Diary of a Lost Student: From Theory to Practice -Foundational Anesthesia Concepts for All Providers
Anesthesia pharmacology, physics, and physiology explained one idea at a time — for residents, SRNAs, CRNAs, anesthesia assistants, and anesthesiologists.The gas laws. Drug mechanisms. Where a drug came from and why it does what it does at three in the morning. Covered in anesthesia school — just not all the way down. This show goes underneath.One foundational anesthesia concept per episode. Under fifteen minutes. Twice a week.For anesthesia residents, SRNAs and CRNAs, student anesthesia assistants (AAs), practicing anesthesiologists, and anyone considering applying to anesthesia school.Not board prep. Just the moment a hard thing finally makes sense.
Desflurane: The Fastest Wash-In and Wash-Out in Anesthesia (Free Preview)
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Desflurane: The Fastest Wash-In and Wash-Out in Anesthesia (Free Preview)
The chemists took isoflurane and swapped its one chlorine atom for fluorine. That single substitution produced the lowest blood-gas partition coefficient of any clinical volatile — 0.42 — and nearly everything about the drug follows from it.
This episode covers: how one number produces the fastest emergence in anesthesia, the pros and cons of the fluorine substitution and much more.
The full episode, available on Supe...
The Shunt Equation: Why More Oxygen Won't Fix True Shunt | Anesthesia Physics
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The Shunt Equation: Why More Oxygen Won't Fix True Shunt
Every arterial blood gas is a mixture of two streams — blood that saw ventilated alveoli and picked up oxygen, and blood that skipped them entirely. The shunt equation solves for what fraction came from the second stream.
This episode covers: the mass-balance algebra of Qs/Qt = (CcO₂ − CaO₂) / (CcO₂ − CvO₂); PAO₂ versus PaO₂; why normal shunt sits near 5% and anything above 10% is pathologic; true shunt versus V̇/Q̇...
0.9% Sodium Chloride: The Drug We Give Without Thinking (Free Preview) | Anesthesia Drug Compendium Series
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0.9% Sodium Chloride: The Drug We Give Without Thinking (Free Preview) | Anesthesia Drug Compendium Series
Normal" saline is not normal. Plasma runs Na⁺ ≈ 140 and Cl⁻ ≈ 100; the bag holds 154 of each at 308 mOsm/L. The supraphysiological chloride — half again above normal — defines everything modern medicine worries about in the bag.
This episode covers: the 1832 cholera outbreak that invented IV fluid resuscitation, Hamburger's 1896 red-cell experiments that gave us the "0.9%" (and overshot the true isotonic value), hyperchloremic metabolic acidosis via...
Massive Transfusion Protocol: The 1:1:1 Ratio, and the Diamond of Death | Anesthesia Clinical Concepts
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Massive Transfusion Protocol: The 1:1:1 Ratio, and the Diamond of Death | Anesthesia Clinical Concepts
Ten units of red cells in 24 hours. That was the old definition — arbitrary, borrowed because ten units approximates one adult blood volume. It never accounted for rate. A patient can lose half their volume in an hour and never reach ten units before they arrest. Massive transfusion is not a number. It is a physiology problem with a clock attached.
This ep...
Phase II Conjugation: Glucuronidation and Why Some Drugs Last Longer | Anesthesia Foundational Concepts
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Phase 2 Conjugation: Glucuronidation and Why Some Drugs Last Longer | Anesthesia Foundational Concepts
Imagine trying to catch a very slippery fish with your bare hands. It keeps slithering away. Now imagine someone glues a heavy, easy-to-grip handle onto the fish. Suddenly you can catch it.
That is conjugation. Fat-soluble drug molecules are the slippery fish — they slip through the kidneys, get reabsorbed, and stick around in the body. Phase II enzymes glue a polar handle on...
INTRALIPID 20%: The Lipid Emulsion That Reverses LAST (Free Preview) | Anesthesia Drug Compendium Series
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INTRALIPID 20%: The Lipid Emulsion That Reverses LAST (Free Preview) | Anesthesia Drug Compendium Series
The same bag of fat that feeds the sickest patients is the antidote that restarts a poisoned heart. It was built to feed people — the world's first safe intravenous fat, a soybean-oil emulsion held in water by egg-yolk phospholipid, developed by the Swedish biochemist Arvid Wretlind at the Karolinska Institute and approved in 1962 after a decade spent taming the toxicity of the fat so...
