Airwayve

In this episode, join Manuela and Ashlyn as they dive into perioperative bleeding and blood transfusion, laying the foundation for our two-part series on massive hemorrhage protocol (MHP). We start with a review of hemostasis, including primary and secondary hemostasis, fibrinolysis and the role of tranexamic acid (TXA).

From there, we get into the practical side of perioperative bleeding, including how to assess bleeding risk, interpret CBC, PT/INR and aPTT, and understand newer tools like TEG and ROTEM. We also break down blood typing, group and screen, crossmatching and the different blood products available in the OR, including red blood cells, plasma, platelets and fibrinogen concentrate.

We then work through the principles of fluid resuscitation and blood transfusion before discussing hemorrhagic shock, the lethal triad and the physiologic consequences of major blood loss. To wrap things up, we work through a couple of clinical questions to put it all together.

Whether you're preparing for your anesthesia rotation or just want to build a solid foundation for understanding massive hemorrhage, this episode covers the key concepts you need to know before diving into MHP in Part 2.

Credits
– Writer: Manuela Morgan
– Resident Reviewer: Dr. Muizz Hussain
– Staff Reviewer: Dr. Sebastian Vuong

Support the show

In this episode, Josephine and Manuela dive into malignant hyperthermia (MH), one of the most serious anesthetic emergencies. From calcium release and skeletal muscle physiology to recognizing the early signs of an MH crisis, we break down the pathophysiology, triggers and key principles of acute management.

We also discuss how to approach patients with known or suspected MH before surgery, including preparing the anesthesia machine, avoiding triggering agents and developing a safe anesthetic plan. To wrap things up, we work through a clinical case to put it all together.

Whether you're preparing for your anesthesia rotation or just want to know what to do when the temperature starts rising, this episode covers the essentials you need to know about MH.

Credits

– Writer: Dr. Alexander Xiang 

– Student Editor: Manuela Morgan

– Resident Editor: Dr. Akashdeep Grewal

– Staff Editor: Dr. Mary Elbrakey

Support the show

In this episode, Josephine and Manuela explore the anesthetic considerations for patients with coronary artery disease (CAD) undergoing non-cardiac surgery. From coronary physiology and myocardial oxygen supply-demand balance to acute coronary syndromes, perioperative risk assessment and intraoperative management, they break down the key concepts every medical student should know.

Whether you’re preparing for your anesthesia rotation or looking for a practical framework for managing patients with CAD in the perioperative setting, this episode is packed with clinically relevant pearls and a case that brings everything together.

Episode Resources

Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery

2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

American College of Surgeons NSQIP calculator

Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines

Credits

– Writer: Josephine Ding

– Editors: Manuela Morgan

– Resident Editor: Dr. Bradley Murphy and Dr. Sanjum Hunjan

– Staff Reviewer: Dr. Joshua Peachey

Support the show

In this episode, Jessica and Alex explore anesthetic considerations for patients with thyroid disease and those undergoing thyroidectomy. Starting with a review of thyroid physiology, they break down how hypo- and hyperthyroidism affect major organ systems and why these changes matter in the perioperative setting. The discussion covers pre-operative optimization, airway assessment, intraoperative management, and important postoperative complications including neck hematoma, recurrent laryngeal nerve injury, hypocalcemia, thyroid storm, and myxedema coma.

Through a clinical case, the team ties together key concepts and practical approaches to managing thyroid disease safely in the OR. Whether you’re preparing for clerkship, reviewing endocrine physiology, or looking for a concise overview of thyroid anesthesia, this episode has you covered.

Credits

Writer: Jessica Xiong
Editors: Alexander Xiang, Jenny Xinye Hu
Resident Editor: Alexis Baker
Staff Reviewer: Dr. Andrew Syrett 

Support the show

In this episode, Alex and Josephine sit down with their colleagues Iliya and Kaitlyn, who both matched to anesthesia at McMaster University, and Tariq, who matched to anesthesia at the University of Alberta, to reflect on their journeys to residency. From choosing electives to preparing for interviews, they share practical insights and honest reflections on the CaRMS process, including parallel planning and personal growth along the way.

Whether you’re gearing up for CaRMS or just curious about the path to anesthesia, this episode is full of thoughtful advice you won’t want to miss.

Disclaimer: The advice shared in this episode is based solely on personal experiences as medical students navigating CaRMS. We are not affiliated with, nor do we represent, the McMaster University residency admissions committee or any other residency program.

