Explore every episode of the podcast Deep Breaths

Today, we look back on one of our most-loved episodes by our listeners. We are joined by special guest Dr Shaun Roberts to discuss in-depth cases of patients with tricky cardiac conditions who require non-cardiac surgery.

Resources for today's episode:

ANZCA Blue Book 2021

ESC Guidelines on cardiovascular assessment and management of patients undergoing non cardiac surgery

2014 ACC/AHA guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non-cardiac Surgery  

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Thanks for listening, and happy studying!

Today, we go back to take 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

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Today, we look back at a fantastic and insightful discussion about upper limb regional anaesthesia with special guest, Dr Michael Kerr. If you liked this episode, you can find the second part of this episode in season 5, episode 12.

In this episode, part 1, we focus on the interscalene block.

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Resources for today's episode:

Anatomy of the brachial plexus and its implications for daily clinical practice: regional anesthesia is applied anatomy by G.C. Feigl et. al.

Video: The Infraclavicular Block - Essentials of Ultrasound-Guided Regional Anesthesia by Ki-Jinn Chin

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine: Executive Summary 2015 by J.M. Neal et. al.

Axillary block videos:

The in-depth video: Ultrasound Guided Axillary Block NYSORA Regional Anesthesia by NYSORA - Education

The short-and-sweet video: Ultrasound Guided Axillary Brachial Plexus Block NYSORA Regional Anesthesia by NYSORA - Education

The simple and fantastic video: US-guided Axillary Brachial Plexus Block - the Simple Guide by Ki-Jinn Chin

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Today, we revisit a topic that was recommended to us by Dr David Tragen of the Sunshine Coast University Hospital - the perioperative management of the direct oral anticoagulant medications or DOACs.

We start with some basic revision of the mechanism of action of the DOACs and their indications before diving more closely into the recommendations for stopping and starting these medications around the time of surgery, and the implications for our anaesthetic.

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Resources for today's episode:

2021 ANZCA Blue Book: Direct Acting Oral Anticoagulants - pharmacology and perioperative considerations by Dr Kate Drummond (p147)

TGA Website

RE-ALIGN Trial

GALILEO Trial

BMJ: Coagulation assessment with the new generation of oral anticoagulants by  Charles Pollack Jr

Journal of Thrombosis and Haemostasis: Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians by J. Douxfils et al.

PAUSE Trial

Regional Anesthesia and Acute Pain: Regional anaesthesia in the patient receiving antithrombotic or thrombolytic therapy, 5th edition (ASRA 2025 Guidelines)

RE-VERSE-AD Trial

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Deep Breaths will return this year with a slightly different twist. We're taking a little break, but that doesn't mean we've forgotten about our wonderful listeners! 

We'll be recording the occasional new episode with guest interviewees that we're excited to be chatting with. We're also going to be re-releasing some of our best episodes.

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Thanks for listening, and happy studying!

In today's episode, we revisit challenges in the diagnosis and management of oesophageal intubation and anaesthetic crises in general. Recognising an oesophageal intubation may seem simple, but by looking at coroner's cases both here in Australia and in the UK, as well as cases in the NAP4, it can be far more complex.

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Resources for today's episode include:

NSW Coroner's Court website

Why does oesophageal intubation still go unrecognised? Lessons for prevention from the coroner’s court

National Audit Project 4

ANZCA Professional Documents

Red Man Syndrome 

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So get ready for something a little different... this week's episode was recorded live from the ANZCA Annual Scientific Meeting 2024, in our home city of Brisbane, Australia. 

We interviewed some fascinating guests, covering topics as diverse as the role of the college moving forward, how we can be more sustainable in anaesthesia, and the future of podcasting; and we had plenty of fun along the way. 

Enjoy this interactive and entertaining discussion with Dr Chris Cokis, Professor David Story, Professor Kate Leslie, Dr Andrew Cumpstey, Professor Eugenie Kayak, and Dr Lahiru Amaratunge. 

