss the changes to the ERAS application system including program signals, geographic preferences, experiences, and general advice. We answer questions submitted by the ASA Medical Student Component.

In this 254th episode I welcome Dr. Gillian Isaac back to the show for another ABA Keyword episode. We discuss muscular dystrophies and trisomy 21.

In this 253rd episode I welcome Drs. Segna, Rayaz, Jaremko and Barnhart to the show to discuss the acute pain service, how to formulate a multimodal acute pain regimen for a patient, and how to think about the various medications involved.

In this 252nd episode I welcome Dr. Tim Poore, a palliative care physician, to the show to discuss palliative care in general and in the ICU in particular. He gives us some concrete tools to use when having difficult, end of life conversations with patients and families. 

In this 251st episode I welcome Dr. Emily Vail and Dr. Varun Goyal to the show to discuss the Anesthesiologist's role in organ donation.

In this 250th episode I welcome back Drs. Essandoh and Cody and, for the first time, Dr. Kjome, to discuss different career settings in anesthesiology. We discuss academics, the military and private practice.

In this 249th episode I welcome Dr. Gillian Isaac back to the show for another ABA Keyword episode. We discuss retrobulbar blocks and the oculocardiac reflex.

In this 248th episode I welcome Dr. Samir Gautam to the show. Dr. Gautam is a nephrologist specializing in AKI in the ICU and we talk about the diagnosis, causes, treatment and prognosis of AKI.

In this 247th episode I welcome Kali Dayton back to the show to discuss her work helping ICUs around the country learn how to get their intubated patients awake and up and walking and implement the ABCDEF bundle.

In this 246th episode I welcome Dr. Phil Carullo to the show to discuss Tape. That's right, tape. We discuss tape as a medical device, the tape-skin interface, how to prevent injury and infections from tape, and the evidence for different taping techniques.

In this 245th episode I welcome Drs. Christina Miller and Adam Schiavi to the show to discuss the importance of simulation, the evidence for using it in education, and important lessons learned in how to develop an effective program for trainees.

In this 244th episode I welcome back Dr. Mike Essandoh and welcome for the first time Dr. Nick Kumar to discuss their recent article about using a novel hemodynamic measurement, the Pulmonary Artery Pulsatility Index (PAPI) to assess right heart function in general and in LVAD recipients specifically.

In this 243rd episode I welcome Dr. Jae Grymes to the show. Jae is a board certified pediatric dentist and a board certified dental anesthesiologist. We talk about the field of dental anesthesiology, its history, training, and the role that it plays in dentistry. We also discuss the controversial practice of dentists doing their own anesthesia.

In this 242nd episode I welcome Dr. Richard "Harry" Harris to the show to discuss his incredible experience saving the lives of the Thai boys soccer team that was trapped in a flooded cave in Thailand in 2018.

In this 241st episode we play the audio from our live podcast in New Orleans at the Anesthesiology 2022 conference. We discuss Jesse's impressive career including his recent election as president-elect of the AMA, his advocacy work, and his work with AI in healthcare.

In this 240th episode I welcome Drs. Hofkamp and Sharpe to the show to discuss their work investigating whether there may be inadequate analgesia for patients undergoing cesarean delivery.

Hey there ACCRAC listeners! If you'll be at the ASA annual meeting in New Orleans on October 22nd come check out our live podcast at 2pm from Center Stage. We'll be interviewing Dr. Jesse Ehrenfeld, president-elect of the AMA!

In this 239th episode I welcome Dr. Jimmy Turner back to the show. Jimmy is an academic anesthesiologist at Wake Forest in North Carolina and a certified coach for physicians. He is also the founder of The Physician Philosopher blog and podcast. In addition to this, he is the author of a book that came out in July of 2022 entitled Determined: How Burned Out Doctors Can Thrive in a Broken Medical System. We discuss his book and it's messages about burnout and resilience.

In this 238th episode I welcome back Financial Planner Justin Harvey to discuss the recent changes in student loans, public service loan forgiveness, the No Surprises Act, the pros and cons of doing a fellowship versus going straight into practice, and mistakes to avoid when starting a new job.

In this 237th episode I welcome Dr. Bryan Sexton to the show to discuss his work with characterizing, researching and trying to address healthcare provider burnout. We discuss what burnout is and how it differs from moral injury, how to prevent it, treat it, and what a better system might look like.

In this 236th episode I welcome Dr. Katherine Hoops to the show to discuss her work with gun violence prevention. We discuss the horrific statistics around gun violence during the COVID pandemic, what can be done to try to prevent it, and what providers can do to help.

