The Nurse Anesthesia Podcast

Sass and Jeremy talk about the preparation and perioperative management of a patient who requires the removal of a pheochromocytoma. They discuss the important preoperative optimization that’s required to appropriately care for these patients, and what you can do if you ever experience an unexpected pheochromocytoma during the anesthetic care of your patients. References 1.    Elisha S. “Anesthesia Case Management for Excision of a Pheochromocytoma.” Case Studies in Nurse Anesthesia. 1st ed. Elsevier, 2021. 2.    Elisha S. “The Endocrine System and Anesthesia.” In Elisha S, Heiner JS, Nagelhout JJ. Nurse Anesthesia. 7th ed. Elsevier 2023. 3.    Fagundes GFC, Almeida MQ. Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas. J Endocr Soc. 2022;6(2):bvac004. Published 2022 Jan 14. doi:10.1210/jendso/bvac004  4.    Kamath AS, Singh K. Perioperative Management of Pheochromocytoma. [Updated 2023 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-.  About The Nurse Anesthesia We provide continuing education for CRNAs and RNs.  Our goal is provide the very best in anesthesia education, and to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and practicing CRNAs who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. We are here for you. For anyone who wants to learn, or if you just want to review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you want to be. Let's do this together. It's Go Time!  Visit us at www.thenurseanesthesia.com  Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase this series. Resident Registered Nurse Anesthesiologists will absolutely find value in taking these courses! Learn more about our courses at www.thenurseanesthesia.com  Follow us on Instagram @thenurseanesthesia Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl 

In this episode of the Nurse Anesthesia Podcast, Jeremy sits down with two SUPERSTAR ultrasound and acute pain management educators…Nicolette Hooge, DNP, CRNA, FAANA and Christian Falyar, DNAP, CRNA, FAANA from the Middle Tennessee School of Anesthesia. They talk about the core ultrasound-guided anesthesia nerve blocks that every CRNA should learn and have available as part of their skill set for anesthesia practice.  If you’re interested in peripheral nerve blocks and ultrasound-guided regional anesthesia…this is an amazing conversation with so many gems and take-aways…you absolutely will want to listen!  Resources/information discussed in podcast 1.    Acute Surgical Pain Management Fellowship at Middle Tennessee School of Anesthesia at this link: https://mtsa.edu/admissions/fellowship/ 2.    Nurse Anesthesia 7th edition   About The Nurse Anesthesia We provide continuing education for CRNAs and RNs, and our goal is to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl 

Our guests in this episode are Christian Falyar, DNAP, CRNA, FAANA and Nicolette Hooge, DNP, CRNA, FAANA from the Middle Tennessee School of Anesthesia. They are some of the top educators of regional anesthesia in the country, and direct the only Acute Surgical Pain Management Fellowship for CRNAs. They literally are the rock stars of regional anesthesia! Jeremy had the opportunity to sit down with them and talk about the state of the state regarding ultrasound-guided regional anesthesia education.    You can find more information about them and the Acute Surgical Pain Management Fellowship at Middle Tennessee School of Anesthesia at this link: https://mtsa.edu/admissions/fellowship/   References 1.    Nurse Anesthesia 7th edition       About The Nurse Anesthesia We provide continuing education for CRNAs and RNs, and our goal is to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs and RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl  Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

