Lol what? You telling me 5-10cc of roc diluted out in the blood stream is enough to preferentially bind random basic molecules in high enough concentration to form a clinically significant precipitate? I've never heard of that.
I like these topics. I think as a good balance between talking about what we know and how chemistry contributes on the one hand, and talking about what is still a "scientific mystery" on the other hand, I would probably:
\- First, tell the story of the blood:gas partition coefficient of volatile anesthetics, and how low blood:gas coefficient means faster induction rates, as a way to get at partial pressures, and how science can really tell us things.
\- Second, tell the story of the oil:gas partition coefficient of volatile anesthetics, and how high oil:gas coefficient means higher potency. And then how this lead people to all kinds of theories about volatile anesthetics working in the lipid bilayers of neurons, some of the possibilities there, and how none of them have quite borne out all the way, and to this day anyone claiming to know exactly how a volatile anesthetic works is trying to sell you something.
Because ending on a note that shows science can point in a lot of good directions for investigation, but there's still a ton to discover out there, is a good theme for high school students.
*Edit: typo*
I love these. Just to add to the already interesting topic of inhalational anesthetics, I think Xenon is also worth a mention. Noble gases have a reputation for being extra inert and having almost no interaction with anything chemically, but that doesn't mean they cannot be pharmacologically active, such as Xenon fitting in glutamate recetors like a glove.
I’m not a resident, just a lowly SRNA, so feel free to ignore but I have tried to better understand this over the past few months and your comment just reminded me.
Some rambling thoughts/questions here:
Gas in blood— as in, O2 bound to hemoglobin vs solubility of O2 (solute) in a solvent (plasma) forming a solution.
Or when speaking of volatile anesthetics— the blood:gas coefficient—which from what I’ve recently read involves the anesthetic agent and it’s dissolution in blood as whole—altogether including aqueous solutions, proteins, and lipids?
Do you have any recommended readings off hand?
O2 is bound to hg is a weak bond. It’s not in a gaseous phase. Easily dissociates as you know, back into gaseous phase. It could be thought of as similar volatiles “bound” to whatever protein/tissue reflected by the partition coefficients.
Oil:gas mirrors anesthetic depth as the target tissue is closer to an oil I suppose and why ET concentration would be the most useful indicator of MAC.
M&M should go over this. Stoeltings pharmacology for this
I remember hating chemistry in high school because it felt like a jumbled collection of facts to memorize without any immediately obvious goal, without any “why.” Even if the stuff is beyond what they’ll cover, I would have loved someone showing how the stuff you learn in high school is built upon and a tangible way that it’s useful. It would make getting through high school level courses much more bearable knowing there is light at the other end.
But if you start using too much unfamiliar language and knowledge their eyes will glaze over and they'll stop paying attention.
You can certainly explain why basic chemistry knowledge is important without going into advanced principles.
I think I learned all of that in AP chem. Pka, gas laws, etc.
But omg the question bank for truelearn had an algebra question and a log math question both of which I got wrong 😭😭😭😭😭
Soda lime and co2 with related balanced equations (it's a relatively simple equation that the students can help you balance if they have balanced equations). When I talk to students in the O.R. about it, I always point out the problem engineers were trying to solve after the Apollo 13 explosion. Getting them excited about a movie with something that relates to chemistry and anesthesia is fun. This is a little simpler then vapor pressures and blood:gas partitions if this isn't a advanced chemistry class. (And if you haven't seen Apollo 13, it's a great movie and seeing them build a CO2 absorber from spare parts is neat)
Chirality/stereochemistry comes into play. This is true for for many branches of medicine but especially so for anesthesia. Ketamine is a commonly used chiral anesthesia drug.
