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 depthofanesthesia@gmail.com 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/. https://first10em.com/aerosols-droplets-and-airborne-spread/ __ By listening to this podcast, you agree not to use information as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. Opinions expressed are solely those of the host and guests and do not express the views or opinions of Massachusetts General Hospital.  

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

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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Dr. Caroline Andrew and Dr. David Nathan join the show to discuss the literature pertaining to intraoperative administration of dexamethasone. Dr. Caroline Andrew is an anesthesia resident at the Massachusetts General Hospital. Dr. David Nathan is the Director of the Diabetes Center at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School.  This podcast was recorded as part of the Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues. — Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Tien M, Gan TJ, Dhakal I, White WD, Olufolabi AJ, Fink R, Mishriky BM, Lacassie HJ, Habib AS. The effect of anti-emetic doses of dexamethasone on postoperative blood glucose levels in non-diabetic and diabetic patients: a prospective randomised controlled study. Anaesthesia. 2016 Sep;71(9):1037-43. doi: 10.1111/anae.13544. PMID: 27523051. Polderman JA, Farhang-Razi V, Van Dieren S, Kranke P, DeVries JH, Hollmann MW, Preckel B, Hermanides J. Adverse side effects of dexamethasone in surgical patients. Cochrane Database Syst Rev. 2018 Nov 23;11(11):CD011940. doi: 10.1002/14651858.CD011940.pub3. PMID: 30480776; PMCID: PMC6426282. Andrew J. Toner, Vyhunthan Ganeshanathan, Matthew T. Chan, Kwok M. Ho, Tomas B. Corcoran; Safety of Perioperative Glucocorticoids in Elective Noncardiac Surgery: A Systematic Review and Meta-analysis. Anesthesiology 2017; 126:234–248 doi: https://doi.org/10.1097/ALN.0000000000001466 Corcoran TB, O'Loughlin E, Chan MTV, Ho KM. Perioperative Administration of Dexamethasone And blood Glucose concentrations in patients undergoing elective non-cardiac surgery - the randomised controlled PADDAG trial. Eur J Anaesthesiol. 2021 Sep 1;38(9):932-942. doi: 10.1097/EJA.0000000000001294. PMID: 32833858. Pang, QY., Wang, JY., Liang, XL. et al. The safety of perioperative dexamethasone with antiemetic dosage in surgical patients with diabetes mellitus: a systematic review and meta-analysis. Perioper Med 12, 4 (2023). https://doi.org/10.1186/s13741-023-00293-4 De Oliveira GS Jr, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials. Anesth Analg. 2013 Jan;116(1):58-74. doi: 10.1213/ANE.0b013e31826f0a0a. Epub 2012 Dec 7. PMID: 23223115.

37: Should intraoperative dexamethasone be avoided in patients with diabetes mellitus?

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 faculty appointment in the Division of Hematology and Blood Transfusion Service and is assistant professor of medicine at Harvard Medical School. This podcast was recorded as part of the Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues. — Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References CRASH-2 trial collaborators; Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010 Jul 3;376(9734):23-32. doi: 10.1016/S0140-6736(10)60835-5. Epub 2010 Jun 14. PMID: 20554319. Henry DA, Carless PA, Moxey AJ, et al. Anti‐fibrinolytic use for minimising perioperative allogeneic blood transfusion. Cochrane Database of Systematic Reviews. 2011;(1). doi:10.1002/14651858.CD001886.pub3 Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054. doi:10.1136/bmj.e3054 Myles PS, Smith JA, Forbes A, et al. Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery. New England Journal of Medicine. 2017;376(2):136-148. doi:10.1056/NEJMoa1606424 Devereaux PJ, Marcucci M, Painter TW, et al. Tranexamic Acid in Patients Undergoing Noncardiac Surgery. New England Journal of Medicine. 2022;386(21):1986-1997. doi:10.1056/NEJMoa2201171 POISE 3 PeriOperative ISchemic Evaluation-3 (POISE-3) study Shakur H, Roberts I, Fawole B, et al. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum hemorrhage (WOMAN): an international, randomized, double-blind, placebo-controlled trial. The Lancet. 2017;389(10084):2105-2116. doi:10.1016/S0140-6736(17)30638-4 Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. The Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 Taeuber I, Weibel S, Herrmann E, et al. Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Surgery. 2021;156(6):e210884. doi:10.1001/jamasurg.2021.0884