In this episode Jeremy talks about a powerful dual-technique for intubation that blends two modern airway tools — the video laryngoscope and the single-use flexible intubating scope — into a single, coordinated approach. He calls this method Videolaryngoscopy Including Flexible Intubation, or VIFI. This airway technique combines the visibility of the videolaryngoscope with the precision of the flexible intubating scope.  During this episode Jeremy talks about some patient conditions and situations where VIFI may be useful as well as a step-by-step description on how to perform this technique. This is one you definitely should check out!     References 1. Hu, Hui-Zhong et al. “A visual laryngoscope combined with a fiberoptic bronchoscope improves intubation outcomes in patients with predicted difficult airways in thoracic surgery.” BMC pulmonary medicine vol. 24,1 558. 7 Nov. 2024, doi:10.1186/s12890-024-03369-z 2. Ottoveggio, Gaetano et al. “Combined videolaryngoscope and fiberoptic intubation for difficult airways in head and neck surgery: A prospective observational study.” Current problems in surgery vol. 70 (2025): 101852. doi:10.1016/j.cpsurg.2025.101852 3. Strayer RJ, Caputo N. “How to Use Video-Assisted Flexible Endoscopic Intubation.” ACEP Now: The Official Voice of Emergency Medicine. November 11, 2022. https://www.acepnow.com/article/how-to-use-video-assisted-flexible-endoscopic-intubation/?singlepage=1 4. Stein, M L et al. “Efficacy of a hybrid technique of simultaneous videolaryngoscopy with flexible bronchoscopy in children with difficult direct laryngoscopy in the Pediatric Difficult Intubation Registry.” Anaesthesia vol. 78,9 (2023): 1093-1101. doi:10.1111/anae.16049   About The Nurse Anesthesia We provide continuing education for CRNAs and Nurses which the goal of building a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, practical know how to give you the most current and relevant anesthesia content available. We’re here for you! For anyone who wants to learn or if you just review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you want to be. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs and RNs get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcast is for educational and informational purposes only. It does not constitute medical or professional advice. While we strive for accuracy, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl  Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

In this episode of The Nurse Anesthesia Podcast, Jeremy, Sass, Mark, and Chloe Gomez discuss the evolution of Topical Thunder for Awake Intubation. They examine how this topical technique for anesthetizing the airway was developed, and talk about each of their unique experiences with Topical Thunder for awake intubation.    Topical Thunder is a technique that uses only topical lidocaine to anesthetize the airway in preparation for awake intubation. It consists of three steps:  Step 1 is spraying the oral and hypo-pharyngeal structures with atomized 4% lidocaine solution. Step 2 utilizes 5% lidocaine paste to anesthetize the posterior tongue and vallecular structures. Step 3 involves spraying the hypopharyngeal and periglottic structures with atomized 4% lidocaine solution.    This is an episode you absolutely do not want to miss, because when it comes to awake intubation…it really is…GO TIME!   Resources/information discussed in podcast Check out the My Favorite Learners Podcast on your favorite podcatcher and on YouTube! https://www.youtube.com/@myfavoritelearners/search   About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We are seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, practical know how to give you the most current and relevant anesthesia content available. We’re here for you! For anyone who wants to learn or if you just want to review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you want to be. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical or professional advice. While we strive for accuracy, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl   

In this episode of The Nurse Anesthesia Podcast, Sass and Jeremy talk about the most commonly used benzodiazepine in anesthesia practice…Midazolam. Without a doubt, this is one of the medications we use frequently to help relieve patient anxiety prior to an operation…it’s just like the Ramones sing…”(They) Wanna Be Sedated!” You won’t want to miss the discussion between Jeremy and Sass as they review the mechanism of action, indications, pharmacokinetics, and reasons we use this drug in anesthesia practice.  Resources/information discussed in podcast Come check us out at the Western Summit for Nurse Anesthesiology on October 3-5. We’ll be running the Advanced Airway Workshop on Friday October 3 and presenting on Crisis Management and Awake Intubation using the TOPICAL THUNDER technique on Saturday October 4. https://westerncrnasummit.com/   About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We are educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com   Come get your FREE Anesthesia and Critical Care Crisis Checklists at www.thenurseanesthesia.com  Follow us on Instagram @thenurseanesthesia Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.   Music by Alex Grohl Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

This is the 7th round of Q&A with TNA, and in this round Jeremy and Sass ask some questions and give some answers on Inotropic medications including Epinephrine, Norepinephrine, Milrinone, Dobutamine, Dopamine, and Isoproterenol.  This is a perfect episode to brush up on your question and answer skills while learning or relearning these medications at the same time! About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care!  We are educators and practicing anesthesia clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you!  For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com   Get our FREE Crisis Management Checklists at www.thenurseanesthesia.com     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.   Music by Alex Grohl 