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Today's episode is the second of our two part series on ruptured AAA repairs. We discuss the case of a 72 year old man with a ruptured abdominal aortic aneurysm that is contained, and who is scheduled for an urgent endovascular repair within the interventional radiology suite with special guest, Dr Lahiru Amaratunge.

Apologies for the audio quality in this episode - even though it sounds like we recorded on a submarine, we can assure you we were sitting in our study the entire time.

Resources for today's episode:

BJAED: Anaesthesia for endovascular repair of ruptured abdominal aortic aneurysmsby K. Berry et al.

LITFL: AAA by C. Nickson

Lancet: Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial by Patel, R. et al.

Annals of Surgery: Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial by Sweeting, M. et al.

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Today - in part 1 of our 2 part series - we talk through the case of an 82 year old man with a ruptured abdominal aortic aneurysm who is scheduled for urgent open repair with special guest, Dr Lahiru Amaratunge.

Resources for today's episode:

BJAED: Anaesthesia for endovascular repair of ruptured abdominal aortic aneurysms by K. Berry et al.

LITFL: AAA by C. Nickson

Lancet: Endovascular versus open repair of abdominal aortic aneurysm in 15-years' follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial by Patel, R. et al.

Annals of Surgery: Endovascular Repair of Abdominal Aortic Aneurysm in Patients Physically Ineligible for Open Repair: Very Long-term Follow-up in the EVAR-2 Randomized Controlled Trial by Sweeting, M. et al.

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In today's episode, we cover the recently released consensus clinical practice recommendation regarding the peri-procedural use of the GLP-1 and GIP receptor antagonists. 

Enjoy this topical episode - this is sure to be an evolving area.  

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This week we're under the pump with work and life, but we'll be with you soon and it's a cracker of an episode covering an extremely topical subject. 

Keep an eye out for our next episode dropping something in the next couple of weeks. As an apology, we'll have a bonus ep coming sometime towards the end of the season! 

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Today's episode is the final in our series on inotropic and vasopressor medications. Today, we're going to tackle some of the more obscure inotropes and vasopressors - these medications typically aren't encountered terribly often within anaesthesia. During this episode, we discuss milrinone, levosimendan, methylene blue and hydroxocobalamin (Vitamin B12). 

Resources for today's episode:

StatPearls:
Inotropes and vasopressors by D. VanValkinburgh et al.
Adrenergic Drugs by K. Farzam et al.

LITFL:
Inotropes, vasopressors and other vasoactive agents by C. Nickson
Milrinone by C. Nickson
Levosimendan by C. Nickson
Methylene blue by C. Nickson
Hydroxocobalamin by N. Long

Deranged Physiology:
Classification of inotropes and vasopressors
Milrinone
Levosimendan

DRUGBANK Online:
Milrinone
Levosimendan

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Today's episode - the second in our three episode series focusing on inotropic and vasopressor medications - sees us covering some more medications commonly (or uncommonly, depending on your scope of practice) encountered within anaesthesia. During this episode, we discuss vasopressin, dopamine and dobutamine. 

Resources for today's episode:

StatPearls:
Inotropes and vasopressors by D. VanValkinburgh et al.
Adrenergic Drugs by K. Farzam et al.

LITFL:
Inotropes, vasopressors and other vasoactive agents by C. Nickson
Vasopressin by C. Nickson
Dopamine by C. Nickson
Dobutamine by C. Nickson

Deranged Physiology:
Classification of inotropes and vasopressors
Vasopressin
Dobutamine

DRUGBANK Online:
Vasopressin
Dopamine
Dobutamine

BJAED:
Vasopressin and its role in critical care by A. Sharman & J. Low.

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Today's episode is the first in a series of three that focus on inotropic and vasopressor medications used within anaesthetic practice. During this episode, we discuss metaraminol, ephedrine, phenylephrine, noradrenaline and adrenaline. 

