Deep Breaths

Today's episode is the second and final of our obstetric cardiac disease series where we take a close look at a few case scenarios with special guest, Dr Michael Toon.

Our third case takes a closer look at pulmonary hypertension in pregnancy and how this impacts the delivery and our anaesthetic options. We then end with a case in which a patient with congenital cardiac disease and a fontan circulation requires semi-urgent delivery. In our final two cases we take a close look at the pathophysiological changes that occur with the disease process as well as its management for delivery.

Resources for today's episode:

Anaesthetic Care of the Pregnant Patient with Cardiovascular Disease: A Scientific Statement From the American Heart Association by Meng, M.L et al.  (Circulation, 2023)

BJAED: Pulmonary arterial hypertension in pregnancy by Kariyawasam. S., and Brown, J. (be sure to seek access through ANZCA or your national anaesthetic college)

BJAED: Management of cardiac disease in pregnancy by Burt, C.C. & Durbridge, J.

ANZCA 2015 Blue Book: Pulmonary Hypertension: An overview for the "non cardiac" anaesthetist by Smith, I. (p 75)

ECS Guidelines: Cardiovascular Diseases During Pregnancy (Management of) Guidelines (this link includes further links to the pocket guidelines app)

Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations by Meng, M.L. & Arendt, K.W. 

Obstetric anesthesia management of the patient with cardiac disease by Arendt, K.W. & Lindley, K.J.

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today's episode is the first of two where we take a close look at a few obstetric case scenarios that deal with major cardiac disease with special guest, Dr Michael Toon.

Our first case explores a pregnancy and delivery in a patient with moderate to severe mitral stenoses. We then chase this with a case scenario revolving around a patient with a peripartum cardiomyopathy. In both cases we take a close look at the pathophysiological changes that occur with the disease process as well as its management for imminent delivery.

Resources for today's episode:

Anaesthetic Care of the Pregnant Patient with Cardiovascular Disease: A Scientific Statement From the American Heart Association by Meng, M.L et al.  (Circulation, 2023)

BJAED: Pulmonary arterial hypertension in pregnancy by Kariyawasam. S., and Brown, J. (be sure to seek access through ANZCA or your national anaesthetic college)

BJAED: Management of cardiac disease in pregnancy by Burt, C.C. & Durbridge, J.

ECS Guidelines: Cardiovascular Diseases During Pregnancy (Management of) Guidelines (this link includes further links to the pocket guidelines app)

Obstetric Anesthesia and Heart Disease: Practical Clinical Considerations by Meng, M.L. & Arendt, K.W. 

Obstetric anesthesia management of the patient with cardiac disease by Arendt, K.W. & Lindley, K.J. 

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today, we finish our discussion about post obstetric nerve injury with an in-depth discussion about the different intrinsic obstetric nerve palsies that can occur as a result of the mechanisms of labour and delivery. We follow this with a chat about our approach to assessing patients with altered neurology post delivery and in whom a neuraxial anaesthetic has been performed.

Resources for today's episode:

Anaesthesia Cute of the Week (ATOTW): Peripartum Neurological Injury

Anaesthesia Patient Safety Foundation (APSF): Postpartum Peripheral Nerve Injuries - What is Anaesthesia’s Role? by McCrory, E. H. et al. 

BJAED: Post-natal Neurological Problems by Boyce, H. & Plaat, F. 

Management of Neurological Deficit In Postpartum Patients (Northumbria Healthcare Guidelines) by Bird, R. & Backe, S.K.

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today, we discuss post-delivery nerve injury in obstetric patients. In this first of two episodes, our discussion begins with revision of the classification of nerve injury severity, followed by a chat about the different clinical syndromes observed as a result of nerve injury during neuraxial anaesthesia. 

Resources for today's episode:

Anaesthesia Tute of the Week (ATOTW): Peripartum Neurological Injury

Anaesthesia Patient Safety Foundation (APSF): Postpartum Peripheral Nerve Injuries - What is Anaesthesia’s Role? by McCrory, E. H. et al. 

BJAED: Post-natal Neurological Problems by Boyce, H. & Plaat, F. 

Management of Neurological Deficit In Postpartum Patients (Northumbria Healthcare Guidelines) by Bird, R. & Backe, S.K.

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today's episode is the second part in our discussion about anaesthesia for eye surgery with special guest, Dr Lahiru Amaratunge. We discuss two emergency eye surgeries and our options for managing these potentially challenging situations.

Resources for today's episode:

ABCs of anaesthesia ophthalmic anaesthesia youtube playlist (as mentioned by Dr Amaratunge during the episode):

ABCs of anaesthesia specific videos:
Subtenon's Block
What I use for my eye block anaesthesia formula

Useful articles:
BJAED: Regional anaesthesia for ophthalmic surgery by Anker, R. & Kaur, N.

BJAED: Update on anaesthesia for paediatric ophthalmic surgery by Lewis, H. &  James, I.

BJAED: Intraocular pressure by Murgatroyd, H. & Bembridge, J. 