The Nurse Anesthesia Team gets together on this episode to talk all things cricothyrotomy in preparation for the AANA Annual Congress in Nashville! Jeremy, Sass, and Mark will be hosting and running the Advanced Airway Skills Workshop at the Annual Congress. Part of that workshop includes practicing several cricothyrotomy techniques.  In this episode, they discuss the three cricothyrotomy techniques that include: (1) percutaneous needle cricothyrotomy; (2) percutaneous wire-guided cricothyrotomy; & (3) the surgical bougie-assisted cricothyrotomy. Even though this is a rare procedure, it is absolutely essential to have an understanding of these techniques and to regularly practice them so that you’ll be ready if you’re ever in an emergency airway situation where you cannot intubate and cannot ventilate/cannot oxygenate.    References 1.Apfelbaum JL, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81.  2.Cook TM, et al. Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31.  3.Joffe AM, et al. “Management of Difficult Tracheal Intubation: A Closed Claims Analysis.” Anesthesiology vol. 131,4 (2019): 818-829.  4.Law JA, et al. “Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient.” Canadian journal of anaesthesia vol. 68,9 (2021): 1373-1404. 5.Infographic on the bougie-assisted cricothyrotomy - Price TM, et al. “Emergency front of neck access in airway management.” BJA education vol. 19,8 (2019): 246-253.     Sign up for The Nurse Anesthesia Courses! Our CRISIS MANAGEMENT VIDEO SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com     We also have a book of FREE Crisis Checklists  Come get them at www.thenurseanesthesia.com     Follow us on Instagram @thenurseanesthesia

This was a super fu episode where Jeremy invites Rhea Temmermand on the show! Dr. Rhea Temmermand PhD, MSN, CRNA, FAANA is a distinguished research scientist specializing in neuropharmacology within the Department of Pharmacology and Physiology at Drexel University. In addition to her full-time research endeavors, she serves as an Adjunct Professor in Drexel University’s Nurse Anesthesia program. She is also the co-founder of Atomic Anesthesia and co-host of the Atomic Anesthesia Podcast. In this episode, Jeremy and Rhea go through 10 crises with a focus on how to target the correct diagnosis and then appropriately manage each one…and they do this in a format that is rapid fire! Resources/information discussed in podcast Go get our FREE Crisis Management Checklists! www.thenurseanesthesia.com Check out the Atomic Anesthesia Podcast: https://open.spotify.com/show/4Kdd7jV7x0AE5LmejLYc0E   About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We are educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl  Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

Episode Summary  In this episode of The Nurse Anesthesia Podcast, Jeremy reviews basic kidney function and focuses on the different types of Diuretic Medications. These include Osmotic agents, Loop Diuretics, Carbonic Anhydrase Inhibitors, Thiazide Diuretics, Aldosterone Antagonists, Potassium Sparing Diuretics, and Vasopressin Antagonists. Some diuretics we use during anesthesia management and some medications patients take to manage medical conditions. If you want to brush up on your diuretic medications, then turn on this episode and “Let it flow”!  About The Nurse Anesthesia  We are building a commUNITY of learning in anesthesia and critical care! We are CRNA educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you!  For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!  Sign up for The Nurse Anesthesia Courses  Our CRISIS MANAGEMENT SERIES is currently available!   RN’s get CE credits when they purchase this series.  Learn more about it at www.thenurseanesthesia.com    ALSO…The Nurse Anesthesia Crisis Checklists are FREE to download from our website!    Follow us on Instagram @thenurseanesthesia    Legal Disclaimer  The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.    Music by Alex Grohl  

In this episode of The Nurse Anesthesia Podcast, Jeremy discusses questions and answers from previous TNA podcast episodes 22 – BIS Monitoring During Anesthesia, 24–Perioperative Hypovolemia: The Tank is Empty, & 25–Albuterol & Epinephrine for the Treatment of Intraoperative Bronchospasm. Here are several examples of questions he discusses in the episode. For a complete review of all the questions, check out the episode wherever you listen to podcasts! 1.     Which EEG waveforms is most commonly associated with deep anesthesia and may indicate a patient who is excessively sedated or in a deeply hypnotic state? a. Alpha waves (8-13 Hz) b. Beta waves (13-30Hz) c. Theta waves (4-8 Hz) d. Delta waves (0.5-4Hz) 2.     Which hemodynamic finding is most consistent with severe intraoperative hypovolemia? a. Widened pulse pressure and bradycardia b. Elevated central venous pressure (CVP) and warm extremities c. Narrow pulse pressure and tachycardia d. Hypertension and bounding pulses 3.     Which is the primary mechanism of action of albuterol causing bronchodilation? a. Inhibition of muscarinic receptors b. Inhibition of acetylcholine release at the neuromuscular junction c. Activation of G-proteins causes increased cAMP & smooth muscle relaxation d. Direct inhibition of calcium channels in bronchial smooth muscle About the Nurse Anesthesia Our goal is to build acommUNITY of learning in anesthesia and critical care! Please consider sharing our podcast with your colleagues and friends. Follow us on Instagram@thenurseanesthesia Sign up for The Nurse Anesthesia Courses our CRISIS MANAGEMENT SERIES is available! RNs can get CEs when they take this course. Learn more about it at www.thenurseanesthesia.com Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl  

