Depth of Anesthesia

By David Hao, MD

What's Depth of Anesthesia about?

Depth of Anesthesia is a podcast that critically explores dogmatic practices (we call them claims) in anesthesiology. Join us as we explore the literature around the latest clinical controversies!

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Depth of Anesthesia episodes:

12.06.2023
36. Does tranexamic acid increase the risk of thromboembolism?
Dr. Zach Cost and Dr. Tem Bendapudi join the show to discuss the literature pertaining to tranexamic acid and thromboembolic risk. Dr. Zach Cost is an anesthesia resident at the Massachusetts General Hospital. Dr. Pavan (“Tem”) Bendapudi holds a joint...
07.30.2023
35. Does spinal anesthesia decrease the risk of postoperative delirium?
Dr. Mark Neuman and Dr. Sam Falkson join the show to discuss the literature around risks of regional versus general anesthesia for postoperative delirium. Dr. Neuman is the founding Director of the Center for Perioperative Outcomes Research and Transformation and...
04.02.2023
34. Are double lumen endotracheal tubes superior to bronchial blockers?
Dr. Nick Kumar and Dr. Andy Siemens from the Massachusetts General Hospital anesthesia residency join the show to discuss the literature comparing double lumen endotracheal tubes and bronchial blockers. Dr. Dan Saddawi-Konefka joins as our faculty expert - special thanks...
01.04.2023
33. Do perioperative gabapentinoids decrease postoperative pain?
It's our first solo episode! We review the evidence around perioperative use of gabapentinoids (gabapentin and pregabalin) and discuss interesting concepts including trial sequential analysis and minimally important difference. If you enjoy our content, leave a 5-star review on Apple...
10.18.2022
32: Do LMAs increase the risk of aspiration compared to ETTs? - Part II of II
Dr. Chris Di Capua and Dr. Bryan Glezerson (@BryanGlezerson) join the show to discuss the literature around the risk of aspiration with LMAs compared to ETTs. This is an episode produced from the Depth of Anesthesia Podcast Elective that’s available...
08.10.2022
31: Do LMAs increase the risk of aspiration compared to ETTs? - Part I of II
Dr. Chris Di Capua and Dr. Bryan Glezerson (@BryanGlezerson) join the show to discuss the literature around the risk of aspiration with LMAs compared to ETTs. This is part I of a two-part series on LMAs. In part II, we...
05.23.2022
30: Live from the IARS Annual Meeting - Part II of II
In this special two-part series, we record a live episode at the International Anesthesia Research Society meeting. Dr. Dan Saddawi-Konefka and I revisit a question from our very first Depth of Anesthesia episode: is it necessary to confirm mask ventilation...
05.10.2022
29: Live from the IARS Annual Meeting - Part I of II
In this special two-part series, we record a live episode at the International Anesthesia Research Society meeting. Dr. Dan Saddawi-Konefka and I revisit a question from our very first Depth of Anesthesia episode: is it necessary to confirm mask ventilation...
03.11.2022
28: What is the infectious risk of arterial catheters?
Dr. Ben Weaver and Dr. Elisa Walsh (@elisacwalsh) from Massachusetts General Hospital join the show to discuss the literature around the infectious risk of arterial catheters and the role of barrier precautions. This is the first episode produced from a...
01.10.2022
27: Does BIS monitoring reduce accidental awareness during general anesthesia?
Dr. Bryan Glezerson (@BryanGlezerson), a neuroanesthesiologist in Montreal, Canada, joins the show to discuss the literature around BIS monitoring and awareness with recall under general anesthesia. Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode. ...
07.29.2021
26: Should buprenorphine be discontinued preoperatively?
Dr. Tony Anderson, an anesthesiologist at the Stanford University School of Medicine, joins us to discuss the evolving literature and evidence around perioperative management of buprenorphine. Special thanks to Dr. Ashwini Joshi for her assistance with researching for the episode. ...
06.08.2021
25: Should stress-dose steroids be given?
In this episode, Dr. Jonathan Charnin and Dr. Daniel Saddawi-Konefka join us to explore the evidence around perioperative stress dose steroids and adrenal insufficiency. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and...
04.27.2021
24: Is low flow anesthesia with sevoflurane safe?
In this episode, Dr. Ross Kennedy and Dr. Cas Woinarski join us to discuss the evidence on whether low-flow anesthesia with sevoflurane is safe. We discuss Compound A generation and nephrotoxicity. This episode was made possible through production and research...
03.30.2021
23: What is the data on COVID-19 vaccines? + FAQ
In this episode, Dr. Adam Flaczyk from Massachusetts General Hospital joins us to summarize the data on the latest COVID-19 vaccines and to answer frequently asked questions. Frequently asked questions start at 30:03 including: What is the data on side...
03.16.2021
22: Is evidence-based medicine easy?
In this special episode, Dr. Justin Morgenstern of First10EM joins us to discuss a 6-step approach to primary literature. His strategy will give you the tools to feel more comfortable with taking an active role in reading and critically evaluating...
02.16.2021
21: Should smaller endotracheal tubes be used for elective surgery?
In this episode, we explore the evidence on whether smaller endotracheal tubes are... 1. Less likely to maintain a secure patent airway 2. Less reliable in facilitating positive pressure ventilation 3. Less able to seal the trachea and protect the...
12.11.2020
20: Do lower intraoperative tidal volumes reduce postoperative pulmonary complications?
