Depth of Anesthesia
Depth of Anesthesia is a podcast that critically explores dogmatic practices in anesthesiology, referred to as 'claims'. Hosted by David Hao, MD, it delves into the latest clinical controversies by examining the relevant literature. The podcast aims to challenge established norms and encourage evidence-based thinking in the field.
Episodes
41: Do pulmonary artery catheters improve outcomes in cardiac surgery?
Dr. Taylor Thomas and Dr. Matt Vanneman join the podcast to discuss the evidence on whether pulmonary artery catheters improve outcomes in cardiac surgery. Dr. Thomas is a dual obstetric and adult cardiothoracic anesthesia fellow at MGH and recent graduate of the anesthesia residency program. Dr. Vanneman is a Clinical Associate Professor in the Department of Anesthesiology, Perioperative and Pain
40: Are peripartum opioids safe for breastfeeding mothers?
Dr. Gopika Hari and Dr. Lana Joudeh join the podcast to discuss the literature on the safety of peripartum opioid use and its implications for breastfeeding. Dr. Hari is an anesthesia resident in the MGH Anesthesia Residency Program and a graduate of Washington University School of Medicine in St. Louis. Dr. Joudeh completed her anesthesia residency at Massachusetts General Hospital and is current
39: Should opioid-free anesthesia be implemented? A Pro-Con Debate.
Dr. Mary Daniels and Dr. Scott Cao join the show to discuss the literature surrounding opioid-free versus opioid-based anesthesia and analgesia techniques. Dr. Scott Cao is currently serving as a chief resident of the MGH anesthesia residency program. He is a graduate of the University of Colorado School of Medicine. Dr. Mary Daniels is a graduate of Harvard Medical School and she is a resident in
38: Does remifentanil cause opioid-induced hyperalgesia?
Dr. Jess Hawkins joins the show to discuss the literature pertaining to remifentanil and opioid-induced hyperalgesia. Dr. Hawkins is an anesthesia resident at the Massachusetts General Hospital. This podcast was recorded as part of the Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your collea
37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?
Dr. Caroline Andrew and Dr. David Nathan join the show to discuss the literature pertaining to intraoperative administration of dexamethasone. Dr. Caroline Andrew is an anesthesia resident at the Massachusetts General Hospital. Dr. David Nathan is the Director of the Diabetes Center at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. This podcast was recorded as
36. Does tranexamic acid increase the risk of thromboembolism?
Dr. Zach Cost and Dr. Tem Bendapudi join the show to discuss the literature pertaining to tranexamic acid and thromboembolic risk. Dr. Zach Cost is an anesthesia resident at the Massachusetts General Hospital. Dr. Pavan ("Tem") Bendapudi holds a joint faculty appointment in the Division of Hematology and Blood Transfusion Service and is assistant professor of medicine at Harvard Medical School. Th
35. Does spinal anesthesia decrease the risk of postoperative delirium?
Dr. Mark Neuman and Dr. Sam Falkson join the show to discuss the literature around risks of regional versus general anesthesia for postoperative delirium. Dr. Neuman is the founding Director of the Center for Perioperative Outcomes Research and Transformation and Professor of Anesthesiology at Penn Medicine. Dr. Sam Falkson is an anesthesia resident at the Massachusetts General Hospital. This podc
34. Are double lumen endotracheal tubes superior to bronchial blockers?
Dr. Nick Kumar and Dr. Andy Siemens from the Massachusetts General Hospital anesthesia residency join the show to discuss the literature comparing double lumen endotracheal tubes and bronchial blockers. Dr. Dan Saddawi-Konefka joins as our faculty expert - special thanks to Dan for supporting the ongoing Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a
33. Do perioperative gabapentinoids decrease postoperative pain?
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 @D
32: Do LMAs increase the risk of aspiration compared to ETTs? - Part II of II
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 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, leav
31: Do LMAs increase the risk of aspiration compared to ETTs? - Part I of II
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
30: Live from the IARS Annual Meeting - Part II of II
In this special two-part series, we record a live episode at the International Anesthesia Research Society meeting. Dr. Dan Saddawi-Konefka and I revisit a question from our very first Depth of Anesthesia episode: is it necessary to confirm mask ventilation before paralyzing? Supporting graphics are available at depthofanesthesia.com and on our Instagram @DepthofAnesthesia. Special thanks to Dr. S
29: Live from the IARS Annual Meeting - Part I of II
In this special two-part series, we record a live episode at the International Anesthesia Research Society meeting. Dr. Dan Saddawi-Konefka and I revisit a question from our very first Depth of Anesthesia episode: is it necessary to confirm mask ventilation before paralyzing? Supporting graphics are available at depthofanesthesia.com and on our Instagram @DepthofAnesthesia. Special thanks to Dr. S
28: What is the infectious risk of arterial catheters?
