Ep. 381 Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar

Ep. 381 Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar

In this episode, interventional radiologists Dr. Aaron Fritts, Dr. Vishal Kumar, and Dr. Chris Beck discuss types of sedation for IR procedures. --- CHECK OUT OUR SPONSOR Medtronic OBL https://www.medtronic.com/obl --- SHOW NOTES We start the discussion off by dividing the spectrum of patient sedation into three tiers: local anesthesia, moderate sedation with fentanyl and Versed, and deep sedation which encompasses anything beyond fentanyl and Versed. The conversation revolves around the fluidity of this spectrum, underscoring the ease with which patients can transition between these sedation levels, thereby adding layers of complexity to the decision-making process. Chris emphasizes the significance of embracing trauma-informed care, highlighting the potential for IR procedures to be maximally traumatic despite their minimally invasive nature. The doctors emphasize the importance of establishing comprehensive pre-procedural patient education to align expectations about pain management. Procedures that automatically trigger the requirement for an anesthesia team include procedures such as TIPS, tumor ablations, as well as declot procedures more recently. Decisions regarding anesthesia for these procedures are additionally influenced by factors such as the patient's condition, history of methadone exposure, the preference of the IR providers, and the comfort level of nursing staff. Vishal highlights the game-changing concept of having an anesthesia team present for real-time monitoring and the administration of nerve blocks during IR procedures. This collaboration is especially helpful for complex interventions. Vishal advocates for prioritizing patient safety over logistical considerations. He firmly contends IRs should be empowered to decide the level of anesthesia care since they have the most experience with the specific procedures and are best suited to recognize anesthesia needs. The conversation delves into the American Society of Anesthesiologists (ASA) scoring system, which categorizes patients based on their health status from ASA 1 (healthy) to ASA 6 (brain death). While IR procedures usually involve ASA 3 or ASA 4 patients, today’s discussion uncovers the tendency among clinicians to underestimate a patient's ASA classification while overestimating their pain tolerance. The discussion raises critical questions about whether the IR community has grown complacent with moderate sedation in procedures and whether alternative approaches are warranted. --- RESOURCES American Society of Anesthesiologists Classification (ASA) Classification: https://www.ncbi.nlm.nih.gov/books/NBK441940/

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Ep. 50 Practicing IR in India with Dr. Deepa Shree

Ep. 50 Practicing IR in India with Dr. Deepa Shree

Dr. Deepa Shree tells us about the challenges she faced building her IR practice in Chennai, and how she is spreading awareness of the specialty and training new IRs to help serve the need throughout India.

13 Okt 201948min

Ep. 49 Collaboration in the Hybrid OR with Dr. Racadio and Dr. von Allmen

Ep. 49 Collaboration in the Hybrid OR with Dr. Racadio and Dr. von Allmen

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/Ucy8jI Director of IR Innovation Dr. John Racadio and Pediatric Surgeon-in-Chief Dr. Daniel von Allmen of Cincinnati Children’s Hospital discuss their experiences in the Hybrid OR, how they built it, and how cross-specialty collaboration with pulmonary, urology, and orthopedic surgeons has greatly improved patient care.

30 Sep 201929min

Ep. 48 IR and ENT Treatment of Epistaxis with Dr. Ashley Agan and Dr. Sabeen Dhand

Ep. 48 IR and ENT Treatment of Epistaxis with Dr. Ashley Agan and Dr. Sabeen Dhand

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/xQPc7h In this episode, Dr. Ashley Agan and Dr. Sabeen Dhand join Dr. Gopi Shah to discuss IR and ENT treatment of epistaxis. We cover the differences in how epistaxis presents for ENT and IR as well as how epistaxis presents in children and older patients. Dr. Agan tells us about the types of nosebleeds that are common and the general treatment algorithm she follows. We discuss nasal packing and decongestant sprays for treatment and how to know when to take the patient to the OR. Dr. Agan talks about isolating the bleeding spot, how to use a foley for posterior nosebleeds, and SPA litigation. We discuss why ENT might consult IR for an embolization. Dr. Dhand tells us about the contraindications for embolization and the procedure for treating the epistaxis. We review the materials that should be used and why it is important to look out for artery connections and pseudoaneurysms. We discuss the pearls and pitfalls of ENT and IR treatment of epistaxis and how to avoid the risk of stroke.

30 Aug 201933min

Ep. 47 BRTO vs. PARTO and other Techniques with Dr. Luke Wilkins

Ep. 47 BRTO vs. PARTO and other Techniques with Dr. Luke Wilkins

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/ZvpYnL Special Guest Dr. Luke Wilkins of University of Virginia VIR discusses BRTO and PARTO techniques for treatment of gastric variceal bleeding.

18 Aug 201941min

Ep. 46 Collaboration not Competition between IR and IC with Dr. Achal Sahai and Dr. Chris Beck

Ep. 46 Collaboration not Competition between IR and IC with Dr. Achal Sahai and Dr. Chris Beck

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/bobcIg Interventional Cardiologist (IC) Dr. Achal Sahai and Interventional Radiologist (IR) Dr. Christopher Beck discuss ways these two specialties collaborate on complex cases, share endovascular techniques, and avoid the "turf war" trap.

31 Juli 201945min

Ep. 45 Coping with Complications with Dr. Maureen Kohi and Dr. Sandeep Bagla

Ep. 45 Coping with Complications with Dr. Maureen Kohi and Dr. Sandeep Bagla

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/uVVOw3 Dr. Maureen Kohi from UCSF Medical Center and Dr. Sandeep Bagla from Vascular Institute of Virginia discuss the challenges of dealing with procedural complications, and the importance of talking with colleagues and mentors in effective coping.

1 Juli 201959min

Ep. 44 TIPS Procedure Techniques: East to West Coast with Dr. Peder Horner and Dr. Peter Bream

Ep. 44 TIPS Procedure Techniques: East to West Coast with Dr. Peder Horner and Dr. Peter Bream

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/2WK9kp East Coast "McBreamy" and "Western Peder" discuss their Colapinto vs. Uchida needle preference, advantages of the ICE catheter, and other great pearls and pitfalls for the TIPS Procedure. Special thanks to our sponsor RADPAD® Radiation Protection. Protect yourself and your patients during those lengthy TIPS cases.

16 Juni 20191h

Ep. 43 Managing Urosepsis with Dr. Caire and Dr. Bennett

Ep. 43 Managing Urosepsis with Dr. Caire and Dr. Bennett

Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs here: https://earnc.me/rn9T7J Urologist Dr. Arthur Caire and IR Dr. Shelby Bennett return to the BackTable Podcast to discuss their approaches to urosepsis, stent vs. nephrostomy for a variety of presentations, and the middle-of-the-night patient.

2 Juni 201934min

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