In this 235th episode I welcome Drs. Karla Castro-Frenzel and Haleh Saadat to the show. They share their stories of being diagnosed with serious diseases, becoming physician-as-patients, and how they coped with the diagnosis and figured out how to move forward.

In this 234th episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword. We cover PONV for the Basic and Advanced exam.

In this 233rd episode we post a recording from Drs. Elena Madan and Lauren Buhl about how to optimally present anesthesia plans.

In this 232nd episode I welcome Drs. Wang, Larson and Rishel to the show to discuss WikiAnesthesia. We discuss what it is, how it came to be, what it offers for anesthesia practitioners, and how people can get involved.

In this 231st episode I welcome Dr. Mike Essandoh back to the show to discuss the Total Artificial Heart. We discuss what it is, how it works, how it is put in, who is a good candidate, and how to manage people with TAHs from an anesthetic perspective when they come in for non-cardiac surgery.

In this 230th episode I welcome Dr. Greg Booth to the show to discuss how artificial intelligence can be used in healthcare, how it works, what the benefits are, and what the potential downsides are that we need to be aware of.

In this 229th episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword. We discuss Epidurals for both the Basic and Advanced Exam.

In this 228th episode I welcome Dr. Nicole Rizkalla to the show to discuss the details of liver transplant anesthesiology. We discuss patient selection and preparation, intraop and postop management, the training pathway to be a transplant anesthesiologist and what the future may hold.

In this 227th episode I welcome Dr. Christian Meyhoff to the show from Denmark where he is one of the world leaders on hyperoxia research. We discuss his recent VIXIE Trial as well as his A&A article looking at the VISION study data retrospectively. We also discuss why the data on hyperoxia is so mixed and what future studies should examine.

In this 226th episode I welcome back Dr. Gillian Isaac to do another ABA keyword episode. We cover all 9 of the newborn emergencies that are laid out in the ABA keywords.

In this 225th episode I welcome Dr. Maxime Cannesson to the show to discuss his work developing AI systems for use in anesthesiology. We discuss what these systems can do, the evidence for their use, and whether they will replace human providers.

In this 224th episode I welcome back Drs. Essandoh and Cody to talk about the MitraClip procedure. We review the pathophysiology of mitral regurgitation and then talk about the indications for this endovascular procedure, how it's done and what complications can arise.

In this 223rd episode I welcome Dr. Marius Fassbinder back to the show to discuss the glycocalyx. We discuss what it is, what roll it plays in fluid dynamics, and what we need to know about how it influences our fluid management.

In this 222nd episode I welcome Drs. Catherine Chen and Jennifer Lucero to the show to discuss their NEJM article about aversive racism in academic medicine. We talk about what aversive racism is, what role it plays, and how we can try to work to counter its effects.

In this 221st episode I welcome Dr. Anna Gitterman to the show to put me through the oral board ringer. She takes me through a stem and we break down strategy for you.

In this 220th episode I welcome Dr. Wes Ely to the show to discuss his new book, Every Deep Drawn Breath and the personal journey as an intensivist that he took to writing it. We discuss PICS and PICS-F, early mobility, and bringing humanity to the ICU.

In this 219th episode I welcome Dr. Steven Bradley to the show to discuss medical ethics in general and some specific issues that arise in anesthesiology.

In this 218th episode I welcome Dr. Mark Neuman to the show. Dr. Neuman is the PI of the REGAIN trial, published in the NEJM which compared spinal and sedation vs. GA for hip surgery. We discuss the trial and the results.

In this 217th episode I welcome Dr. David Convissar to the show to talk about the landscape of social media resources in anesthesiology education and the pros and cons of using those resources.

In this 216th episode I discuss case reports of using Lipid Emulsion Therapy for Amniotic Fluid Embolus. Big thanks to Dr. Adam Olson for bringing this to my attention!

In this 215th episode I welcome Dr. Kia Sedghi and Dr. Stephen Freiberg to the show to discuss tips and tricks for making the transition from training to practice.

In this 214th episode I welcome back Dr. Gillian Isaac to do another ABA Keyword episode. We review non-depolarizing neuromuscular blockers and myesthenic syndromes.

In this 213th episode we take the show on the road in front of a live audience at Anesthesiology 2021 in San Diego! I interview Dr. Aditee Ambardekar about her programatic leadership roles at UT Southwestern and the ACGME and we also discuss her practice with pediatric burn anesthesia. I also interview Dr. Doug Bacon about his interest in the history of anesthesiology, anesthesiology during WWII, and his leadership role as a department chair.

