OpenAnesthesia is dedicated to promoting evidenced based medicine in anesthesiology, critical care, and pain management.

Wiggles, Squiggles, and Drugs: Neuromonitoring with Michael Puglia

Direct download: 201912SPAVGR.m4v
Category:general -- posted at: 1:49pm PST

Low Tidal Volume Ventilation: Lung protective effect

Direct download: Keys_to_the_Cart__December_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Forced Care During Pregnancy with Julie Cantor

Direct download: 201912OB.m4v
Category:general -- posted at: 7:09am PST

The Pediatric Difficult Airway

Direct download: 201912SPA.m4a
Category:general -- posted at: 5:24am PST

Pulmonary Hypertension and Liver Transplantation

Direct download: 201912TEE.m4v
Category:general -- posted at: 11:45am PST

Neonatal Respiratory Distress Syndrome with Aditee Ambardekar

Direct download: 201912Peds.m4v
Category:general -- posted at: 7:38am PST

Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers?

and 

Targeted Use of Alcohol-Based Hand Rub on Gloves During Task Dense Periods: One Step Closer to Pathogen Containment by Anesthesia Providers in the Operating Room

Direct download: 201912Birnbach.mp3
Category:general -- posted at: 7:33am PST

Vasopressin; Arginine Vasopressin: Mechanism of Action; CV Effects of Vasopressin

Direct download: Keys_to_the_Cart__December_1_2019.m4v
Category:general -- posted at: 12:00pm PST

Arginine Vasopressin

Direct download: Keys_to_the_Cart__November_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Obstetric Critical Care with Jennifer Hofer

Direct download: 201911OB.m4v
Category:general -- posted at: 1:26pm PST

Placental transfer: anesthetic drugs

Direct download: Keys_to_the_Cart__November_1_2019.m4v
Category:general -- posted at: 12:00pm PST

Rescue TEE and Pulmonary Embolus

Direct download: 201911TEE.m4v
Category:general -- posted at: 1:21pm PST

Caring for Patients with Congenital Heart Disease

Direct download: 201911SPA.m4a
Category:general -- posted at: 6:28am PST

Congenital Heart Disease Associated with Genetic Syndromes with Faith Ross

Direct download: 201911Peds.m4v
Category:general -- posted at: 6:20am PST

ABA Manuscript Series November 2019

Direct download: 201911Warner.mp3
Category:general -- posted at: 5:35am PST

Transfusion-related Immunomodulation (TRIM); Transfusion: Leukoreduction

Direct download: Keys_to_the_Cart__October_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Neurologic Complications in Obstetric​ Anesthesia with Christine Warrick

Direct download: 201910OB.m4v
Category:general -- posted at: 2:40pm PST

Global health

Direct download: 201910Newton.mp3
Category:general -- posted at: 4:31am PST

Laryngomalacia with Debnath Chatterjee

Direct download: 201910peds.m4v
Category:general -- posted at: 5:21am PST

Pregnancy: DIC

Direct download: Keys_to_the_Cart__October_1_2019.m4v
Category:general -- posted at: 12:00pm PST

Red Blood Cell Transfusion in Pediatric Orthotopic Liver Transplantation: What a Difference a Few Decades Make

Direct download: 201910Davis.mp3
Category:general -- posted at: 10:39am PST

Non-Compaction Cardiomyopathy

Direct download: 201910TEE.m4v
Category:general -- posted at: 6:31am PST

Pregnancy: DIC

Direct download: Keys_to_the_Cart__September_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Building a Career in Academia with Arvind Palanisamy

Direct download: OB201909.m4v
Category:general -- posted at: 7:56am PST

Heart Failure and Mechanical Circulatory Support

Direct download: 201909TEE.m4v
Category:general -- posted at: 5:04am PST

Anesthetic Implications for Pediatric Patients Undergoing Scoliosis Repair with Denise P. Chang