There's one section of our episode where we thought it important to clarify what we're saying, as to out ears it sounds a little confusing. During our discussion about adrenaline, we state that both noradrenaline and adrenaline have the same affinity for beta-1 adrenoceptors. We then advise that the reason for the inotropic and chronotropic effects of adrenaline - not seen with noradrenaline - are because adrenaline has much greater affinity for beta-2 adrenaceptors than noradrenaline.

Resources for today's episode:

StatPearls:
Inotropes and vasopressors by D. VanValkinburgh et al.
Adrenergic Drugs by K. Farzam et al.

LITFL:
Inotropes, vasopressors and other vasoactive agents by C. Nickson
Metaraminol by R. Buttner
Phenylephrine by C. Nickson
Noradrenaline by C. Nickson
Adrenaline by C. Nickson

Deranged Physiology:
Classification of inotropes and vasopressors
Metaraminol
Noradrenaline
Adrenaline

DRUGBANK Online:
Metaraminol
Ephedrine
Phenylephrine
Noradrenaline
Adrenaline

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Today, we discuss a 2023 BJA Education article titled 'Perioperative care for transgender and gender diverse adults'.  We start with a discussion of words and terms that are useful to understand, before diving in to discussions about a trauma-informed care approach to minimise and hopefully eradicate negative preoperative experiences, physical, chemical and surgical options for gender affirmation, and lastly how this can inform the provision of safe anaesthesia for transgender patients.

Resources for this episode:

BJA Education: Perioperative considerations for transgender and gender diverse adults by Harding, D. et al.

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Today, in part 2 of our 2 part series on anaesthesia for previous heart transplant recipients, we discuss the care of these patients for non-cardiac surgery with special guest, Dr Ivan Rapchuk.

We begin by covering the electrophysiology of a transplanted heart and what you may see on the ECG, and then proceed to the management of our theoretical patient for general anaesthesia for non-cardiac surgery.

Resources for this episode:

Oxford Handbook of Transplant Anaesthesia and Critical Care

BJAED: Anaesthesia for a patient with a cardiac transplant (2002) by Morgan-Hughes, N. & Hood, G.

Circulation (2004): Drug therapy in the heart transplant recipient by Lindenfeld, J. et al.

Indian Journal of Anaesthesia: Post cardiac transplant recipient: Implications for anaesthesia by M. Choudhury

RCEM India Learning - The ECG after cardiac transplantation

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Today, in part 1 of our 2 part series on anaesthesia for previous heart transplant recipients, we discuss the care of these patients for non-cardiac surgery with special guest, Dr Ivan Rapchuk.

We start our discussion with a review of how to assess whether these patients are suitable for elective surgery, and follow this with a deep-dive on the typical immunosuppressant medications that these patients may be taking,  as well as their mechanism of action and side effects.

Resources for this episode:

Oxford Handbook of Transplant Anaesthesia and Critical Care

BJAED: Anaesthesia for a patient with a cardiac transplant (2002) by Morgan-Hughes, N. & Hood, G.

Circulation (2004): Drug therapy in the heart transplant recipient by Lindenfeld, J. et al.

Indian Journal of Anaesthesia: Post cardiac transplant recipient: Implications for anaesthesia by M. Choudhury

RCEM India Learning - The ECG after cardiac transplantation

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Today, we discuss the rise of GLP-1 receptor agonists - what they are, how they work, and how they affect fasting during the perioperative period. 

Resources for today's episode:

StatPearls: Physiology, Gastrointestinal Hormonal Control by Parikh, A. & Thevenin, C.
https://www.ncbi.nlm.nih.gov/books/NBK537284/

StatPearls: Glucagon-like Peptide-1 Receptor Agonists by Collins, L. & Costello, R.
https://www.ncbi.nlm.nih.gov/books/NBK551568/ 

ANZCA PG07(A) Appendix
https://www.anzca.edu.au/getattachment/897f5bf5-b665-4c99-a56f-e72678f19f7e/PG07(A)-Appendix-1-%E2%80%93-Fasting-guideline 