In this episode, we explore the evidence on whether lower intraoperative tidal volumes (e.g., 6 vs. 9 cc/kg) reduce postoperative pulmonary complications. Our guest is Dr. Avery Tung. Dr. Tung is Professor of Anesthesia & Critical Care at the University...
11.11.2020
19: Is hydrocortisone, ascorbic acid (Vitamin C), and thiamine therapy effective for treatment of sepsis?
In this episode, we discuss the role of hydrocortisone, ascorbic acid (Vitamin C) and thiamine (HAT therapy) in the treatment of patients with septic shock. We discuss biological plausibility and comprehensively review the latest evidence. Our guest is Dr. Jonathan...
10.07.2020
18: Is mixing in lidocaine effective for preventing burning with propofol?
In this episode, we discuss the mechanisms of burning with propofol infusion and explore the evidence behind strategies like mixing lidocaine with propofol. Our guest today is Dr. Stu Forman, Professor of Anesthesiology at Massachusetts General Hospital. He is an...
09.09.2020
17: Is it important to reverse to a train-of-four target of 90%? - Part 2 of 2
In this part II or II series on neuromuscular blockade, we investigate the claim that a train-of-four target of 90% is important to achieve prior to extubation. Our guest today is Dr. Daniel Saddawi-Konefka, residency program director at Mass General....
08.03.2020
16: Is emergence from sevoflurane substantially faster than from isoflurane?
We investigate the claim that emergence from sevoflurane is substantially faster than from isoflurane. We explore rationales and discuss cost. Our guest today is Dr. Keith Baker, Vice Chair of Education at Massachusetts General Hospital. Connect with us @DepthAnesthesia on...
07.03.2020
15: Is dural puncture epidural (DPE) the optimal labor analgesia technique?
In this episode, we investigate the following claims related to DPE: 1. Dural puncture epidural (DPE) technique improves analgesic quality versus traditional epidural 2. DPE technique has faster onset of analgesia versus traditional epidural 3. DPE has less adverse effects...
05.07.2020
14: What is the approach to post-extubation stridor in COVID-19?
In this episode, we explore the evidence for various strategies to manage post-extubation stridor and the applications to COVID-19 patients. Our guest today is Dr. Tiara Calhoun (@tiaraforsyth), an internal medicine resident at the Massachusetts General Hospital. She is an...
04.29.2020
13: Does COVID-19 cause ARDS?
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...
04.11.2020
12: Is COVID-19 spread by aerosols and aerosol-generating procedures?
Our guest today is Dr. Justin Morgenstern (@First10EM). His website (First10EM) provides critical appraisals of important emergency medicine and critical care topics. Connect with us @DepthAnesthesia on Twitter or email us at [email protected] Thanks for listening! Please rate us on...
01.03.2020
11: Does cricoid pressure reduce the risk of pulmonary aspiration?
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...
11.22.2019
10: Is a subjective assessment of functional capacity predictive of perioperative complications?
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...
10.11.2019
9: Is it safe to peripherally administer norepinephrine?
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. Connect...
09.20.2019
8: Does ketorolac increase the risk of bleeding?
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...
08.19.2019
7: How do you reverse neuromuscular blockade? - Part 1 of 2
We investigate claims about reversal of neuromuscular blockade. Claim 1. Location of train-of-four assessment matters Claim 2. Train-of-four is unnecessary with "sufficient" time from the last dose Claim 3. Fade can be discriminated by tactile assessment Our guest today is...
07.29.2019
6: Is the sniffing position optimal for viewing the glottic opening?
We investigate the claim that the sniffing position aligns the "axes" and is the optimal position for viewing the glottic opening. Our guest is Dr. Keith Baker, Vice Chair for Education and a thoracic anesthesiologist at the Massachusetts General Hospital. ...
07.24.2019
5: Do preoperative anxiolytics improve patient satisfaction?
We investigate pro and con positions on preoperative anxiolytics. Pro claim: Preoperative anxiolytics improve patient satisfaction. Con claim: Preoperative anxiolytics delay recovery and discharge. My guest is Dr. Matthew Vanneman, an attending cardiothoracic anesthesiologist at the Massachusetts General Hospital....
06.04.2019
4: Is it safe to administer cefazolin in penicillin-allergic patients?
We investigate the claim that an alternative antibiotic to cephalosporins (e.g., cefazolin) should be selected for penicillin-allergic patients in the perioperative setting. Claim 1. Alternative antibiotics may be as efficacious in preventing surgical site infections Claim 2. Cephalosporins (e.g., cefazolin)...
05.16.2019
3: Does morphine cause more nausea than hydromorphone?
We investigate the claim that morphine causes more nausea than hydromorphone. My guest is Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital. Full show notes available at depthofanesthesia.com. Connect with us @DepthAnesthesia on...
05.02.2019
2: Is it necessary to confirm mask ventilation before paralyzing?
We investigate the claim that mask ventilation should be "checked" or "confirmed" before administering paralytics. My guest is Dr. Daniel Saddawi-Konefka, program director of the Anesthesia Residency Program at Massachusetts General Hospital. Full show notes available at depthofanesthesia.com. Connect...
04.27.2019
1: Welcome to Depth of Anesthesia!
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...