Direct download: 201909VGR.m4v
Category:general -- posted at: 4:01am PST

One-lung ventilation in children

Direct download: templeton2019.m4a
Category:general -- posted at: 3:51am PST

Post-op Cardiac Event: Risk Factors; Pre-anesthesia Eval: Cardiac

Direct download: 8.m4v
Category:general -- posted at: 12:00pm PST

Necrotizing enterocolitis (NEC) with Aditee Ambardekar

Direct download: 201909Peds.m4v
Category:general -- posted at: 5:25am PST

Do You Really Mean It? Assessing the Strength, Frequency, and Reliability of Applicant Commitment Statements During the Anesthesiology Residency Match

Direct download: 2019-09Moran.mp3
Category:general -- posted at: 3:00pm PST

ACC/AHA Guidelines: Stents; Old MI: Perioperative Risk Assessment

Direct download: 7.m4v
Category:general -- posted at: 12:00pm PST

Impacting the Labor and Delivery Floor Using Quality and Patient Safety Metrics with Klaus Kjaer

Direct download: 201908OB.m4v
Category:general -- posted at: 11:25am PST

Pediatric One-lung ventilation with Debnath Chatterjee

Direct download: 201908Peds.m4v
Category:general -- posted at: 11:15am PST

Perioperative management of sickle cell disease

Direct download: 201908Haberkern.m4a
Category:general -- posted at: 1:47pm PST

Lambert-Eaten Physiology; Myasthenic Syndrome vs Myasthenia Gravis: Sx

Direct download: 6.m4v
Category:general -- posted at: 12:00pm PST

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Perioperative Opioid Minimization in Opioid-Naive Patients

Direct download: 201908Wu.m4a
Category:general -- posted at: 12:00pm PST

Intracardiac Mass

Direct download: 201908TEE.m4v
Category:general -- posted at: 5:15am PST

Erector Spinae Plane Block

A novel inter-fascial plane block first described in 2016. This technique has been used for analgesia for the following procedures:

- Video-assisted thoracoscopic surgery (VATS)

- Pulmonary lobectomy

- Thoracic rib and sternal fractures

- Mastectomy

- Axillary sentinel lymph node biopsy

- Abdominal surgery

- Hip surgery

- Thoracic neuropathic pain relief

 

Unique Contraindications:

- Localized active infectious process at injection site

- Extensive tissue depth between skin and transverse process limiting visualization of transverse process

 

Unique Complications:

- Pneumothorax

- Lower extremity motor weakness if performed at lower thoracic level

 

Technique:

- Transverse probe at midline of the spine and identify spinous process, lamina, transverse process and rib

- Slide probe laterally and center view over transverse process

- Rotate probe 90 degrees to parasagittal view of transverse process

- Insert needle from cranial to caudal direction and contact transverse process

- Inject local anesthetic aiming for pooling above transverse process and lifting of erector spinae muscle.  For this video, 30 ml of Ropivacaine 0.5% was used.

 

Tips:

- Other postural positions (i.e. prone or lateral) may facilitate placement

- Although the T5 transverse process had been the traditional plane of insertion, the block can be performed at any level

- Rostral spread 2-3 levels and approximately 5 levels caudally

- Ultrasound identification/differentiation of the target transverse process and its transition to its adjacent rib can ensure injection at the correct site

- Transverse process appears as blunt and flat while the rib is seen as round on ultrasound with pleura clearly seen in close proximity

- Constant visualization of the needle along its entire length until its contact to the transverse process may decrease the likelihood of a pneumothorax

- Consider use of weight-appropriate dose of local anesthetic to decrease the likelihood of LAST

 

Block Anesthesiologist:  Gloria Shih Cheng, M.D.

Synopsis:  Jose Enrique Lagueras Garcia, M.D.