36. Does tranexamic acid increase the risk of thromboembolism?

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 Professor of Anesthesiology at Penn Medicine. Dr. Sam Falkson is an anesthesia resident at the Massachusetts General Hospital. This podcast was recorded as part of the Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues. — Follow us on Instagram @DepthofAnesthesia and on Twitter (X) @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Guay J, Parker MJ, Gajendragadkar PR, Kopp S. Anaesthesia for hip fracture surgery in adults. Cochrane Database Syst Rev. 2016;2(2):CD000521. Ravi B, Pincus D, Choi S, Jenkinson R, Wasserstein DN, Redelmeier DA. Association of duration of surgery with postoperative delirium among patients receiving hip fracture repair. JAMA Netw Open. 2019;2(2):e190111. Patel V, Champaneria R, Dretzke J, Yeung J. Effect of regional versus general anaesthesia on postoperative delirium in elderly patients undergoing surgery for hip fracture: a systematic review. BMJ Open. 2018;8(12):e020757. Zheng X, Tan Y, Gao Y, Liu Z. Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials. BMC Anesthesiol. 2020 Jun 30;20(1):162. Neuman MD, Feng R, Carson JL, et al. Spinal anesthesia or general anesthesia for hip surgery in older adults. N Engl J Med. 2021;385(22):2025-2035. Rathmell JP, Avidan MS. Patient-centered outcomes after general and spinal anesthesia. N Engl J Med. 2021 Nov 25;385(22):2088–9. Stone AB, Poeran J, Memtsoudis SG. There remains a role for neuraxial anesthesia for hip fracture surgery in the post-REGAIN era. Reg Anesth Pain Med. 2023 Aug;48(8):430-432. doi: 10.1136/rapm-2022-104071. Epub 2023 Mar 28. PMID: 36977527. Li T, Li J, Yuan L, et al. Effect of regional vs general anesthesia on incidence of postoperative delirium in older patients undergoing hip fracture surgery: the raga randomized trial. JAMA. 2022;327(1):50-58.

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

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 to Dan for supporting the ongoing Depth of Anesthesia podcast elective. Thanks for listening! If you enjoy our content, leave a 5-star review on Apple Podcasts and share our content with your colleagues. — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you'd like to join our team. Music by Stephen Campbell, MD. — References Clayton-Smith A, Bennett K, Alston RP, Adams G, Brown G, Hawthorne T, Hu M, Sinclair A, Tan J. A Comparison of the Efficacy and Adverse Effects of Double-Lumen Endobronchial Tubes and Bronchial Blockers in Thoracic Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth. 2015 Aug;29(4):955-66. doi: 10.1053/j.jvca.2014.11.017. Epub 2014 Dec 2. PMID: 25753765. Uwe Klein, Waheedullah Karzai, Frank Bloos, Mathias Wohlfarth, Reiner Gottschall, Harald Fritz, Michael Gugel, Albrecht Seifert; Role of Fiberoptic Bronchoscopy in Conjunction with the Use of Double-lumen Tubes for Thoracic Anesthesia : A Prospective Study. Anesthesiology 1998; 88:346–350 doi: https://doi.org/10.1097/00000542-199802000-00012 Risse J, Szeder K, Schubert AK, Wiesmann T, Dinges HC, Feldmann C, Wulf H, Meggiolaro KM. Comparison of left double lumen tube and y-shaped and double-ended bronchial blocker for one lung ventilation in thoracic surgery-a randomised controlled clinical trial. BMC Anesthesiol. 2022 Apr 2;22(1):92. doi: 10.1186/s12871-022-01637-1. PMID: 35366801; PMCID: PMC8976407. Morris BN, Fernando RJ, Garner CR, Johnson SD, Gardner JC, Marchant BE, Johnson KN, Harris HM, Russell GB, Wudel LJ Jr, Templeton TW. A Randomized Comparison of Positional Stability: The EZ-Blocker Versus Left-Sided Double-Lumen Endobronchial Tubes in Adult Patients Undergoing Thoracic Surgery. J Cardiothorac Vasc Anesth. 2021 Aug;35(8):2319-2325. doi: 10.1053/j.jvca.2020.11.056. Epub 2020 Nov 28. PMID: 33419686. Jo Mourisse, Jordi Liesveld, Ad Verhagen, Garance van Rooij, Stefan van der Heide, Olga Schuurbiers-Siebers, Erik Van der Heijden; Efficiency, Efficacy, and Safety of EZ-Blocker Compared with Left-sided Double-lumen Tube for One-lung Ventilation. Anesthesiology 2013; 118:550–561 doi: https://doi.org/10.1097/ALN.0b013e3182834f2d

