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

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 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.

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, 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

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, 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

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 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

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!

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

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 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)

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, 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

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!