Interesting Recently-Listened to Medical Podcasts (June 16 2018) / by Muhammad Amir Ayub

As the title implies (with a slight bias towards anesthesia-related podcasts)..

OpenAnesthesia: Concussion and Anesthesia (an interview with Monica Vavilala). We recently had a case that was planned for beach chair positioning but with a "recent" history of concussion (not so recent according to this expert if it's 3 weeks ago). According to this pediatric anesthetist, elective surgery should be delayed until resolution of concussion symptoms (which usually takes up to 10 days). However, we really don't have the complete safety data to back things up (it's all generally just expert opinion). If surgery is needed urgently, cerebral protection must be maintained as there is proof that autoregulation of cerebral blood flow is impaired following even mild traumatic brain injuries.

OpenAnesthesia Article of the Month, an interview with T.J. Gan on Enhanced Recovery After Surgery (ERAS). He is a Malaysian pushing the research in the US on ensuring that patients recover as fast as possible after major surgery, with benefits to both patients and healthcare systems.

OpenAnesthesia: The Opioid Epidemic and Pediatric Anesthesia (interview with Dr. Myron Yaster). While in Malaysia we have been pushing forward wih the “pain as 5th vital sign” initiative, in the  States the opioid epidemic has swung the pendulum to the other direction, and deservedly so. There patients are given so much opioids on their discharge home (in excess of their need) to ensure so-called good satisfaction in regards to their pain relief. Here in Malaysia, we’re just trying to ensure that healthcare workers properly identify patients in pain, and in general it appears that we are still managing it at an appropriate level (looking at how bad the opioid epidemic is in the US, it’s probably better to slightly undertreat pain rather than overtreat it).

JAMA: When Will It Stop? Clinicians Are Still Ordering Routine ECGs Despite Recommendations to the Contrary. It’s interesting how the data shows that the ECG has been shown to be a more and more useless tool for general health screening in low risk individuals. For preop assessment, there is a role for testing, but recommendations are moving towards not performing it mandatorily especially for low risk surgery (even with known disease), as most of the evidence are all level B or worse and perioperative management is not altered. But for sports screening, I would still advocate it, since stopping them from strenuous physical activity (as part of their sports training and play) could be life saving (could Zeke's life be saved by not playing?). Or they could also end up like Jeff Green, who had open heart surgery and was later able to continue playing safely (a miracle of modern medicine), in the NBA Finals no less.