What could go wrong during a routine sedation case?

A patient presents for a seemingly straightforward procedure. She’s appropriately fasted, has no obvious aspiration risk factors, and the plan is simple: propofol sedation, spontaneous ventilation, and local anesthesia from the surgeon.

Then everything changes.

In this episode of The Anesthesia Playbook, we work through a case inspired by a real event and put you in the anesthesiologist’s seat as the situation evolves.

What would you do next—and more importantly, why?

Follow along, commit to your decisions, and see how your approach compares as the case unfolds.

Understand more. Memorize less.

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A 45-year-old woman with poorly controlled Graves disease presents for thyroidectomy with a massive goiter, positional dyspnea, and subtle stridor. The question isn’t just how you’re going to secure the airway—it’s what could happen if you take away the things currently keeping it open.

In this episode of The Anesthesia Playbook, we work through the case from pre-op evaluation to the PACU. We’ll reason through the difficult airway, awake intubation, anesthetic planning, thyroid physiology, and the recognition and treatment of thyroid storm. Then, just when the case seems finished, new postoperative problems force us to rethink the differential: hoarseness, neck swelling, and stridor.

Along the way, we’ll tackle the kinds of questions that matter both in the OR and on oral boards:

Would you sedate this patient? Would you induce general anesthesia before securing the airway? How would you recognize thyroid storm—and distinguish it from malignant hyperthermia? What would you do if she developed an expanding neck hematoma after surgery?

This isn’t about memorizing a list of answers. It’s about understanding the physiology, anticipating what could happen next, and making a defensible clinical decision.

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Understand more. Memorize less.

The Anesthesia Playbook is intended for education only and does not replace clinical judgment, institutional protocols, or appropriate supervision.

In this episode of The Anesthesia Playbook, we walk through a real-world case of aortic stenosis anesthesia for a patient undergoing shoulder arthroplasty in the beach chair position.

This case highlights the critical importance of hemodynamic management, myocardial oxygen supply and demand, and cerebral perfusion in patients with fixed outflow obstruction.

We break down:

• How to manage aortic stenosis in the OR
• Choosing and performing an interscalene block + superficial cervical plexus block
• Airway considerations including diabetic stiff joint syndrome and difficult intubation
• Why phenylephrine is the pressor of choice
• Understanding stroke volume, preload, afterload, and contractility
• The role of atrial kick and sinus rhythm in cardiac output
• Myocardial ischemia from tachycardia and hypotension
• Risks of the beach chair position, including cerebral hypoperfusion
• Cerebral autoregulation and why chronic hypertension shifts the curve
• Managing Bezold-Jarisch reflex in shoulder surgery

This episode is designed for anesthesia residents, CRNAs, and practicing anesthesiologists who want a clear, case-based understanding of complex physiology without memorizing textbooks.

If you want to better understand how physiology applies in real cases and how to stay ahead of complications in the OR this episode is for you.

On this episode of The Anesthesia Playbook, we break down one of the most important and high-yield patients in obstetric anesthesia: the preeclamptic patient.

This case-based episode walks through a real-world scenario, from labor epidural placement to urgent Cesarean section, while teaching the physiology, anesthetic decision-making, and complication management you need to understand to take care of these patients safely.

We cover:

• The pathophysiology of preeclampsia (and why it’s more than just hypertension)
• Key pregnancy physiology that drives anesthetic management
• Epidural vs spinal vs CSE in preeclamptic patients
• Platelet thresholds and neuraxial anesthesia considerations
• Practical epidural tips in patients with scoliosis
• Blood pressure goals and vasopressor management
• Magnesium sulfate: mechanism, benefits, and anesthetic implications
• Fluid management and risk of pulmonary edema
• Intraoperative management for Cesarean section
• Postoperative complications including respiratory distress and lower extremity weakness

This episode is designed for anesthesia residents, CRNAs, and practicing anesthesiologists who want a clear, physiology-based understanding of preeclampsia and how to manage it in real clinical scenarios.

If you’ve ever wondered:

• “Is it safe to place an epidural with low platelets?”
• “Why can fluids worsen preeclampsia?”
• “What’s the safest anesthetic for a C-section in these patients?”

This episode answers those questions and more.

Studies showing benefit of using "individualized PEEP" which is often higher than convention.

Another study showing benefit of individualized PEEP in abdominal surgeries.

In this episode, we walk through a real-world case of an obese patient undergoing a robotic hysterectomy, and why these cases can quickly become a ventilation challenge.

Obesity, pneumoperitoneum, and steep Trendelenburg create a perfect storm for decreased functional residual capacity (FRC), increased closing capacity, and worsening lung compliance. If you don’t anticipate these changes early, you’ll spend the entire case trying to catch up.