Production: Sandy Thammasithiboon, M.D. / ST Film

 

 

References:

  1. Altiparmak B, et al. 2019. Comparison of the effects of modified pectoral nerve block and erector spinae plane block on postoperative opioid consumption and pain scores of patients after radical mastectomy surgery: a prospective, randomized, control trial. J Clin Anesth. 54:61-65.
  2. Altinpulluk EY, et al. 2019. Bilateral postoperative ultrasound-guided erector spinae plane block in open abdominal hysterectomy: a case series and cadaveric investigation. Rom J Anaesth Intensive Care. 26(1): 83-88.
  3. Ahiskalioglu, et al. 2018. Erector spinae plane block for bilateral lumbar transverse process fracture in emergency department: a new indication. Am J Emerg Med. 36(10)1927.
  4. Ciftci B, et al. 2019. Ultrasound-guided single shot preemptive erector spinae plane block for postoperative pain management.J Cardiothorac Vasc Anesth. 33(4): 1175-1176.
  5. Elkoundi A, et al. 2019. Erector spinae plane block for pediatric hip surgery-a case report. Korean J Anesthesiol. 72(1):68-71.
  6. Ince I, et al. 2018. Erector spinae plane block catheter insertion under ultrasound guidance for thoracic surgery: case series of three patients. Eurasian J Med. 50(3)204-205.
  7. Jadon A, et al. 2018. Flouroscopic-guided erector spinae plane block: a feasible option. Indian J Anaesth. 62(10):806-808.
  8. Jones MR, et al. 2019. Confirmation of erector spinae plane block analgesia for 3 distinct scenarios: a case report. A A Pract. 12(5): 141-144.
  9. Luis-Navarro JC, et al. 2018. Erector spinae plane block in abdominal surgery: case series. Indian J Anaesth. 62(7): 549-554.
  10. Kumar, A, et al. 2018. The use of liposomal bupivacaine in erector spinae plane block to minimize opioid consumption for breast surgery: a case report. A A Pract. 10(9)239-241.
  11. Nath S, et al. 2018. USG-guided continuous erector spinae block as a primary mode of perioperative analgesia in open posterolateral thoracotomy: a report of two cases. Saudi J Anaesth. 12(3): 471-474.
  12. Petsas D, et al. 2018. Erector spinae plane block for postoperative analgesia in laparoscopic cholecystectomy. J Pain Res. 11: 1983-1990.
  13. Tulgar S, et al. 2019. Ultrasound-guided erector spinae plane block: indications, complications, and effects on acute and chronic pain based on a single-center experience. Cureu 11(1): e3815.
Direct download: 201908Block.m4v
Category:general -- posted at: 6:49am PST

Latex allergy: Fruits; Anaphylaxis: Epinephrine Treatment; Latex Allergy: Treatment

Direct download: 5.m4v
Category:general -- posted at: 12:00pm PST

Beyond the Binary: Caring for Sexual and Gender Minority Patients on the Birth Unit

Direct download: 201907OB.m4v
Category:general -- posted at: 9:56am PST

Pediatric ECMO with Faith Ross

Direct download: 201907Peds.m4v
Category:general -- posted at: 11:27am PST

Sugammadex (Bridion®), Pharmacology. Warnings and precautions, and Reintubation considerations after use

Direct download: 4.m4v
Category:general -- posted at: 12:00pm PST

Technology in anesthesiology

Direct download: 201907SPA.m4a
Category:general -- posted at: 7:17am PST

Hypertrophic Cardiomyopathy

Direct download: 201907TEE.m4v
Category:general -- posted at: 7:05am PST

Hypothalamus; Pituitary gland; Hypothalamic-pituitary-target organ axes Sheehan’s syndrome Management

Direct download: 3.m4v
Category:general -- posted at: 12:00pm PST

Neuraxial Techniques to Optimize Labor Analgesia with Brendan Carvalho

Direct download: 201906OB.m4v
Category:general -- posted at: 9:56am PST

Rheumatic Mitral Disease

Direct download: 201906TEE.m4v
Category:general -- posted at: 2:46pm PST

The Pediatric Transgender Patient: Foundations and Perioperative Considerations with Remigio Roque