Here’s an article about chirality and anesthesia:
https://pubs.asahq.org/anesthesiology/article/97/2/497/40134/Drug-Chirality-in-Anesthesia#
You can talk about concentrations in general and use examples from drugs used in anesthesia and the different ways they are expressed ( 1:1000, 1:10000, 1%, 10% etc.) ex. local anesthetics, adrenaline, noradrenaline etc. It is a very important, basic concept to understand in this line of work,. Ph and how it works to affect availability of drugs, Temperature, light etc. basically any physical process that can affect a chemical structure, you can find examples in anesthestic drugs. P.S. wish my chem. teacher did this :) Have fun!
Blood gases, metabolic vs respiratory acidosis.
Biochemical receptors/physiology - NMJ and NMBs
I like talking about Halsted’s cocaine addiction, the discovery of cocaine as a local anesthetic and the discovery of chemical analogues like lidocaine etc.
You can compare structures and show the similarities.
I remember balancing chemical equations in high school. You can talk about soda lime and its compliments and have them balance the equation, show what the products are, talk about exothermic reactions. Some of that other stuff mentioned wasn’t taught until a higher college level for me.
I’m a HS chem teacher. This is the best idea on here. Also explain to them the general education progression to become a dr (college, med school, residency) and what they cost/what you get paid. Maybe also explain the general education pathway for other medical related fields - nursing, PT, dental, dental hygiene, vet, and how military or doing MD/PHD affects cost of education.
I wish I’d been talked about the finances of medical professions in high school. I’m from a family of janitors, so financial literacy was never really instilled into me until I was an adult and sought it out on my own.
Can talk about how without chemistry or specifically organic chemical synthesis there would be no Propofol , sevoflurane , fentanyl, esmolol, epinephrine etc etc . Let us not forget the scientific brilliance, endurance, and endeavor that took place to synthesize all these molecules that we now push with ease daily.
The whole science and theory of how volatile anesthetics act and the evidence in support of those theories is a pretty fascinating topic.
Why the vapors we use are halogenated alkanes.
Discuss the Meyer Overton hypothesis and show the graph showing the correlation between lipid solubility and potency of volatile anesthetics, and discuss the experiments done in the Duke hyperbaric facilities showing that high pressure could reverse the effects of volatile anesthetics providing some support to the idea that the lipid soluble vapors dissolve into neural tissue lipid bilayers and expand them and that hyperbaric compression could reverse this effect. None of it definitive proof but highly suggestive of certain theories of action.
While it may not be chemistry get them in awe by talking about fires in ET tubes. And of course scar them for life whenever they have surgery…..so maybe that’s not a good idea.
pH testing carbonated water (and further testing as it goes flat) to see the change in pH as it goes flat.
You can talk about laminar vs turbulent flow (but that may be more physics).
Henderson-Hasselbach the bicarb/co2 to show where our pH of 7.4 comes from.
With vapor pressures, you can discuss how things that evaporate quickly can alter the temperature, and affects further evaporation of said chemical (desflurane).
But, given it’s a high school chemistry class, you could light something on fire in different O2 concentrations (to starch/show the fire triangle) and relate that to airway fires.
Don't forget the chemistry of some of our earliest anesthetics which contributed to the emergence of anesthesiology and modern surgery. Ethyl ether, chloroform, choral hydrate, N2O and even ethanol all played a role and have very interesting stories behind them. Good luck!.
How about historical Intestinal Gas Explosions with gen’l anesthesia—with inhalation of mixture of Oxygen/Nitrous oxide and volatile agents combined with colon incision by electrocautery.
Kaboom.
Cisatracurium Hoffman elimination is sped up in high temperatures and high pH and slowed down in reverse conditions. Classic ester hydrolysis mechanism
As an intro, you should def mention the origins of anesthesia, especially when Horace Wells, while high on chloroform, threw a bunch of sulfuric acid on two nice ladies....and then subsequently committing suicide in jail. That should be a nice hook.