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

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 Podcasts and share our content with your colleagues.  — Follow us on Instagram @DepthofAnesthesia and on Twitter @DepthAnesthesia for podcast and literature updates. Email us at depthofanesthesia@gmail.com with episode ideas or if you’d like to join our team. Music by Stephen Campbell, MD. — References Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002 Sep;97(3):560-4. doi: 10.1097/00000542-200209000-00007. PMID: 12218520. Ian Gilron; Is Gabapentin a “Broad-spectrum” Analgesic?. Anesthesiology 2002; 97:537–539 doi: https://doi.org/10.1097/00000542-200209000-00004 Mishriky BM, Waldron NH, Habib AS. Impact of pregabalin on acute and persistent postoperative pain: a systematic review and meta-analysis. Br J Anaesth. 2015 Jan;114(1):10-31. doi: 10.1093/bja/aeu293. Epub 2014 Sep 10. PMID: 25209095.Fabritius ML, Geisler A, Petersen PL, Nikolajsen L, Hansen MS, Kontinen V, Hamunen K, Dahl JB, Wetterslev J, Mathiesen O. Gabapentin for post-operative pain management - a systematic review with meta-analyses and trial sequential analyses. Acta Anaesthesiol Scand. 2016 Oct;60(9):1188-208. doi: 10.1111/aas.12766. Epub 2016 Jul 18. Erratum in: Acta Anaesthesiol Scand. 2017 Mar;61(3):357-359. PMID: 27426431. Chan JSK, Harky A. Trial sequential analysis in meta-analyses: A clinically oriented approach with real-world example. J Thorac Cardiovasc Surg. 2021 Jul;162(1):167-173. doi: 10.1016/j.jtcvs.2020.06.063. Epub 2020 Jun 27. PMID: 32868066. Clephas PRD, Kranke P, Heesen M. How to perform and write a trial sequential analysis. Anaesthesia. 2022 Jul 13. doi: 10.1111/anae.15811. Epub ahead of print. PMID: 35831946. Michael Verret, François Lauzier, Ryan Zarychanski, Caroline Perron, Xavier Savard, Anne-Marie Pinard, Guillaume Leblanc, Marie-Joëlle Cossi, Xavier Neveu, Alexis F. Turgeon, the Canadian Perioperative Anesthesia Clinical Trials (PACT) Group; Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain: A Systematic Review and Meta-analysis. Anesthesiology 2020; 133:265–279 doi: https://doi.org/10.1097/ALN.0000000000003428 Deljou A, Hedrick SJ, Portner ER, Schroeder DR, Hooten WM, Sprung J, Weingarten TN. Pattern of perioperative gabapentinoid use and risk for postoperative naloxone administration. Br J Anaesth. 2018 Apr;120(4):798-806. doi: 10.1016/j.bja.2017.11.113. Epub 2018 Feb 10. PMID: 29576120. Kharasch ED, Clark JD, Kheterpal S. Perioperative Gabapentinoids: Deflating the Bubble. Anesthesiology. 2020 Aug;133(2):251-254. doi: 10.1097/ALN.0000000000003394. PMID: 32667153; PMCID: PMC7367437.

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

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