Dr. Ben Weaver and Dr. Elisa Walsh (@elisacwalsh) from Massachusetts General Hospital join the show to discuss the literature around the infectious risk of arterial catheters and the role of barrier precautions. This is the first episode produced from a new podcast elective that's available to MGH anesthesia residents. Special thanks to Dr. Saddawi-Konefka for supporting the initiative. Thanks for
27: Does BIS monitoring reduce accidental awareness during general anesthesia?
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
26: Should buprenorphine be discontinued preoperatively?
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 offse
25: Should stress-dose steroids be given?
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 @D
24: Is low flow anesthesia with sevoflurane safe?
In this episode, Dr. Ross Kennedy and Dr. Cas Woinarski join us to discuss the evidence on whether low-flow anesthesia with sevoflurane is safe. We discuss Compound A generation and nephrotoxicity. This episode was made possible through production and research support from Davies Agyekum, MD, PhD. Thanks for listening! If you enjoy our content, consider helping us offset the costs of production b
23: What is the data on COVID-19 vaccines? + FAQ
In this episode, Dr. Adam Flaczyk from Massachusetts General Hospital joins us to summarize the data on the latest COVID-19 vaccines and to answer frequently asked questions. Frequently asked questions start at 30:03 including: What is the data on side effects? What is the potential for anaphylaxis? Any data on use of antipyretics or NSAIDS with vaccination? — Thanks for listening! If you enjoy ou
22: Is evidence-based medicine easy?
In this special episode, Dr. Justin Morgenstern of First10EM joins us to discuss a 6-step approach to primary literature. His strategy will give you the tools to feel more comfortable with taking an active role in reading and critically evaluating the literature. Step 1: How do I find a paper to read? Step 2: Is this paper worth reading? Step 3: Read the paper Step 4: Interpret the paper (stats ar
21: Should smaller endotracheal tubes be used for elective surgery?
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 Ro
20: Do lower intraoperative tidal volumes reduce postoperative pulmonary complications?
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. Thanks for listening! If you enjoy our content, consid
19: Is hydrocortisone, ascorbic acid (Vitamin C), and thiamine therapy effective for treatment of sepsis?
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 Multi-specialty Anesthesia and Critical Care Medi
18: Is mixing in lidocaine effective for preventing burning with propofol?
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. Conn
17: Is it important to reverse to a train-of-four target of 90%? - Part 2 of 2
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 listening! Please rate us on iTunes and share wit
16: Is emergence from sevoflurane substantially faster than from isoflurane?
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! Please rate us on iTunes and share with your colle
15: Is dural puncture epidural (DPE) the optimal labor analgesia technique?
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 George (@Ron_George), Professor and Chief of Obstet
14: What is the approach to post-extubation stridor in COVID-19?
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 newsletter that appraises the rapidly evolving literat
13: Does COVID-19 cause ARDS?
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 rapidly evolving literature on SARS-CoV-2. Check FLA
12: Is COVID-19 spread by aerosols and aerosol-generating procedures?
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 Campbell, MD. __ References Justin Morgenstern,
11: Does cricoid pressure reduce the risk of pulmonary aspiration?
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 today is Dr. Jerome Crowley, an adult cardiothora
10: Is a subjective assessment of functional capacity predictive of perioperative complications?
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 perioperative complications in any major non-cardiac surg
9: Is it safe to peripherally administer norepinephrine?
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. Thanks for listening! Please rate us on iTunes a
8: Does ketorolac increase the risk of bleeding?
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 Claim 3. The magnitude of bleeding propensity attribu
7: How do you reverse neuromuscular blockade? - Part 1 of 2
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 notes available at depthofanesthesia.com. C
6: Is the sniffing position optimal for viewing the glottic opening?
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 Twitter or depthofanesthesia@gmail.com. Thanks for
5: Do preoperative anxiolytics improve patient satisfaction?
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 depthofanesthesia.com. Recommend a guest or topic a
4: Is it safe to administer cefazolin in penicillin-allergic patients?
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. Claim 3. Administering cephalosporins (e.g., cefa
3: Does morphine cause more nausea than hydromorphone?
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 listening! Please rate us on iTunes and share with y
2: Is it necessary to confirm mask ventilation before paralyzing?
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! Ple
1: Welcome to Depth of Anesthesia!
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 base but "stand to reason". We hope you start to see
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