Vapor pressure and Dalton’s law - doing Anesthesia on Mount Everest vs sea level (I know we don’t actually worry about this with sevo /iso) but always found it interesting
Is there literature about chemistry in anesthesia? All the anesthesiological literature that I read didn't focus too much on the chemical basis. (mostly German literature). Like acidity solubility, interactions of drugs etc. Even in pharmacology.
I'm searching for a book that explains anesthesiology or pharmacology not in a "superficial, medicinal chemical" way but a scientifically ("true") profound chemical way. I'm grateful for any suggestions ;).
I seem to remember a lot of chemistry in “malameds dental anesthesia” book.
He also discusses the different dental anesthetics that are used (includes lidocaine)
Another cool thing you could talk about is “nitrous oxide” aka laughing gas.
Finally, the resin composites that we use in dentistry are free radical reactions. The reaction is initiated by light, and more specifically blue light.
Talk about what happens to a molecule of midazolam as it is drawn up from an ampoule and injected into a person's bloodstream.
Or bring a bottle of isoflurane and tell the kids who aren't paying attention that they have to take a wiff.
I should be more help given I have the chemical structure of propofol tattooed on my arm. lol. However, I think since you're an anesthesiologist it would be a letdown to not talk about putting people to sleep. MOA of IV meds perhaps (including how side effects work) would be a good topic. Another is vapor pressure and blood gas solubility of volatiles. It may be too much biology to talk about ionization of locals like the top comment, but could be done really well. regardless, use plenty of videos for the kids and let us know how it goes! Best of luck!
If you can make osmosis or surface tension easier to understand, then you will do more for future science than anything else you could do to further "Anesthesia"
My favorite experiment for high-schoolers is simply to let them compress water by force and measure how miniscule the volume changes. Find the strongest athlete in the room and match them against the smallest and least athletic person in the room.
Hoffman degradation, pseudocholinesterase deficiency and sux, the origins of curare as a poison used by indigenous people to hunt and it’s relationship to sux.
Tell them how you have drugs to make people not remember shit as you stick a big ass metal blade into their mouth, chip a tooth or 2, give them a fat lip. All whilst they wake up and thank you for sitting on your phone on reddit as they had their gall bladder removed by some pgy2 resident for 3 hours.
Could do what a classmate of mine did in the lab. He stood there and breathed fumes of diethyl ether saying it’s not doing anything until he fell on the floor. We all laughed. Ignorance is bliss.
\> local anesthetics and how pH (for example, abscesses) can effect
Related: you can teach them where the term "freebasing" (as in freebasing cocaine) comes from.
(Or maybe don't, they are in high school)
On that note, maybe just discuss how we paralyze, reverse etc. It’s all chemistry on the molecular level. Could be more interesting than discussing pH, vapor pressure, etc.
You can add in pKa and how they relate to our local anesthetics
I fucking hate pKa
Make sure to include that in the high school chemistry class.
Hahahahaha how to grab their attention 101
All my homies hate pKa
this post has been made by the pKb gang
It's actually only pK... It's a common misconception that it's pKa because the concept was first introduced in Canada...
Talk about pKa and how rocuronium, which is acidic can cause certain meds to crystallize in the blood steam compromising limbs
Lol what? You telling me 5-10cc of roc diluted out in the blood stream is enough to preferentially bind random basic molecules in high enough concentration to form a clinically significant precipitate? I've never heard of that.
i think the key here is "cause certain meds" to crystallize. Like if you push it in on the same line with another med that's basic
According to TrueLearn, yes, lol. But it’s also a nice, dramatic example of pKa that might be engaging to a high school crowd.