What's Depth of Anesthesia about?

Download our free app to listen on your phone

Depth of Anesthesia episodes:

36. Does tranexamic acid increase the risk of thromboembolism?

35. Does spinal anesthesia decrease the risk of postoperative delirium?

34. Are double lumen endotracheal tubes superior to bronchial blockers?

33. Do perioperative gabapentinoids decrease postoperative pain?

32: Do LMAs increase the risk of aspiration compared to ETTs? - Part II of II

31: Do LMAs increase the risk of aspiration compared to ETTs? - Part I of II

30: Live from the IARS Annual Meeting - Part II of II

29: Live from the IARS Annual Meeting - Part I of II

28: What is the infectious risk of arterial catheters?

27: Does BIS monitoring reduce accidental awareness during general anesthesia?

26: Should buprenorphine be discontinued preoperatively?

25: Should stress-dose steroids be given?

24: Is low flow anesthesia with sevoflurane safe?

23: What is the data on COVID-19 vaccines? + FAQ

22: Is evidence-based medicine easy?

21: Should smaller endotracheal tubes be used for elective surgery?

20: Do lower intraoperative tidal volumes reduce postoperative pulmonary complications?

19: Is hydrocortisone, ascorbic acid (Vitamin C), and thiamine therapy effective for treatment of sepsis?

18: Is mixing in lidocaine effective for preventing burning with propofol?

17: Is it important to reverse to a train-of-four target of 90%? - Part 2 of 2

16: Is emergence from sevoflurane substantially faster than from isoflurane?

15: Is dural puncture epidural (DPE) the optimal labor analgesia technique?

14: What is the approach to post-extubation stridor in COVID-19?

13: Does COVID-19 cause ARDS?

12: Is COVID-19 spread by aerosols and aerosol-generating procedures?

11: Does cricoid pressure reduce the risk of pulmonary aspiration?

10: Is a subjective assessment of functional capacity predictive of perioperative complications?

9: Is it safe to peripherally administer norepinephrine?

8: Does ketorolac increase the risk of bleeding?

7: How do you reverse neuromuscular blockade? - Part 1 of 2

6: Is the sniffing position optimal for viewing the glottic opening?

5: Do preoperative anxiolytics improve patient satisfaction?

4: Is it safe to administer cefazolin in penicillin-allergic patients?

3: Does morphine cause more nausea than hydromorphone?

2: Is it necessary to confirm mask ventilation before paralyzing?

1: Welcome to Depth of Anesthesia!