Direct download: 201906PedsGR.m4v
Category:general -- posted at: 12:00pm PST

Retinopathy of Prematurity with Aditee Ambardekar

Direct download: 201906Peds.m4v
Category:general -- posted at: 11:40am PST

Post-Operative Urinary Retention (POUR); Control of micturition; Management of POUR

Direct download: 2.m4v
Category:general -- posted at: 12:00pm PST

Drug Calculation Errors in Anesthesiology Residents and Faculty: An Analysis of Contributing Factors

Direct download: 201906Black.mp3
Category:general -- posted at: 3:46am PST

Local anesthetics: Mechanism of action, Onset, potency, duration, Nerve fibers; Local Anesthetic Systemic Toxicity (LAST)

Direct download: 1.m4v
Category:general -- posted at: 12:00pm PST

None Born Positive: Elimination of Maternal to Child Transmission of HIV

Direct download: 201905OB.m4v
Category:general -- posted at: 10:19am PST

Hemostasis in pediatric cardiac anesthesia

Direct download: 201905SPA.m4a
Category:general -- posted at: 9:10am PST

Pediatric Cardiomyopathy with Faith Ross

Direct download: 201905Peds.m4v
Category:general -- posted at: 9:21am PST

Volume Status: Monitoring; CVP Waveform: Components

Direct download: Keys_to_the_Cart__May_1_2019.m4v
Category:general -- posted at: 12:00pm PST

Carcinoid heart disease

Direct download: 201905TEE.m4v
Category:general -- posted at: 12:00pm PST

Nighttime Extubation Does Not Increase Risk of Reintubation, Length of Stay, or Mortality: Experience of a Large, Urban, Teaching Hospital

Direct download: 201905Everhart.mp3
Category:general -- posted at: 12:00pm PST

Epidural hematoma; Epidural Abscess; Post Spinal Backache

Direct download: Keys_to_the_Cart__April_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Shared Decision Making on Labor​ and Delivery with May Pian-Smith​

Direct download: 201904OB.m4v
Category:general -- posted at: 9:13am PST

Mitral valve endocarditis

Direct download: 201904TEE.m4v
Category:general -- posted at: 7:43am PST

Wake up safe!

Direct download: 2019Tyler.m4a
Category:general -- posted at: 12:08pm PST

Value of OB Anesthesia–Current Needs, Future Directions, Controversies

Direct download: SOAP201904.mp3
Category:general -- posted at: 11:43am PST

Opioids, The Opioid Epidemic, and The OB Anesthesiologist

Direct download: SOAP201901.mp3
Category:general -- posted at: 11:41am PST

Perioperative Hyperglycemia; Glucose Control

Direct download: Keys_to_the_Cart__April_1_2019.m4v
Category:general -- posted at: 12:00pm PST

Long-Term Cognitive and Functional Impairments after Critical Illness

Direct download: 201904article.mp3
Category:general -- posted at: 5:35am PST

Fetal Interventions with Debnath Chatterjee

Direct download: 201904peds.m4v
Category:general -- posted at: 11:03am PST

The NPMS Hemorrhage Bundle: Enhancing the Management of Maternal Hemorrhage with Michaela Farer

Direct download: 201903OB.m4v
Category:general -- posted at: 2:10pm PST

Laryngospasm including Laryngeal Closure Reflex, Signs and symptoms and Management

Direct download: Keys_to_the_Cart__March_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Placenta accreta (Definition and Risk factors); Anesthetic management of cesarean delivery of placenta accreta

Direct download: Keys_to_the_Cart__March_1_2019.m4v
Category:general -- posted at: 12:00pm PST

Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult?