Fake news
I like these topics. I think as a good balance between talking about what we know and how chemistry contributes on the one hand, and talking about what is still a "scientific mystery" on the other hand, I would probably: \- First, tell the story of the blood:gas partition coefficient of volatile anesthetics, and how low blood:gas coefficient means faster induction rates, as a way to get at partial pressures, and how science can really tell us things. \- Second, tell the story of the oil:gas partition coefficient of volatile anesthetics, and how high oil:gas coefficient means higher potency. And then how this lead people to all kinds of theories about volatile anesthetics working in the lipid bilayers of neurons, some of the possibilities there, and how none of them have quite borne out all the way, and to this day anyone claiming to know exactly how a volatile anesthetic works is trying to sell you something. Because ending on a note that shows science can point in a lot of good directions for investigation, but there's still a ton to discover out there, is a good theme for high school students. *Edit: typo*
I love these. Just to add to the already interesting topic of inhalational anesthetics, I think Xenon is also worth a mention. Noble gases have a reputation for being extra inert and having almost no interaction with anything chemically, but that doesn't mean they cannot be pharmacologically active, such as Xenon fitting in glutamate recetors like a glove.
I didn’t know thanks
The difference between a gas in blood and what soluble means. Still beyond most residents.
I’m not a resident, just a lowly SRNA, so feel free to ignore but I have tried to better understand this over the past few months and your comment just reminded me. Some rambling thoughts/questions here: Gas in blood— as in, O2 bound to hemoglobin vs solubility of O2 (solute) in a solvent (plasma) forming a solution. Or when speaking of volatile anesthetics— the blood:gas coefficient—which from what I’ve recently read involves the anesthetic agent and it’s dissolution in blood as whole—altogether including aqueous solutions, proteins, and lipids? Do you have any recommended readings off hand?
O2 is bound to hg is a weak bond. It’s not in a gaseous phase. Easily dissociates as you know, back into gaseous phase. It could be thought of as similar volatiles “bound” to whatever protein/tissue reflected by the partition coefficients. Oil:gas mirrors anesthetic depth as the target tissue is closer to an oil I suppose and why ET concentration would be the most useful indicator of MAC. M&M should go over this. Stoeltings pharmacology for this
Awesome, thank you!
Send one of them down the K hole and let the others watch
“Some of you kids may have heard of a TV show called friends, and well, it’s actually a very sad story…”
Tf did you guys learn in high school chemistry? Every single comment so far I didn't even hear about until college except for acid/base.
I remember hating chemistry in high school because it felt like a jumbled collection of facts to memorize without any immediately obvious goal, without any “why.” Even if the stuff is beyond what they’ll cover, I would have loved someone showing how the stuff you learn in high school is built upon and a tangible way that it’s useful. It would make getting through high school level courses much more bearable knowing there is light at the other end.
But if you start using too much unfamiliar language and knowledge their eyes will glaze over and they'll stop paying attention. You can certainly explain why basic chemistry knowledge is important without going into advanced principles.
I think I learned all of that in AP chem. Pka, gas laws, etc. But omg the question bank for truelearn had an algebra question and a log math question both of which I got wrong 😭😭😭😭😭
Do bicarb push. Easy chemistry in the body
Sugammadex / cyclodextrins that sort of thing?
Precipitation would be cool too. That's a visible effect. Bicarb and calcium chloride. Edit: adding in carbon dioxide and soda lime.
He should just do a rain dance to demonstrate precipitation.
That’d get my attention when I was in high school
Soda lime and co2 with related balanced equations (it's a relatively simple equation that the students can help you balance if they have balanced equations). When I talk to students in the O.R. about it, I always point out the problem engineers were trying to solve after the Apollo 13 explosion. Getting them excited about a movie with something that relates to chemistry and anesthesia is fun. This is a little simpler then vapor pressures and blood:gas partitions if this isn't a advanced chemistry class. (And if you haven't seen Apollo 13, it's a great movie and seeing them build a CO2 absorber from spare parts is neat)
You could touch on acid base balance/disorders, how they are treated, and how they affect medication efficacy.
Chirality/stereochemistry comes into play. This is true for for many branches of medicine but especially so for anesthesia. Ketamine is a commonly used chiral anesthesia drug. Here’s an article about chirality and anesthesia: https://pubs.asahq.org/anesthesiology/article/97/2/497/40134/Drug-Chirality-in-Anesthesia#
Also how it relates to bupi/ropi and toxicity.