We break this case down step by step, just like you should in the OR:

• Identifying your biggest concerns in an obese patient undergoing robotic surgery
• Defining your anesthetic goals for ventilation and oxygenation
• Understanding how obesity and positioning affect FRC and closing capacity
• How pneumoperitoneum and Trendelenburg worsen compliance
• Using PEEP effectively to prevent atelectasis and improve oxygenation
• Interpreting airway pressures, including plateau pressure and driving pressure
• Recognizing and managing hypoxia in the PACU

You’ll be challenged with questions throughout the episode, forcing you to pause, think, and apply what you know in real time.

Because that’s how you train your mind to respond under pressure.

We also highlight key patterns you’ll see again and again:

Obesity + anesthesia → decreased FRC and rapid atelectasis
Closing capacity exceeding FRC → airway closure and hypoxia
Laparoscopy + Trendelenburg → decreased compliance and increased airway pressures
Poor ventilatory strategy → postoperative hypoxia

By the end of this episode, you’ll have a clear framework for managing ventilation in obese patients undergoing robotic surgery—and a better understanding of how to stay ahead of the physiology.

This episode is especially relevant for anesthesia residents and is commonly tested on written and oral board exams.

The goal isn’t to give you more to memorize.

It’s to change how you think.

Understand more. Hesitate less.

How should you actually use The Anesthesia Playbook?

In this episode, we break down the method behind the podcast, and how to use it to improve your clinical thinking in the OR.

Because the problem isn’t effort.
It’s the system.

Most anesthesia learning is built around textbooks and isolated topics.
But real anesthesia doesn’t happen one chapter at a time.

It happens in patients with multiple comorbidities, evolving physiology, and real-time decision making.

The Anesthesia Playbook is built differently.

Each episode is structured around a real clinical case, guiding you through the same thought process you should be using every day in the operating room:

• Identifying your biggest concerns
• Defining your anesthetic goals
• Understanding key physiology and pathology
• Anticipating complications before they happen
• Applying that knowledge directly back to the patient

You won’t just listen—you’ll be challenged with questions throughout each episode, forcing you to pause and think.

Because that’s how you train your mind to respond under pressure.

We also focus on pattern recognition and spaced repetition, so the same high-yield concepts like hemodynamics, ventilation, and pharmacology start to stick and become second nature.

These episodes are designed to fit into your day:

On your commute
Between cases
At the gym
Or whenever you have 20–30 minutes to learn something that actually matters.

Alongside the podcast, we’ll also provide high-yield study guides and quick-reference materials to help you go deeper when you need to without wasting time.

Whether you’re:
• A CA-1 building your foundation
• A CA-2 or CA-3 preparing for oral boards
• Or an attending looking to stay sharp

This podcast is designed to help you show up prepared, think ahead, and manage cases with confidence.

The goal isn’t to give you more to memorize.

It’s to change how you think.

Welcome to The Anesthesia Playbook.
Where anesthesia stops being memorized and starts being understood.

Welcome to The Anesthesia Playbook—a modern, case-based approach to learning anesthesia.

If you’ve ever struggled to get through long textbook chapters… felt unprepared walking into the OR… or found yourself memorizing facts without truly understanding how to apply them...then this is for you.

Because the truth is, anesthesia isn’t learned one chapter at a time.

It’s learned in real patients. Real decisions. Real moments where you have to think quickly and act with confidence.

This podcast is built to help you think like an anesthesiologist.

Not just pass exams.
Not just memorize information.
But actually understand what’s happening in front of you and what to do next.

Each episode of The Anesthesia Playbook is designed around real clinical scenarios, guiding you through:

• Key concerns for the patient
• Goals of the anesthetic
• High-yield physiology and pathology
• Common and high-risk complications
• Practical, real-world decision making

You’ll be challenged with questions throughout each episode so you’re not just listening, you’re actively thinking.

Because that’s how you train your mind to respond under pressure.

Whether you’re:
• A CA-1 trying to build a strong foundation
• A CA-2 or CA-3 preparing for oral boards
• Or an attending looking to stay sharp

This podcast is designed to fit into your day and improve your clinical thinking. One case at a time.

With spaced repetition, high-yield concepts, and real-world application, you’ll start to recognize patterns faster, build stronger differentials, and approach cases with confidence.

This is your go-to resource for:
anesthesia residents, anesthesia boards, oral boards prep, physiology, pharmacology, airway management, regional anesthesia, pediatric anesthesia, critical care, and real-world OR decision making.

Welcome to The Anesthesia Playbook.

Where anesthesia stops being memorized… and starts being understood.