ADS-ANZCA Perioperative and Hyperglycaemia Guidelines (Adults)
https://www.diabetessociety.com.au/wp-content/uploads/2023/03/ADS-ANZCA-Perioperative-Diabetes-and-Hyperglycaemia-Guidelines-Adults-November-2022-v2-Final.pdf 

Up To Date: Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus by Dungan, K. & DeSantis, A.
https://www.uptodate.com/contents/glucagon-like-peptide-1-based-therapies-for-the-treatment-of-type-2-diabetes-mellitus#:~:text=Like%20native%20GLP%2D1%2C%20all,%27Glycemic%20efficacy%27%20below.) 

American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists by Joshi, G. et al.
https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative

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It's taken almost a year, but we're finally giving you part 2 of our series on complex and uncommon cardiac conditions for non-cardiac surgery with special guest, Dr Shaun Roberts. Hold on to your earphones - this episode is a long one! If you haven't listened to part one, you can find it within season 6 - be sure to check it out before you listen to part 2.

Today, we discuss anaesthesia for patient's with ventricular assist devices (or VADs), and we talk about providing anaesthetic care for a patient with a hypertrophic obstructive cardiomyopathy (or HOCM).

Resources for today's episode:

ANZCA Blue Book 2021

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Today, we take a close look at the SNACC guidelines for the diagnosis and treatment of neuroanaesthetic emergencies, and take a little time to discuss each of these emergencies in turn.

Resources for the episode:

Cognitive aids for the diagnosis and treatment of neuroanaesthetic emergencies: Consensus guidelines on behalf of the Society for Neuroscience in Anaesthesiology and Critical Care (SNACC) education committee by Hoefnagel, A.L. et al. (full journal article)

SNACC cognitive aids for neurosurgical emergencies (cognitive aids only)

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Today, in part two of our two part series looking at perioperative hypotension and acute kidney injury (AKI), we take a closer look at the methods we can adopt - as anaesthetists - to try to prevent perioperative AKI and the evidence of their effectiveness in preventing this complication.

Resources for today's episode:

BJA: Role of perioperative hypotension in postoperative acute kidney injury: a narrative review (sciencedirectassets.com) by Lankadeva, Y. et al.

KDIGO 2012 Acute Kidney Injury Guidelines

LITFL: RIFLE criteria and AKIN classification

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Today, in part one of our two part series looking at perioperative hypotension and acute kidney injury (AKI), we take a close look at the diagnostic criteria for acute kidney injury. We then briefly revise aspects of renal physiology that make the kidney particularly susceptible to hypoxic injury, as well as looking at risk factors and other facets of anaesthesia that additionally predispose the kidney to perioperative injury.

In part two - which will be released in a fortnight - we will take a closer look at the methods we can adopt as anaesthetists to try to prevent perioperative AKI and the evidence of their effectiveness in preventing this complication.

Resources for today's episode:

BJA: Role of perioperative hypotension in postoperative acute kidney injury: a narrative review (sciencedirectassets.com) by Lankadeva, Y. et al.

KDIGO 2012 Acute Kidney Injury Guidelines

LITFL: RIFLE criteria and AKIN classification

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Today we continue our discussion regarding preoperative functional capacity assessment. We'll cover the M-DASI, the 6-minute walk test, and put it all together to figure out how this applies to our practice as anaesthetists.

Resources for today's episode include:

BJAED: Subjective methods for preoperative assessment of functional capacity by Silvapulle & Darvall

BJA: A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study by Riedel, B. et al.

BJAED: Preoperative cardiopulmonary exercise testing by Agnew. N.

BJA: Using the six-minute walk test to predict disability free survival after major surgery by Shulman, M. et al.

STAT Pearls: 6 minute walk test by Matos Casano, M. & Anjum, F.

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Today, in part one of our two part series, we're taking a close look at the methods for performing pre-operative functional capacity assessments and their utility in predicting patient outcomes. In part 1, we focus our discussion on METS, activities of daily living (ADLs) and the DASI score.