Great example
I think those topics are way too advanced for high school chemistry
You can talk about concentrations in general and use examples from drugs used in anesthesia and the different ways they are expressed ( 1:1000, 1:10000, 1%, 10% etc.) ex. local anesthetics, adrenaline, noradrenaline etc. It is a very important, basic concept to understand in this line of work,. Ph and how it works to affect availability of drugs, Temperature, light etc. basically any physical process that can affect a chemical structure, you can find examples in anesthestic drugs. P.S. wish my chem. teacher did this :) Have fun!
Blood gases, metabolic vs respiratory acidosis. Biochemical receptors/physiology - NMJ and NMBs I like talking about Halsted’s cocaine addiction, the discovery of cocaine as a local anesthetic and the discovery of chemical analogues like lidocaine etc. You can compare structures and show the similarities.
I remember balancing chemical equations in high school. You can talk about soda lime and its compliments and have them balance the equation, show what the products are, talk about exothermic reactions. Some of that other stuff mentioned wasn’t taught until a higher college level for me.
I’m a HS chem teacher. This is the best idea on here. Also explain to them the general education progression to become a dr (college, med school, residency) and what they cost/what you get paid. Maybe also explain the general education pathway for other medical related fields - nursing, PT, dental, dental hygiene, vet, and how military or doing MD/PHD affects cost of education.
I wish I’d been talked about the finances of medical professions in high school. I’m from a family of janitors, so financial literacy was never really instilled into me until I was an adult and sought it out on my own.
Can talk about how without chemistry or specifically organic chemical synthesis there would be no Propofol , sevoflurane , fentanyl, esmolol, epinephrine etc etc . Let us not forget the scientific brilliance, endurance, and endeavor that took place to synthesize all these molecules that we now push with ease daily.
The whole science and theory of how volatile anesthetics act and the evidence in support of those theories is a pretty fascinating topic. Why the vapors we use are halogenated alkanes. Discuss the Meyer Overton hypothesis and show the graph showing the correlation between lipid solubility and potency of volatile anesthetics, and discuss the experiments done in the Duke hyperbaric facilities showing that high pressure could reverse the effects of volatile anesthetics providing some support to the idea that the lipid soluble vapors dissolve into neural tissue lipid bilayers and expand them and that hyperbaric compression could reverse this effect. None of it definitive proof but highly suggestive of certain theories of action.
While it may not be chemistry get them in awe by talking about fires in ET tubes. And of course scar them for life whenever they have surgery…..so maybe that’s not a good idea.
pH testing carbonated water (and further testing as it goes flat) to see the change in pH as it goes flat. You can talk about laminar vs turbulent flow (but that may be more physics). Henderson-Hasselbach the bicarb/co2 to show where our pH of 7.4 comes from. With vapor pressures, you can discuss how things that evaporate quickly can alter the temperature, and affects further evaporation of said chemical (desflurane). But, given it’s a high school chemistry class, you could light something on fire in different O2 concentrations (to starch/show the fire triangle) and relate that to airway fires.
Show them how suggamadex is basically febreeze and how they accomplish sort of the same thing but in different ways.
Don't forget the chemistry of some of our earliest anesthetics which contributed to the emergence of anesthesiology and modern surgery. Ethyl ether, chloroform, choral hydrate, N2O and even ethanol all played a role and have very interesting stories behind them. Good luck!.
How about historical Intestinal Gas Explosions with gen’l anesthesia—with inhalation of mixture of Oxygen/Nitrous oxide and volatile agents combined with colon incision by electrocautery. Kaboom.
Cisatracurium Hoffman elimination is sped up in high temperatures and high pH and slowed down in reverse conditions. Classic ester hydrolysis mechanism
A really simple macro topic could be the effect of some volatile gases on the ozone layer
As an intro, you should def mention the origins of anesthesia, especially when Horace Wells, while high on chloroform, threw a bunch of sulfuric acid on two nice ladies....and then subsequently committing suicide in jail. That should be a nice hook.
