Anesthesia Clerkship Podcast Blake

VTDAT Approach



This should complement teachings you've likely already received on an ABCDE approach.



Three boxes: Anesthetic, Surgical, Patient

Categories: Hypovolemic, Distributive, Cardiogenic, Obstructive, Mixed



Use history, physical, non-invasive and invasive monitors, investigations (ECG, blood work, ultrasound, etc) to rule in or rule out your differential. Trial treatments. Assess response to treatments. Don't anchor, reconsider differential diagnosis if not improving.



Have questions, comments, corrections, or concerns? Please reach out via email:

anesthesiaclerkship@gmail.com



References:

1. Emergency Manual. “Stanford Medicine Emergency Manual.” Accessed August 27, 2023. https://emergencymanual.stanford.edu/.


All research, scriptwriting and recording done by Misa Gillis MSI4 and Blake Birnie, UBC Anesthesiology R3

PDPH is a recognised complication of neuraxial anesthesia.



Around 4 minutes I misspoke and stated an 18G spinal needle - I meant epidural needle, I corrected myself the second time I stated it, sorry for the confusion!



Have questions, comments, corrections, or concerns? Please reach out via email:

⁠anesthesiaclerkship@gmail.com



References:

1. Gobel, Hartmut. “7.2.1 Post-Dural Puncture Headache.” ICHD-3. Accessed September 16, 2023. https://ichd-3.org/7-headache-attributed-to-non-vascular-intracranial-disorder/7-2-headache-attributed-to-low-cerebrospinal-fluid-pressure/7-2-1-post-dural-puncture-headache/.

2. Plewa, Michael C., and Russell K.
McAllister. “Postdural Puncture Headache.” In StatPearls. Treasure
Island (FL): StatPearls Publishing, 2023. http://www.ncbi.nlm.nih.gov/books/NBK430925/. 

3. Uppal, Vishal, Robin Russell, Rakesh
Sondekoppam, Jessica Ansari, Zafeer Baber, Yian Chen, Kathryn DelPizzo, et al. “Consensus Practice Guidelines on Postdural Puncture Headache From a Multisociety, International Working Group: A Summary Report.” JAMA Network
Open 6, no. 8 (August 15, 2023): e2325387–e2325387. https://doi.org/10.1001/jamanetworkopen.2023.25387.

4. Zhang Q, Pang SY, Liu CW. Chronic headaches related to post-dural puncture headaches: a scoping review. Br J Anaesth. 2022 Nov;129(5):747-757.
https://pubmed.ncbi.nlm.nih.gov/36085093/



All research, scriptwriting and recording were done by Misa Gillis UBC MSI4 and Blake Birnie UBC Anesthesiology R3

In this episode, we define multimodal analgesia and give a brief introduction to the many agents that can be utilised. Opioids are a mainstay of treating post-surgical pain and the goal of multimodal analgesia is not to avoid opioids (termed opioid-sparing analgesia) but to reduce the negative side effects while providing adequate post-surgical pain.



The medications listed are those that are typically used in British Columbia, Canada and may differ from your regional practice. For example, we mention IV acetaminophen briefly, this is difficult to obtain in Canada (at least in British Columbia where we practice) although I am aware that it is quite cheap and widely used in other areas of the world.



Apologies for the hissing - we had technical difficulties with the recording equipment.



Have questions, comments, corrections, or concerns? Please reach out via email:

anesthesiaclerkship@gmail.com



References:

1. Stone AB, Iban YC, Zhong H, et al. B318 Opioid sparing effects of intravenous and oral acetaminophen in hip fracture patients: a population-based study. Reg Anesth Pain Med. 2022;47(Suppl 1):A234-A235.

doi:10.1136/rapm-2022-ESRA.392

2. Rosenberger DC, Pogatzki-Zahn EM. Chronic post-surgical
pain – update on incidence, risk factors and preventive treatment options. BJA Education. 2022;22(5):190-196. doi:10.1016/j.bjae.2021.11.008

3. Djaiani G, Silverton N, Fedorko L, et al. Dexmedetomidine
versus Propofol Sedation Reduces Delirium after Cardiac Surgery: A Randomized Controlled Trial. Anesthesiology. 2016;124(2):362-368. doi:10.1097/ALN.0000000000000951

4. Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Leslie K,
Wiener-Kronish JP. Miller’s Anesthesia. 9th ed. Elsevier Inc.; 2020.