In this 212th episode I welcome Dr. Matt Meyer to the show to discuss the environmental impact of modern healthcare including the downsides of Desflurane and how we can make personal and system changes to help the environment.

In this 211th episode I welcome Drs. Lorenzo Berra and Roberta Santiago to the show to discuss why traditional one size fits all ventilation approaches are not ideal in an increasingly obese population and how we can optimize our ventilation settings for our patients.

In this 210th episode I welcome international pain expert Dr. Steve Cohen to the show to discuss pain in general, how we categorize it, how we try to treat it, and what the future holds.

In this 209th episode I welcome Dr. John Fiadjoe from Boston Children's Hospital and Harvard Medical School to the show to discuss what we can learn in anesthesiology from behavioral economics theory.

In this 208th episode I welcome Drs. Kopanczyk, Al-Qudsi and Bhatt to the show to discuss RV Failure in COVID-19. We talk about how they are using POCUS to assess R heart function, what the new NBE CCEexam is all about, and the growth of POCUS in Anesthesiology.

In this 207th episode I welcome back Drs. Essandoh, Graul and Cody to discuss anesthesia for structural heart procedures. We cover the Mitraclip, TAVR and Watchman.

In this 206th episode I welcome Dr. Derek Fine to the show to discuss the use of CRRT (Continuous Renal Replacement Therapy) in the ICU.

In this 205th episode I welcome Drs. Essandoh, Cody and Graul back to the show to discuss ECMO including significant new technology and devices that have come into play since I last covered ECMO.

In this 204th episode I welcome Dr. Kia Sedghi to the show to discuss the perioperative management of patients with LVADs coming in for non-cardiac surgery.

In this 203rd episode I welcome Dr. Tammy Euliano to the show to discuss how she got involved in writing fiction, how she took her idea all the way to a published novel called Fatal Intent, and how anesthesiologists are portrayed in popular fiction.

In this 202nd episode I welcome Dr. Matt Wixson, co-founder of RADAR (Raising Anesthesiology Diversity and Anti-Racism) to the show to discuss anti-racism in Anesthesiology.

In this 201st episode I welcome Dr. Jeff Swenson to the show to discuss his invention of the original adductor canal block and why he is now doing a simplified version.

In this 200th episode I look back over the past 5 years and 200 episodes of ACCRAC to highlight some of the most memorable episodes and most significant lessons.

In this 199th episode I welcome Salia Farrokh to the show to discuss pharmacology in the neuro ICU. We discuss treatment for status epilepticus, ICP crisis, reversal of anticoagulants in ICH, neurostimulants in TBI and BP management in stroke.

Salia is on LinkedIn at https://www.linkedin.com/in/salia-farrokh-pharm-d-bcps-bcccp-845b1b38/

In this 198th episode I welcome Drs. Essandoh, Cody and Graul to the show to discuss new technology for non-transvenous cardiac devices such as subcutaneous ICDs, leadless pacemakers and wireless-CRT.

Dr. Cody's email is: [email protected]

In this 197th episode I welcome Dr. Shreya Aggarwal to the show to discuss the environmental impact of healthcare in general and anesthesiology specifically. We discuss what the impact is and what we can do to mitigate it.

Dr. Aggarwal is available at: [email protected]

In this 196th episode I welcome Dr. Gillian Isaac back to the show to discuss another ABA keyword. We discuss urologic surgery and renal failure.

Continue reading "Episode 195: Invention and Device Development in Anesthesiology with Trevor Gibbs"

Continue reading "Episode 194: COVID in kids with Anna Sick-Samuels"

Continue reading "Episode 191: Preop assessment for ambulatory surgery with Bobbie Sweitzer"

Continue reading "Episode 188: Anesthesia for Thoracic Surgery"

Continue reading "Episode 187: PEEP for Robotic Surgery with Gabe Tharp"

Continue reading "Episode 183: Keywords Part 13 with Gillian Isaac: Thyroid for the Basic and Advanced Exams"

Continue reading "Episode 182: Med Student Concerns and PD Responses for the COVID Interview Season"

Continue reading "Episode 181: Evidence-based perioperative teaching with Dave Berman."

