Clinical Anaesthesia Podcasts: Conversations with Keith and Courtney

Stay with us! In the final episode of this series, Keith and Courtney introduce Acid-Base Balance and Disturbances. It has taken years for both of them to get to grips on some of the basics of this topic, and they spend the next hour breaking down what is going on and how to interpret the values in front of you. During the second half of this episode, they discuss some case-based scenarios. 

Even if you are not utilising blood gas analysis in practice, it doesn’t mean something acute is not happening to our patients under anaesthesia just because we can’t see it, so it is still useful to understand.

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Last episode, we talked about how carbon dioxide is formed in the body, and how it gets from the cells to the lungs. Now that it has arrived there – what next?! In this episode, Keith and Courtney talk about what happens when carbon dioxide diffuses from the pulmonary capillary into the alveoli to be exhaled. 

They break down the Alveolar Ventilation Equation and the Alveolar Gas Equation into a more user-friendly concept you can apply to your everyday patient and how it is actually useful after the anaesthesia itself. Keith discusses the loss of one of his patients during the recovery period and Courtney shares ways you can continue to support and monitor those patients in this critical time of anaesthesia – after all, your pulse oximeter and capnograph can still be used after they are extubated! 

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In the first episode on carbon dioxide, Keith and Courtney will undoubtedly make you rethink the role of carbon dioxide in the blood – it isn’t the “bad guy” we perhaps thought it was.  

They start their conversation right down at the cellular level again and discuss how it gets from there to the lungs. How is carbon dioxide carried? At what point does it hitch a right on the haemoglobin (Hb) to return to the lungs to be breathed out? If only 25% of the carbon dioxide is carried in the blood – where is the rest? Why do we talk about bicarbonate when talking about carbon dioxide? There are so many questions! 

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In the last of the 3 episodes on oxygen, Keith and Courtney discuss how we can monitor the concentration of oxygen our patient is receiving and also how to monitor our patient’s oxygenation levels – both manually and with a machine. 

We can “flip the lip” (but human eyesight can’t detect cyanosis for quite some time), use our pulse oximeter or run a blood gas analysis. Assuming the patient has normal haemoglobin levels. Anaemia, carbon monoxide poisoning from a house fire and even an overdose of certain everyday drugs can affect functional haemoglobin availability!   

They finish this episode highlighting the importance of using an oxygen concentrator in a circle breathing system, and why we initially have high fresh gas flows to remove the nitrogen sitting in the tubing and carbon dioxide absorbing canister. 

In this second episode, Keith and Courtney discuss how oxygen gets from the lungs and down to the cellular level. This episode won’t Bohr you! Listen out for Keith’s fantastic explanation of how oxygen is carried in the blood to the tissues by using a “football fans and the London Underground network” analogy.  

Also, after breaking down the Oxygen Dissociation Curve, you may want to get your pulse oximeter out and use it in the recovery phase of your patient’s anaesthesia experience! They also throw in a few case base discussion points on tick-bite paralysis, geriatric pets and those animals who have perhaps been exposed to carbon monoxide in a house fire. This episode is relevant for all disciplines in veterinary medicine – not just anaesthesia!

Welcome to the first episode in our third season of the Conversations with Keith and Courtney podcast. This season looks into Oxygen and Carbon Dioxide – from the moment oxygen leaves the cylinder until it gets to the mitochondria, and then how the waste product (carbon dioxide) gets from the tissue to the lungs so it can be exhaled. 

In this episode, Keith and Courtney discuss methods we use to provide oxygen therapy to our patients before anaesthesia, such as through pre-oxygenation via flow-by or face mask delivery, and what type of oxygen concentration you’re actually reaching! If it leaves the cylinder at 100%, it certainly doesn’t mean that the patient gets that. And they will leave you with some frightening figures in regards to using insufficient fresh gas flows in an oxygen cage... 

Much of what is discussed in this episode is also in our article “Are you providing effective Oxygen Therapy?” which you can check out here:

https://bit.ly/3mNoQrw

In the last episode of our second series. Keith and Courtney discuss their bread & butter – mechanical ventilation.

Whether you have a ventilator and don’t use it or your practice is thinking about purchasing one – this episode aims to break down the fear of mechanical ventilation and goes through 3 key things you need to know so you can walk into a room and use any ventilator on any patient. It really is that easy.

If you want more hands-on ventilation training – check out the dates and locations of our Respiratory Roadshow CPD events at www.burtonsveterinary.com/academy.

In this week’s episode, Keith and Courtney discuss the long-awaited Podcast on ventilation across 2 parts, with this one focused on manual ventilation.

During everyday anaesthesia, we may find ourselves needing to give our patients intermittent or regular positive pressure breaths to support their ventilation, for example, during long anaesthesia or due to thoracic surgery.

Although closing the exhaust valve on the breathing system and squeezing the reservoir bag seems very straightforward, there are many factors to consider in regards to patient safety – what is the pressure we are delivering, is the tidal volume known and is this breathing system suitable?

They discuss safe intrathoracic pressures to deliver these manual breaths and how to utilise equipment such as in-circuit manometers, IPPV button valves and how to use each breathing system correctly (even if you have been told the Lack is not suitable for IPPV!).

In this week’s episode, Keith and Courtney follow on from the discussion of the last episode on blood pressure, but this time discussing Invasive Blood Pressure (IBP) monitoring and how to set up all the equipment, how to place an arterial catheter and how to troubleshoot a dampened IBP trace.

With beat-to-beat information, there is so much more than blood pressure monitoring that can be achieved with an IBP set-up. Did you know positive pressure ventilation can affect the patient’s cardiac output and blood pressure? Well, well IBP monitoring, you can actually see it happening! Also, you now have a direct line for arterial blood gas sampling!

They hope by the end of the episode you will realise that IBP monitoring isn’t an unachievable modality in general practice to aim for, and Courtney encourages RVNs to add this type of intensive monitoring to their skill set.

In this week’s episode, Keith and Courtney discuss the equipment, technique and limitations of non-invasive blood pressure measurements (NIBP).

Is the fluffy coat of a patient going to be like going to the doctor for your own blood pressure reading whilst wearing a puffer jacket? Yes! Is the reported number of an oscillometric machine gospel, or should we be looking at the trend?

They hope to get your blood pumping with excitement when they discuss myths and controversies with NIBP machines. And hear about how Keith kills time in the airport...