Support the show

In this Airwayve episode, we kick off our anesthetic emergencies season with a practical look at hypoxemia and hypoxia. We review the oxygen cascade, the A–a gradient, and how oxygen is transported in blood, then clarify the difference between hypoxemia and tissue hypoxia through the lens of oxygen delivery and consumption. We break down the five major causes of hypoxemia and share a stepwise approach to troubleshooting intraoperative desaturation, from patient assessment to circuit and monitor checks. A clinical case of a patient with COPD and obesity ties everything together, highlighting how physiology guides real time anesthetic management.

Credits

Writer: Iliya Khakban

Editors: Alexander Xiang

Resident Editor: Kesikan Jayaraj

Staff Reviewer: Dr. Muhammad Imran Khan

Support the show

Don’t hold your breath for this one. In this month’s episode, we take a deep dive into ventilation basics and walk through how normal respiratory physiology compares to positive-pressure ventilation in the OR. We break down core settings like FiO₂, tidal volume, respiratory rate, I:E ratio, and PEEP, then explore common ventilation modes and when you might choose each one. To round things out, we apply it all to a real case and talk through how to pick safe and sensible settings for a patient with COPD. This episode is packed with practical tips to help you feel more comfortable at the ventilator during your next anesthesia rotation.

Credits

Writer: Irene Zhao

Editors: Alexander Xiang

Resident Editor: Puru Panchal

Staff Reviewer: Dr. Overington

Support the show

In this episode of Airwayve, join Manuela and Tariq as they explore the anesthetic considerations for patients with liver disease. We start with a refresher on liver physiology and its vital roles in metabolism, coagulation, and drug clearance, before delving into the pathophysiology of cirrhosis and how it affects perioperative management. From there, we discuss preoperative risk assessment, intraoperative goals, and postoperative care, highlighting key considerations for fluid management, anesthetic drug selection, and hemodynamic stability.

To put these concepts into context, we then walk through a clinical case and outline how to apply this framework to a patient with advanced liver disease coming to the OR.

Whether you’re preparing for clerkship or want to build a stronger foundation in perioperative medicine, this episode provides a clear and practical approach to managing patients with liver dysfunction.

Credits

Writer: Manuela Morgan
Editors: Alexander Xiang, Jenny Xinye Hu
Resident Editor: Ahmed Akhtar
Staff Reviewer: Dr. Saeda Nair

Support the show

In this episode of Airwayve, Alex and Josephine dive into the challenges of managing pulmonary hypertension in the OR. We begin by reviewing normal pulmonary vascular physiology, then move into the mechanisms and classifications of pulmonary hypertension. From there, we unpack the anesthetic implications, focusing on hemodynamic goals, drug choices, and monitoring strategies.

To bring these principles into context, we walk through a clinical scenario and consider how to assess risk, plan an induction, maintain stability throughout surgery, and safely manage emergence in a patient with pulmonary hypertension.

Whether you’re preparing for clerkship or aiming to sharpen your understanding of cardiopulmonary physiology, this episode offers a clear and practical guide to navigating pulmonary hypertension in anesthesia.

Credits

Writer: Tariq Atkin-Jones

Senior Editors: Alex Xiang & Jenny Xinye Hu

Resident Editor: Dr. Aman Malhotra

Staff Editor: Dr. Brent MacLellan

Support the show

In this episode of Airwayve, join Jenny and Alex as they discuss patients receiving prone positioning in the OR. We first start with the basics- what prone positioning looks like, how patients are safely flipped, and which surgeries require it. From there, we unpack the physiologic changes across cardiac, respiratory, and neurologic systems, and dive into the major complications anesthetists need to anticipate, including peripheral nerve injury, postoperative vision loss, airway challenges, and line access issues.

To bring it all together, we walk through a clinical case of a patient undergoing complex spine surgery, applying these principles to real-world anesthetic planning, intraoperative management, and emergence considerations.

Whether you’re preparing for your OR rotation or brushing up on perioperative physiology, this episode will give you a clear, structured framework for thinking about anesthetic management in prone positioning.

Credits
Writers: Alexander Xiang, Jenny Xinye Hu
Editors: Alexander Xiang, Jenny Xinye Hu
Resident Editor: Dr. Jonathan Wu
Staff Reviewer: Dr. Juan Bravo Montilla

Support the show