Episode Summary In this episode of the nurse anesthesia podcast, Jeremy dives into some Airway Management Adventures! He discusses three airway cases from the Emergency Department to the Operating Room. Each case illustrates critical decision-making under challenging circumstances where key actions by the CRNA are essential. The cases include information on preoxygenation with nasal cannula and a non-rebreather mask, RSI, successful first-pass intubation using video-laryngoscopy, cricothyrotomy, and awake intubation. Major themes discussed in this episode involve preparation with airway plans, checklist use, stress preparation, adaptability, team coordination, and continuous learning from both success and difficulty in airway management.   Resources/information discussed in podcast ·         Get your free The Nurse Anesthesia Crisis Checklists at www.thenurseanesthesia.com ·         Sign up for our Crisis Management Video Series. You’ll get 10 different crisis management videos packed full of the most up-to-date information.  ·         Nurses…you can get CE credits when you sign up for the Crisis Management Video Series.   About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We are educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.   Music by Alex Grohl   

In Episode 26 we welcome a special guest…Rhea Temmermand from the Atomic Anesthesia Podcast! Jeremy talks with Rhea about cognitive aids—like crisis checklists—which are essential tools in anesthesia for guiding rapid decision-making during high-stakes medical emergencies. Originally inspired by aviation’s Crew Resource Management, these aids were adapted for anesthesia…giving rise to Anesthesia Crisis Resource Management (ACRM). Using crisis checklists can help enhance performance, boosts patient safety, and supports better outcomes in perioperative care. This was a great conversation with Rhea! Oh yeah…and don’t forget to grab your FREE Anesthesia Crisis Checklists from www.thenurseanesthesia.com   About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We are educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  RN’s get CE credits when they purchase this series. Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl  Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

Asthma is a chronic inflammatory disorder of the airways characterized by hyperresponsiveness, variable airflow obstruction, and airway remodeling. In the OR, we’re less concerned about chronic control and more focused on acute airway events…namely, bronchospasm. Bronchospasm during general anesthesia can be insidious. You may see rising peak airway pressures, decreased tidal volumes, wheezing if you’re lucky…and if you’re unlucky…desaturation and hypotension. Time is tissue. That’s when it’s time to get medications like albuterol and epinephrine out of the anesthesia cart. In today’s episode, Sass and Jeremy discuss the pharmacology of albuterol and epinephrine as they relate to the management of intraoperative bronchospasm.  References Maddah SA, et al. The Effect of Albuterol Spray on Hypoxia and Bronchospasm in Patients with Chronic Obstructive Pulmonary Disease (COPD) under General Anesthesia: A bouble-Blind Randomized Clinical Trial. Ethiop J Health Sci. 2023;33(3):491-498.  von Ungern-Sternberg BS, et al. Effect of Albuterol Premedication vs Placebo on the Occurrence of Respiratory Adverse Events in Children Undergoing Tonsillectomies: The REACT Randomized Clinical Trial. JAMA Pediatr. 2019;173(6):527-533. Resources/information discussed in podcast Get your free copy of The Nurse Anesthesia Crisis Management Checklists at www.thenurseanesthesia.com    About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We’re educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you’ve always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available! Registered nurses get continuing education credits (CEUs) Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia If you have an idea for a show, please let us know.  Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl 

Episode 24: Perioperative Hypovolemia…The Tank Is Empty!