Direct download: 201903Article.mp3
Category:general -- posted at: 7:11am PST

Anesthesia medication safety

Direct download: 201902Grigg.m4a
Category:general -- posted at: 5:01am PST

Non-obstetric surgery in pregnant women; Timing of non-obstetric surgery; Perioperative fetal monitoring

Direct download: Keys_to_the_Cart__February_15_2019.m4v
Category:general -- posted at: 12:00pm PST

Vasopressor Use in Obstetrics: Past, Present, and Future with Nicole Higgins

Direct download: 201902OB.m4v
Category:general -- posted at: 8:37am PST

Flail mitral leaflet and repair

Direct download: 201902TEE.m4v
Category:general -- posted at: 4:41am PST

Anterior Mediastinal Mass with Aditee Ambardekar

Direct download: 201902Peds.m4v
Category:general -- posted at: 2:02pm PST

ERAS for Cesarean Delivery

Direct download: 201903.m4v
Category:general -- posted at: 12:00pm PST

Emergency Department Airway Management Responsibilities in the United States

Direct download: 201902_Sappenfield.mp3
Category:general -- posted at: 6:06am PST

ACLS in Pregnancy

Direct download: 201902.m4v
Category:general -- posted at: 12:00pm PST

Marijuana in Pregnancy: Sorting through Hazy Evidence with Torri Metz

Direct download: 201901OB.m4v
Category:general -- posted at: 7:58am PST

Ascending aortic aneurysm

Direct download: 201901TEE.m4v
Category:general -- posted at: 7:09am PST

Pulmonary Hypertension with Faith Ross

Direct download: 201901Peds.m4v
Category:general -- posted at: 12:55pm PST

Out of Operating Room Anesthesiology

Direct download: 201901Oscar.m4a
Category:general -- posted at: 11:01am PST

ACLS in Pregnancy

Direct download: 201901.m4v
Category:general -- posted at: 12:00pm PST

Persistent Left Superior Vena Cava (PLSVC)

Direct download: 201812TEE.m4v
Category:general -- posted at: 5:20am PST

Predatory Open-Access Publishing in Anesthesiology

Direct download: 201901article.m4a
Category:general -- posted at: 12:00pm PST

Trial of Labor after Cesarean Delivery: Which patients? Which hospitals?

Direct download: 201812OB.m4v
Category:general -- posted at: 7:48am PST

Mitochondrial disease and anesthesia

Direct download: 201812Morgan.m4a
Category:general -- posted at: 12:00pm PST

Non-Pharmacology and the Art of Induction with Sam Rodriguez

Direct download: 201812Peds.m4v
Category:general -- posted at: 5:44am PST

Decision Making in Anesthesiology: An Introduction to Behavioral Economics with Daniel Katz

Direct download: 201811OB.m4v
Category:general -- posted at: 5:02pm PST

World Health Organization Surgical Safety Checklist: Compliance and Associated Surgical Outcomes in Uganda’s Referral Hospitals

Direct download: 201812Kleiman.mp3
Category:general -- posted at: 9:21am PST

Pediatric Regional Anesthesia Network (PRAN)

Direct download: Polaner.m4a
Category:general -- posted at: 3:47am PST

Massive thromboembolism

Direct download: 201811TEE.m4v
Category:general -- posted at: 10:11am PST

Burnout and wellness

Direct download: 201810Expert.mp3
Category:general -- posted at: 3:47am PST

Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations

Direct download: 201811Ward.mp3
Category:general -- posted at: 12:00pm PST

Surgical Fires: Prevention and Management with Debnath Chatterjee

Direct download: 201811peds.m4v
Category:general -- posted at: 6:30am PST

Postpartum Sterilization with Feyce M. Peralta

Direct download: OB201810.m4v
Category:general -- posted at: 5:33am PST

ACC/AHA Guidelines for Perioperative Cardiovascular Evaluation

Direct download: Keys_to_the_Cart__October_15_2018.m4v
Category:general -- posted at: 12:00pm PST

Citrate Toxicity Dx/Rx; Transfusion Mortality: Causes; Delayed Transfusion Reaction

Direct download: Keys_to_the_Cart__October_8_2018.m4v
Category:general -- posted at: 12:00pm PST

Aortic endocarditis

Direct download: 201810TEE.m4v
Category:general -- posted at: 10:04am PST

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