Continue reading "Episode 180: Keywords part 12 with Gillian Isaac: Local Anesthetics"

Continue reading "Episode 179: Ambulating While Intubated with Kali Dayton"

Continue reading "Episode 177: How To Be a Star Resident"

Continue reading "Episode 176: Keywords Part 11: Barbiturates and Bier Blocks"

Continue reading "Episode 175: Financial Planning in the Time of COVID with Justin Harvey"

Continue reading "Episode 174: Keywords Part 10: OR Fires and Electrical Safety"

Continue reading "Episode 173: Innovation In The Time of Covid: The MasksOn.org story with Drs. Sanjay Vakil, Jackie Boehme and Alex Stone"

Continue reading "Episode 168: COVID in Pregnancy with Dr. Nixon"

Continue reading "Episode 167: COVID Clinical Care Update"

Continue reading "Episode 165: COVID with Drs. Scott, Cereda and Nacoti"

Continue reading "Episode 164: Keywords part 9: Fentanyl and Breathing Circuits"

Continue reading "Episode 163: Thoracic Wall Blocks with Barbara Versyck"

Continue reading "Episode 162: Hypertensive Disorders of Pregnancy with Juanita Henao"

Continue reading "Episode 160: Non-OB Surgery in Pregnancy With Dave Berman"

Continue reading "Episode 159: Postpartum hemorrhage with Juanita Henao"

Continue reading "Episode 158: Keywords part 8-hepatic disease for the advanced exam and PACU for the basic exam with Gillian Isaac"

Continue reading "Episode 156: Personal Finance and Burnout with Jimmy Turner"

Continue reading "Episode 155: Opioid-Free Anesthesia with Michael Manning"

Continue reading "Episode 154: EEG monitoring with Dr. Emery Brown"

Continue reading "Episode 152: Keywords Part 7: MH and Hepatic Disease for the Basic Exam"

Continue reading "Episode 148: Marijuana Use In Healthcare Providers with Mike Fitzsimons"

Continue reading "Episode 145: Personalized PEEP with Dr. Wiener-Kronish Live from ASA 2019"

Continue reading "Episode 144: The Anesthesiologist-Surgeon Relationship with Jeffrey Cooper Live From ASA 2019"

Continue reading "Episode 142: Driving Pressure and Transpulmonary Pressure with Marcos Vidal Melo"

Continue reading "Episode 140: Transfusion Triggers and The TRICS 3 Trial with David Mazer"

Continue reading "Episode 135: A Case For Low Dose Norepinephrine"

Continue reading "Episode 131: Disabilities in Medicine with Drs. Meeks, Brookman and Fitzsimons"

Continue reading "Episode 130: Adults with Congenital Heart Disease with Jochen Steppan"

Continue reading "Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna"

Continue reading "Episode 127: Upper Extremity Blocks with Drs. Segna and Rayaz"

Continue reading "Episode 125: Abusive Head Trauma with Erik Smith"

Continue reading "Episode 124: POCUS with Lee Goeddel"

Continue reading "Episode 123: Surgical Airway with Andrew Merelman"

Continue reading "Episode 121: Difficult Airway Response Team With Lynette Mark"

Continue reading "Episode 119: STOP-IT Trial with Rob Sawyer"

Continue reading "Episode 118: Mother’s Day"

Continue reading "Episode 116: Overview of Pediatric Anesthesia with Bommy Mershon"

Continue reading "Episode 115: The Contaminated Airway with Steve Freiberg"

Continue reading "Episode 112: Anesthesia for ECT with Christina Miller"

Continue reading "Episode 110: Financial Planning For Healthcare Providers With Justin Harvey"

Continue reading "Episode 109: Non-Opioid Adjuncts with Drs. Grant and Bicket part 2"

Continue reading "Episode 108: Non-opioid adjuncts with Drs. Grant and Bicket Part 1"

Continue reading "Episode 107: Suicide in Anesthesia with Mike Fitzsimons"

Continue reading "Episode 106: Hydroxyethyl Starches with Marius Fassbinder"

Continue reading "Episode 105: Blood Management Part 1 With Drs. Frank & Cha"

Continue reading "Episode 101: Coming off Bypass with Stephen Freiberg"

Continue reading "Episode 96: Peds difficult airway with Nick Dalesio"

Continue reading "Episode 94: Organ Donation with Clint Burns"

Continue reading "Episode 92: Early Mobility in the PICU with Sapna Kudchadkar"

Continue reading "Episode 90: OSA"

Continue reading "Episode 80: Lessons from the Military with Jonathan Curley"

Continue reading "Episode 78: The Obesity Code Book Review"

Continue reading "Episode 77: Reversal of Neuromuscular Blockade"

Continue reading "Episode 74: Opioid Crisis Engagement with Chad Brummett"

Continue reading "Episode 73: Medical Liability with Darrell Ranum"

Continue reading "Episode 71: Oral Board Prep 2: part 1"

Continue reading "Episode 67: High Value Care with Pam Johnson"