Episode 23 begins with Jeremy and Sass discussing the historical background of cannabis or “marijuana” use, and then dive into how this psychoactive drug affects each body system. They focus on what you need to know when providing anesthesia for an individual who is a chronic user or acutely intoxicated. Get ready…it’s go time!  References Horvath C, et al. “Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations.” AANA journal vol. 87,6 (2019): 451-458. King DD. Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. AANA J. 2021 Jun; 89(3): 205–212. Kraft B. Lack of analgesia by oral standardized cannabis extract on acute inflammatory pain and hyperalgesia in volunteers. Anethesiology. 2008 Jul;109(1):101-10.  Teitel A, Bozimoski G. A review of the pharmacology and anesthetic implications of cannabis. AANA J. 2020;88(3):237-243. Wiseman LK, et al. The Effect of Preoperative Cannabis Use on Postoperative Pain Following Gynaecologic Oncology Surgery. J Obstet Gynaecol Can. 2022;44(7):750-756. About The Nurse Anesthesia We’re educators and clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. Our goal is to build a commUNITY of learning in anesthesia and critical care. It’s go time! Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT VIDEO SERIES is currently available!  Get 50% off the current price with the code: TNA50 Get our FREE Crisis Checklists – seriously…get them for FREE. They’re a great resource for anyone working in anesthesia or critical care. Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl 

Episode Summary Monitoring the depth of anesthesia, as a CRNA, is important for any surgical or medical procedure. In this episode of The Nurse Anesthesia Podcast, Jeremy and Sass review the bispectral index (BIS) monitor. They discuss the various electroencephalographic (EEG) waveforms the BIS monitor uses to determine depth of anesthesia, and identify the factors and medications that influence the BIS monitor. They finish the episode with an interesting set of studies that investigated at how electromyographic (EMG) activity is incorporated into the BIS algorithm. This is definitely one episode you’ll want to download and catch up on!   References 1.    Gu, Yichun et al. “Effectiveness Assessment of Bispectral Index Monitoring Compared with Conventional Monitoring in General Anesthesia: A Systematic Review and Meta-Analysis.” Anesthesiology research and practice vol. 2024 5555481. 7 Aug. 2024.  2.    Messner, M et al. “The bispectral index declines during neuromuscular block in fully awake persons.” Anesthesia and analgesia vol. 97,2 (2003): 488-491.  3.    Schuller, P J et al. “Response of bispectral index to neuromuscular block in awake volunteers.” British journal of anaesthesia vol. 115 Suppl 1 (2015): i95-i103.    About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! We are educators and clinicians who want to provide free and valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!   Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  Get 50% off the current price with the code: TNA50 Learn more about it at www.thenurseanesthesia.com     Follow us on Instagram We post about all things anesthesia. Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.   Music by Alex Grohl 

In this episode of The Nurse Anesthesia Podcast, Jeremy discusses questions and answers from the previous TNA podcast episodes 14 - POCUS of the Cricothyroid Membrane, 15 - How Anesthesia uses Ketamine, 19 - Push-dose Vasopressors, and 20 - Vasoplegic Syndrome. Here are several examples of questions he discusses in the episode. For a complete review of all the questions, check out the episode wherever you listen to podcasts! 1. Which artery extends the length of the cricothyroid membrane? a. Superior thyroid artery  b.Inferior cricoid artery c.Transverse cricothyroid artery d.Anterior tracheal artery  2. Which are two situations where ketamine can be used as an induction agent to secure an airway during an emergency situation? (SELECT 2) a. An agitated patient in the ED requiring intubation* b. Malignant hyperthermia c. Neuroleptic malignant syndrom d. Massive hemorrhage with hypotension*  3. Which medication can be administered at the site of a norepinephrine intravenous extravasation? a. Epinephrine b. Methylene blue c. Phentolamine* d. Labetalol 4. After vasopressors, IV fluids, and vasopressin have been administered for suspected vasoplegic syndrome, which is the next most effective treatment?  a. Methylene blue* b. Verapamil  c. 5% Albumin d. Calcium chloride About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care!  Follow us on Instagram @thenurseanesthesia Sign up for The Nurse Anesthesia Courses our CRISIS MANAGEMENT SERIES is currently available!  Learn more about it at www.thenurseanesthesia.com   Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl  Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