In part two - which will be released in a fortnight - we'll cover the M-DASI, the 6-minute walk test.

Resources for today's episode:

BJAED: Subjective methods for preoperative assessment of functional capacity by Silvapulle & Darvall

BJA: A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study by Riedel, B. et al.

BJAED: Preoperative cardiopulmonary exercise testing by Agnew. N.

BJA: Using the six-minute walk test to predict disability free survival after major surgery by Shulman, M. et al.

STAT Pearls: 6 minute walk test by Matos Casano, M. & Anjum, F.

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Deep Breaths returns next Monday February 5th with all new episode topics that we're sure will help with exam prep, and will keep your practice up to date. We'll also be joined by more wonderful guests this season and we can't wait to share their expertise with you all, so be sure to tune in and experience the learning revolution!

Links for Lahiru Amaratunge's ANZCA Part 2 exam programs:

Viva Boot Camp Courses (via Anaesthesia Collective)

Online Part 2 Preparation Courses and ABCs of Anaesthesia Foundation Course (via Thinkific) - don't forget to use the code DB20 for 20% off when you purchase any of the two Anaesthetic part 2 exam preparation courses or the Anaesthesia Foundation course.

If you'd like more information about any of these programs, you can email Lahiru at vivabootcamp@gmail.com. 

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Part 2 of our two-part series looking at common problems encountered in the post-anaesthetic care unit. We hope you enjoy another of our favourite topics. 

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This two part series looks at some common problems we encounter in the post-anaesthetic care unit (PACU). It's another of our favourite topics and well worth the review. 

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The final episode on our two-part series on cases in paediatric anaesthesia with special guest, Dr Paul Lee-Archer. Another of our favourites, we hope you enjoy it as much as we did.

Resources for today's episode:

Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatmentby Nair, S. & Wolf, A.

Paediatric massive transfusion by Blain, S. & Paterson, N.

Dilemmas in the preoperative assessment of children by Bhatia, N. & Barber, N. 

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Our two-part series on paediatrics in which we discuss previous anaesthetic viva scenarios with special guest, Dr Paul Lee-Archer, is another favourite of ours. 

Resources for today's episode:

Emergence delirium after paediatric anaesthesia: new strategies in avoidance and treatment by Nair, S. & Wolf, A.

Paediatric massive transfusion by Blain, S. & Paterson, N.

Dilemmas in the preoperative assessment of children by Bhatia, N. & Barber, N. 

Feel free to email us at deepbreathspod@gmail.com 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!

Our second and final episode in our two-part series looking at cases involving one-lung ventilation with special guest, Dr Ivan Rapchuk. This series is one of our favourites!

Resources for today's episode:

Pre-anaesthetic assessment for thoracic surgery by Peter Slinger and Gail Darling.

Feel free to email us at deepbreathspod@gmail.com 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!

One lung ventilation can be tricky, but our two part series with special guest Dr Ivan Rapchuk, attempts to break it down and make it easier to both approach and understand. This series is another favourite!

Resources for this episode:

Pre-anaesthetic assessment for thoracic surgery by Peter Slinger and Gail Darling.

Feel free to email us at deepbreathspod@gmail.com 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!

Obstructive sleep apnoea is an ongoing challenge for anaesthetists. In this episode - another favourite - we discuss sleep apnoea in the context of anaesthesia with special guest, Dr Hamish Pollock. 

Reference for this episode:

Perioperative considerations in the management of obstructive sleep apnoea by Holt, N. et al.  

Feel free to email us at deepbreathspod@gmail.com 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!

In today’s episode, we revisit one of our earliest and most topics - awareness. What it is, how it happens, and most importantly, how to prevent it.

Resources for this episode include:

National Audit Project 5 (NAP5) - https://www.nationalauditprojects.org.uk/NAP5home

B-Aware trial - https://www.sciencedirect.com/science/article/pii/S0140673604163009?via%3Dihub

B-Unaware trial - https://www.nejm.org/doi/full/10.1056/nejmoa0707361

BAG-RECALL trial - https://www.nejm.org/doi/full/10.1056/NEJMoa1100403

Feel free to email us at deepbreathspod@gmail.com 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!