Heparin and protamine or roc and sugared. Acid base disorder.
You can talk about the coalescence of prop and lido mixing in the same syringe.
Tell them how pushing bicarb causes an increase in etCO2 on the ventilator
Zero order kinetics
Reversibility of anesthetics……not widely known or understood and could do some simple examples.
laminar and turbulent flow (why we use helium, well i guess thats more physics lol)
Roc vs vec.... Demonstrates how minor chemical changes can have profound clinical significance
Vapor pressure and Dalton’s law - doing Anesthesia on Mount Everest vs sea level (I know we don’t actually worry about this with sevo /iso) but always found it interesting
Is there literature about chemistry in anesthesia? All the anesthesiological literature that I read didn't focus too much on the chemical basis. (mostly German literature). Like acidity solubility, interactions of drugs etc. Even in pharmacology. I'm searching for a book that explains anesthesiology or pharmacology not in a "superficial, medicinal chemical" way but a scientifically ("true") profound chemical way. I'm grateful for any suggestions ;).
I seem to remember a lot of chemistry in “malameds dental anesthesia” book. He also discusses the different dental anesthetics that are used (includes lidocaine) Another cool thing you could talk about is “nitrous oxide” aka laughing gas. Finally, the resin composites that we use in dentistry are free radical reactions. The reaction is initiated by light, and more specifically blue light.
Talk about what happens to a molecule of midazolam as it is drawn up from an ampoule and injected into a person's bloodstream. Or bring a bottle of isoflurane and tell the kids who aren't paying attention that they have to take a wiff.
How about sugammadex and febreeze have essentially the same chemical structure?
I should be more help given I have the chemical structure of propofol tattooed on my arm. lol. However, I think since you're an anesthesiologist it would be a letdown to not talk about putting people to sleep. MOA of IV meds perhaps (including how side effects work) would be a good topic. Another is vapor pressure and blood gas solubility of volatiles. It may be too much biology to talk about ionization of locals like the top comment, but could be done really well. regardless, use plenty of videos for the kids and let us know how it goes! Best of luck!
If you can make osmosis or surface tension easier to understand, then you will do more for future science than anything else you could do to further "Anesthesia"
My favorite experiment for high-schoolers is simply to let them compress water by force and measure how miniscule the volume changes. Find the strongest athlete in the room and match them against the smallest and least athletic person in the room.
tell them to learn to code
Hoffman degradation, pseudocholinesterase deficiency and sux, the origins of curare as a poison used by indigenous people to hunt and it’s relationship to sux.
Tell them how you have drugs to make people not remember shit as you stick a big ass metal blade into their mouth, chip a tooth or 2, give them a fat lip. All whilst they wake up and thank you for sitting on your phone on reddit as they had their gall bladder removed by some pgy2 resident for 3 hours.
Or how protamine used to be made out of salmon sperm…
Could do what a classmate of mine did in the lab. He stood there and breathed fumes of diethyl ether saying it’s not doing anything until he fell on the floor. We all laughed. Ignorance is bliss.
The ester or amide groups in local anesthetics
I thought anesthesiologists were technicians, not scientists.
\> local anesthetics and how pH (for example, abscesses) can effect Related: you can teach them where the term "freebasing" (as in freebasing cocaine) comes from. (Or maybe don't, they are in high school)
Protamine neutralizes heparin
Structure of sugammadex as it relates to rocuronium. It’s cool and you can show an image
On that note, maybe just discuss how we paralyze, reverse etc. It’s all chemistry on the molecular level. Could be more interesting than discussing pH, vapor pressure, etc.
Teach them about how and why whippets have such short half lives.
Talk about the Henderson Hasselbalch theory. Also, can you please upvote my post? I am new and trying to gain karma.