In this episode of The Nurse Anesthesia Podcast, Jeremy & Sass discuss what happens when the routine treatments for intraoperative hypotension don’t work, and focus on the interventions you can consider when refractory hypotension occurs. They talk about different causes of refractory hypotension with a focus on vasoplegic syndrome. They discuss the differences between refractory hypotension and vasoplegic syndrome, and then identify the potential causes and specific treatments for this rare condition.  References Arevalo VN. Methylene Blue as an adjunct to Treat Vasoplegia in patients undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass: A Literature Review. AANA J. 2018;86(6):455-463. Habib MA. Methylene Blue for Vasoplegic Syndrome Postcardiac Surgery. Indian J Crit Care Med. 2018;22(3) 168-173. Hosseinian L. Methylene Blue: Magic Bullet for Vasoplegia. Anesthesia and Analgesia. 2016;122(1):194-201. Levy B. Vasoplegia Treatments: The past, the present and the future. Critical Care. 2018;22(1):52. Liu H. Vasoplegic syndrome: An update on perioperative considerations. Journal of Clinical Anesthesia. 2017;40:63-71. About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia Courses our CRISIS MANAGEMENT SERIES is currently available!  Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram We post about all things anesthesia. Follow us on Instagram @thenurseanesthesiaLegal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl  Mixed & Edited by Next Day Podcast info@nextdaypodcast.com

Anesthesia induced hypotension is commonly treated with push dose vasopressors. Today Jeremy & Sass dive into what the evidence is showing us about the use of phenylephrine, ephedrine, and norepinephrine IV bolus doses. We talk about cerebral oxygen concentrations and cardiac output when administering these vasopressors, and ultimately ask ourselves…should we be less pushy? References Kee W, et al. Randomized double-blinded comparison of norepinephrine and phenylephrine for maintenance of blood pressure during spinal anesthesia for cesarean delivery. Anesthesiology. 2015 Apr;122(4):736-45.  Larson S, et al. Effect of phenylephrine on cerebral oxygen saturation and cardiac output in adults when used to treat intraoperative hypotension: a systematic review. BI Evid Synth. 2020 Sep 15;19(1):34-58.  Meng L,et al. Effect of phenylephrine and ephedrine bolus treatment on cerebral oxygenation in anaesthetized patients. Br J Anaesth. 2011 Aug; 107(2): 209–217.   Mohta M, et al. Comparison of the potency of phenylephrine and norepinephrine bolus doses used to treat post-spinal hypotension during elective caesarean section. Int J Obstet Anesth. 2019 May;38:25-31.  Nissen P, et al. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care. 2010 Feb;12(1):17-23.  Pelaez A, et al. Effect of adrenergic agonists on coronary blood flow: a laboratory study in healthy volunteers. Physiol Rep. 2016 May;4(10):e12806.  Pancaro C, et al. Risk of Major Complications After Perioperative Norepinephrine Infusion Through Peripheral Intravenous Lines in a Multicenter Study. Anesth Analg. 2020;131(4):1060-1065.  Sharkey  A. Comparison of Intermittent Intravenous Boluses of Phenylephrine and Norepinephrine to Prevent and Treat Spinal-Induced Hypotension in Cesarean Deliveries: Randomized Controlled Trial. Anesth Analg. 2019 Nov;129(5):1312-1318.  Simons C. The Safety and Efficacy of Peripherally Administered Norepinephrine during the Perioperative Period. AANA J. 2022;90(5):387-395. Thiele R, et al. The physiologic implications of isolated alpha(1) adrenergic stimulation. Anesth Analg. 2011 Aug;113(2):284-96.  Vallee F, et al. Norepinephrine reduces arterial compliance less than phenylephrine when treating general anesthesia-induced arterial hypotension. Acta Anaesthesiol Scand. 2017 Jul;61(6):590-600.  About The Nurse Anesthesia We are building a commUNITY of learning in anesthesia and critical care! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia Courses our CRISIS MANAGEMENT SERIES is currently available!  Learn more about it at www.thenurseanesthesia.com  Follow us on Instagram We post about all things anesthesia. Follow us on Instagram @thenurseanesthesia Comments or Suggestions? We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Please contact us on Instagram with suggestions Legal Disclaimer The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party Music by Alex Grohl