Feel free to email us at deepbreathspod@gmail.com 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!

Bad Blood is a two-episode miniseries that takes a closer look at ROTEM. It's a favourite episode of ours and we hope you enjoy listening again too. 

References for part 2:

Deranged Physiology - Interpretation of abnormal ROTEM data.

ROTEM product information and interpretation instructions with case examples.

NHS University Hospitals Sussex ROTEM interpretation flow diagram.

ROTEM e-learning modules. Note: this website defaults to the German language. Google offers a translation service if you do not speak German.

ANZCA 2017 Blue Book. There are several good articles about ROTEM in this issue of the Blue Book. 

Feel free to email us at deepbreathspod@gmail.com 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!

Bad Blood is a two-episode miniseries that takes a closer look at ROTEM. It's a favourite episode of ours and we hope you enjoy listening again too. 

References for part 1:
ROTEM e-learning modules. Note: this website defaults to German language, but can be changed. Alternatively, Google offers a translation service for the website.

ROTEM product information and interpretation instructions with case examples. 

Feel free to email us at deepbreathspod@gmail.com 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!

Sweet Leaf looks at the ways in which medical marijuana impact the provision of safe and effective anaesthesia. This episode is one of our favourites, and is increasingly relevant to our clinical practice as we see more patients presenting for surgery in whom medical marijuana therapy is prescribed. 

Feel free to email us at deepbreathspod@gmail.com 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!

Deep Breaths returns next Monday August 14th with a selection of wonderful topics to help boost your exam prep, and to help keep you up to date. This season will be a little different though. We're taking a well-earned break (our first since Deep Breaths started in August 2020) and for season 7 we will be re-releasing seven of our favourite topics previously already released in earlier seasons. We'll be back with brand new episodes in season 8 next year - fully refreshed, rejuvenated, and ready to sink our teeth into many more interesting topics with a host of brand new as well as previously beloved guest interviewees. So watch this space!

A link to Lahiru Amaratunge's Viva Boot Camp (live zoom-based course) via the Anaesthesia Collective can be found here.

A link to Lahiru Amaratunge's Anaesthesia Final Exam Course - an online course able to be accessed anytime (great for those unable to tune in to the Viva Boot Camp) can be found here.  

Feel free to email us at deepbreathspod@gmail.com 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 deep dive into the pros and cons of having the families of patients present in operating rooms beyond what is already in practice for paediatric anaesthesia and caesarean sections. 

Resources for today's episode:

Could, Should Families Watch Their Loved One's Surgeries and, If So, When? By Quinonez, Z.A. et al.  Note: ANZCA members can access this title via the ANZCA library.

Feel free to email us at deepbreathspod@gmail.com 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 are joined by special guest Dr Shaun Roberts to discuss in-depth cases of patients with tricky cardiac conditions who require non-cardiac surgery.

Resources for today's episode:

ANZCA Blue Book 2021

ESC Guidelines on cardiovascular assessment and management of patients undergoing non cardiac surgery

2014 ACC/AHA guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Non-cardiac Surgery  

Feel free to email us at deepbreathspod@gmail.com 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 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 deepbreathspod@gmail.com 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 share our fourth and final discussion in our four part series about statistics with Dr Shannon Morrison. 

In this episode, we discuss the following topics:

• the research methodology for designing a clinical trial
• pilot trials
• bias and confounding
• ethics committees and the process of ethics approval
• Forest plots

Resources for today's episode:

Zedstatistics (youtube channel) - short videos explaining various concepts in statistics from an Australian Statistician

Johns Hopkins Coursera Short Course - Biostatistics in Public Health (this course has free enrolment and takes approx 4 months to complete - it commenced on January 30th)

Feel free to email us at deepbreathspod@gmail.com 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!