Local Anesthetic Systemic Toxicity: The Signal Jammer You Have to Recognize Early | Anesthesia Clinical Concepts
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Local Anesthetic Systemic Toxicity: The Signal Jammer You Have to Recognize Early | Anesthesia Clinical Concepts
LAST is rare — roughly 0.27 episodes per 1,000 peripheral nerve blocks — but when it happens, it is one of the few true emergencies in anesthesia where the clock, not the diagnosis, decides who lives.
The reason it kills is not that it is hard to treat. It is that it is hard to see. AUnder sedation or general anesthesia, the classic neur...
Tochen's Formula: Neonatal Endotracheal Tube Depth, Explained | Pediatric Anesthesia Concepts
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Tochen's Formula: Neonatal Endotracheal Tube Depth, Explained | Pediatric Anesthesia Concepts
A term newborn's entire trachea is about four centimeters long — shorter than your thumb — and the tube tip has to stop in the middle of it, below the vocal cords and above the point where the airway splits to the two lungs. That leaves a safe window measured in millimeters: an error of a single centimeter drives the tip down a mainstem bronchus, ventilating one lung, or b...
DANTROLENE: The Only Drug That Reverses Malignant Hyperthermia (Free Preview)
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Dantrolene: The Only Drug That Stops Malignant Hyperthermia at Its Source
You shut off the volatile, pour on the cooling, chase the acidosis and the soaring potassium — and a jammed calcium channel deep in the muscle keeps emptying its stores into the cell anyway. In malignant hyperthermia, everything you do buys time. One drug reaches the leak itself.
Dantrolene binds the ryanodine receptor and shuts it — the only intervention that ends the crisis rather than...
Malignant Hyperthermia: Why ETCO₂ Rises Before Temperature | Anesthesia Clinical Concepts
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Malignant Hyperthermia: Why ETCO₂ Rises Before Temperature
A single anesthetic trigger jams the muscle's calcium gate open, and metabolism runs away faster than the body can shed the heat — a rare inherited crisis, loud on the monitor before the skin ever warms, where minutes and Dantrolene decide the outcome.
This episode covers the mechanism — RYR1, CACNA1S, and the runaway calcium release that drives the storm — then follows it to the bedside. Also, why the anes...
Fick's Law of Diffusion: The Equation Behind Every Inhaled Anesthetic | Anesthesia Physics Made Simple
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Fick's Law of Diffusion: The Equation Behind Every Inhaled Anesthetic
Stuff spreads from where it is crowded to where it is not. Fick's law is that intuition written as arithmetic — and it governs every membrane in the body, from the alveolar wall between air and blood to the cell membrane between an anesthetic in your bloodstream and the neuron it needs to reach.
This episode unpacks each lever, then follows them to the bedside. Pr...
PROPOFOL: The First Anesthetic You Could Turn Off | Anesthesia Drug Compendium Series (FREE)
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PROPOFOL: The First Anesthetic You Could Turn Off | Anesthesia Drug Compendium Series (FREE)
Every drug you push has a story — a plant, an accident, a war, a chemist who was looking for something else entirely. Then it has a receptor, a curve, and a reason it does exactly what it does at three in the morning.
The Drug Compendium Series takes one drug per episode and goes all the way down. Where the molecule ac...
What is Anesthesia, Actually? The Physiology Behind the "Sleep" | Anesthesia Foundational Concepts
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What Is Anesthesia, Actually? The Physiology Behind the "Sleep"
Millions of times a year, we switch a person off — no awareness, no pain, no memory — and switch them back on, unchanged. We've gotten so good at it that it's become routine. Here's the part nobody says out loud: we still don't really know what consciousness is, or how our drugs take it away.
Everyone says anesthesia is "putting someone to sleep." But sleep is the...
An ocean of content, and a thimble of time... Welcome!
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We do the most improbable thing in medicine so dependably that we forgot it was improbable. Depth needs a quieter room than the one we learn and work in.
This is that room, and this first episode is the door: who's talking, what the show does with a single idea, and why you were never the only one carrying the same unspoken confession.
Under fifteen minutes. One idea, all the way down. Not board...