5. Butterworth JF, Mackey DC, Wasnick JD. Morgan &
Mikhail’s Clinical Anesthesiology. 7th ed. McGraw Hill LCC.; 2022.

6. O’Neill A, Lirk P. Multimodal Analgesia. Anesthesiology
Clinics. 2022;40(3):455-468. doi:10.1016/j.anclin.2022.04.002

7. Dunn LK, Durieux ME. Perioperative Use of Intravenous
Lidocaine. Anesthesiology. 2017;126(4):729-737. doi:10.1097/ALN.0000000000001527

8. Practice Guidelines for Acute Pain Management in the
Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-273. doi:10.1097/ALN.0b013e31823c1030


All research, scriptwriting and recording were done by Misa Gillis UBC MSI4 and Blake Birnie UBC Anesthesiology R3

We discussed the VTDAT approach to unstable patients in the OR (although this could also apply to out-of-OR situations).

Vitals

(Alert the Room)

Temporize

Differential Diagnosis

Assessment

Treatment



We also discuss an approach to high airway pressure

- patient to machine or machine to patient.



Have questions, comments, corrections, or concerns? Please reach out via email:

⁠anesthesiaclerkship@gmail.com⁠



References:

1. Emergency Manual. “Stanford Medicine
Emergency Manual.” Accessed August 27, 2023. https://emergencymanual.stanford.edu/.

2. Hess, Dean R. “Respiratory Mechanics
in Mechanically Ventilated Patients.” Respiratory Care 59, no. 11
(November 2014): 1773–94. https://doi.org/10.4187/respcare.03410.

3. Nickson, Chris. “High Airway and
Alveolar Pressures.” Life in the Fast Lane • LITFL (blog), January 4,
2019. https://litfl.com/high-airway-and-alveolar-pressures/.

 

All research, scriptwriting and recording were done by Misa Gillis UBC MSI4 and Blake Birnie UBC Anesthesiology R3

We give an example of an "unanticipated" difficult airway situation along with a basic overview of some of the algorithm suggestions.

I would strongly encourage you to check out the Vortex approach, the link is at the bottom of the references.



Have questions, comments, corrections, or concerns? Please reach out via email:

⁠anesthesiaclerkship@gmail.com⁠

References:

1. Apfelbaum, Jeffrey L., Carin A. Hagberg, Richard T. Connis, Basem B. Abdelmalak, Madhulika Agarkar, Richard P. Dutton, John E. Fiadjoe, et al. “2022 American Society of Anesthesiologists
Practice Guidelines for Management of the Difficult Airway*.” Anesthesiology 136, no. 1 (January 1, 2022): 31–81. https://doi.org/10.1097/ALN.0000000000004002.

2. Butterworth, John F., David C. Mackey, and John D. Wasnick. Morgan & Mikhail’s Clinical Anesthesiology. 7th ed. McGraw Hill. LCC., 2022.

3. “DAS Guidelines Home | Difficult Airway Society.” Accessed August 20, 2023. https://das.uk.com/guidelines.

4. “The Vortex Approach to Airway Management.” Accessed November 18, 2023. https://vortexapproach.org/



All research, scriptwriting and recording was by Misa Gillis UBC MSI4 and Blake Birnie UBC Anesthesiology R3

This episode focuses on an overview of physiological changes in pregnancy and how this can impact anesthesia. We discuss the preference for neuraxial anesthesia and use the ABCDE approach to cover some anesthetic considerations.


Have questions, comments, corrections, or concerns? Please reach out via email:

anesthesiaclerkship@gmail.com



References:

1. Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Leslie K, Wiener-Kronish JP. Miller’s Anesthesia.
9th ed. Elsevier Inc.; 2020.

2. Butterworth JF, Mackey DC, Wasnick JD. Morgan &
Mikhail’s Clinical Anesthesiology. 7th ed. McGraw Hill LCC.; 2022.

3. McClelland SH, Bogod DG, Hardman JG. Apnoea in pregnancy: an investigation using physiological modelling. Anaesthesia.
2008;63(3):264-269. doi:10.1111/j.1365-2044.2007.05347.x

4. LoMauro A, Aliverti A. Respiratory physiology of pregnancy. Breathe (Sheff). 2015;11(4):297-301. doi:10.1183/20734735.008615

5. Sullivan P, Birdi T, Bould D, et al. Ottawa Anesthesia Primer. Echo Book Publishing; 2012.

6. UpToDate. https://www.uptodate.com/contents/airway-management-for-the-pregnant-patient

7. https://www.anesthesiaconsiderations.com


All research, scriptwriting and recording was done by Misa Gillis UBC MSI4 and Blake Birnie UBC Anes R3