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 literature on SARS-CoV-2.  Check FLARE out here: https://www.massgeneral.org/news/coronavirus/treatment-guidance/fast-literature-updates An additional question for our listeners to dive into is the optimal timing of steroid administration....

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 FLARE out here: ...

Our guest today is Dr. Justin Morgenstern. His website First10EM provides critical appraisals of important EM and critical care topics Connect with us @DepthAnesthesia on Twitter or [email protected]. Thanks for listening! Please rate us on iTunes and share with your colleagues.  Music by Stephen Campbell, MD.  -- References Justin Morgenstern, "Aerosol generating procedures", First10EM blog, April 6, 2020. Available at: https://first10em.com/aerosol-generating-procedures/. ...

Happy New Year!  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 cardiothoracic anesthesiologist and intensivist at the Massachusetts...

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 surgery. Our guests today are Dr. Elisa Walsh and Dr. Laurie Shapiro of the Massachusetts General...

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.  Recommend a guest or topic at [email protected] or tweet us @DepthAnesthesia.  Rate us on iTunes and share with your colleagues! -- References Cardenas‐Garcia J, Schaub KF, Belchikov YG, Narasimhan M,...

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 attributable to ketorolac is clinically relevant Our guest today is Dr. Jamie Sparling of the...

We explore three claims about reversal of neuromuscular blockade.  1. Location of train-of-four assessment matters 2. Train-of-four is unnecessary with "sufficient" time from the last dose  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.  Recommend a guest or topic at [email protected] or tweet us @DepthAnesthesia.  Rate us on...

In this episode, we explore the claim that the sniffing position aligns the "axes" and is the optimal position for viewing the glottic opening.  We welcome Dr. Keith Baker to the show. Dr. Baker is the Vice Chair for Education and a thoracic anesthesiologist in the Department of Anesthesiology, Critical Care, and Pain Medicine at the Massachusetts General Hospital.  A list of references is also available at depthofanesthesia.com.  We'd love to hear from you! Email us at...

Dr. Matthew Vanneman, an attending cardiothoracic anesthesiologist at the Massachusetts General Hospital, returns for this episode.   We explore pro and con positions on pre-operative anxiolytics.  Pro claim: Preoperative anxiolytics improve patient satisfaction.  Con claim: Preoperative anxiolytics delay recovery and discharge. We'd love to hear from you! Email us at [email protected] or tweet us @DepthAnesthesia.  -- References C. Boncyk, A. S. Hess, A. Gaskell, J....

My guest this week is Dr. Matthew Vanneman, an attending adult cardiothoracic anesthesiologist at the Massachusetts General Hospital.  We explore the claim that an alternative antibiotic to cephalosporins (e.g., cefazolin) should be selected for penicillin-allergic patients in the perioperative setting.  A list of references is available at depthofanesthesia.com.  We'd love to hear from you! Email us at [email protected] or tweet us @DepthAnesthesia. 

We explore the claim that morphine causes more nausea than hydromorphone.  Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital, is back for this discussion.  A list of references and show notes is available at depthofanesthesia.com. Thank you to all our listeners! Leave a comment at depthofanesthesia.com or email us at [email protected]. You can also connect to us on Twitter @anespod. 

In this episode, we explore the claim that mask ventilation should be "checked" or "confirmed" prior to administering a paralytic. We discuss some of the rationales and investigate the literature. A list of references is available at depthofanesthesia.com. We'd love to hear from you! Leave a comment at depthofanesthesia.com or email us at [email protected]

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 these claims and become less satisfied not knowing what you don’t know.