ATOTW: Anaesthesia for ophthalmic surgery

ATOTW: Anaesthesia for paediatric eye surgery

Dr Lahiru Amaratunge also runs a course designed to help prepare trainees for the final anaesthetic vivas. If you're interested, here are the links to these courses:

The Anaesthesia Final Exam Course (online course only)

The Viva Bootcamp Online Course

The Viva Bootcamp Live Zoom Course links for 2023 courses (via Humanitix)

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today's episode is the first of a 2-part series covering anaesthesia for eye surgery with special guest Dr Lahiru Amaratunge. Over the course of these two episodes, we'll hear Dr Amaratunge discussing a few different case scenarios in both elective and emergency surgery for eyes.

Resources for today's episode:

ABCs of anaesthesia ophthalmic anaesthesia youtube playlist (as mentioned by Dr Amaratunge during the episode):

ABCs of anaesthesia specific videos:
Subtenon's Block
What I use for my eye block anaesthesia formula

Useful articles:
BJAED: Regional anaesthesia for ophthalmic surgery by Anker, R. & Kaur, N.

BJAED: Update on anaesthesia for paediatric ophthalmic surgery by Lewis, H. &  James, I.

BJAED: Intraocular pressure by Murgatroyd, H. & Bembridge, J. 

ATOTW: Anaesthesia for ophthalmic surgery

ATOTW: Anaesthesia for paediatric eye surgery

Dr Lahiru Amaratunge also runs a course designed to help prepare trainees for the final anaesthetic vivas. If you're interested, here are the links to these courses:

The Anaesthesia Final Exam Course (online course only)

The Viva Bootcamp Online Course

The Viva Bootcamp Live Zoom Course links for 2023 courses (via Humanitix)

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today, we take a close look at the Complex Regional Pain Syndrome (CRPS).

We discuss the diagnostic criteria, pathophysiology and treatment of this condition, as well as taking a closer look at the role of opioids in the management of pain relating to CRPS.

Resources for today's episode:

Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition by Harden, R.N et al.

ANZCA Blue Book 2019: The changing face of complex regional pain syndrome treatment  by Russo, M., Georgius, P. & Santarelli, D. (p183)

Up To Date Articles:
Complex regional pain syndrome in adults: Pathogenesis, clinical manifestations and diagnosis by Abdi, S.
Complex regional pain syndrome in adults: Treatment, prognosis and prevention by Abdi, S.

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today, we're taking a close look at one of ANZCA's latest professional documents - PG67: Guideline for the care of patients at the end-of-life who are considered for surgery or interventional procedures 2022.

Resources for this episode:

PG67: Guideline for the care of patients at the end-of-life who are considered for surgery or interventional procedures 2022

PG67 BP: Guideline for the care of patients at the end-of-life who are considered for surgery or interventional procedures Background Paper 2022

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today, we're tackling the absolutely mammoth topic of hyponatremia after JAMA recently published a fantastic article about its diagnosis and management.

Part 2's episode focuses on determining the cause of a patient's hypotonic hyponatremia. From here we also go on to discuss the pathophysiology of both the Syndrome of Inappropriate ADH secretion (or SIADH) and cerebral salt wasting before discussing the markedly different managements for these two conditions.

Lastly, we talk through the principles of managing hyponatremia.

Resources for today's episode:

Diagnosis and Management of Hyponatremia - A Review by Adrogue, H.J., Tucker, B.M. and Madras, N.E. (JAMA)

Hyponatremia StatPearls

Up to Date articles:

• Causes of hyponatremia without hypotonicity
• Causes of hypotonic hyponatremia in adults
• Diagnostic evaluation of adults with hyponatremia
• Overview of treatment of hyponatremia in adults
• Pathophysiology and aetiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat
• Cerebral salt wasting

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!

Today, we're tackling the absolutely mammoth topic of hyponatremia after JAMA recently published a fantastic article about its diagnosis and management.

We start with a review of some relevant physiology before talking about the ways in which hyponatremia can present, and the approach to determining the underlying cause of the hyponatremia.

In this episode, we specifically talk about determining whether the patient has either hypertonic, isotonic or hypotonic hyponatremia, as well as a discussion of the causes of hypertonic and isotonic hyponatremia. From here, we go on to focus on the relevant history and examination when working up a patient with hypotonic hyponatremia in order to further sub classify their hypotonic hyponatremia as being hypovolaemic, euvolaemic or hypervolaemic.

Resources for today's episode:

Diagnosis and Management of Hyponatremia - A Review by Adrogue, H.J., Tucker, B.M. and Madras, N.E. (JAMA)

Hyponatremia StatPearls

Up to Date articles:

• Causes of hyponatremia without hypotonicity
• Causes of hypotonic hyponatremia in adults
• Diagnostic evaluation of adults with hyponatremia
• Overview of treatment of hyponatremia in adults
• Pathophysiology and aetiology of the syndrome of inappropriate antidiuretic hormone secretion (SIADH)
• Treatment of hyponatremia: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and reset osmostat
• Cerebral salt wasting

Feel free to email us at [email protected] if you have any questions, comments or suggestions. We love hearing from you! 

And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode.  

Thanks for listening, and happy studying!