The Nurse Anesthesia Podcast

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

1. Horvath C, et al. “Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations.” AANA journal vol. 87,6 (2019): 451-458.
2. King DD. Anesthesia for Patients Who Self-Report Cannabis (Marijuana) Use Before Esophagogastroduodenoscopy: A Retrospective Review. AANA J. 2021 Jun; 89(3): 205–212.
3. 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. 
4. Teitel A, Bozimoski G. A review of the pharmacology and anesthetic implications of cannabis. AANA J. 2020;88(3):237-243.
5. 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

[email protected]

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

1. 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.
2. Habib MA. Methylene Blue for Vasoplegic Syndrome Postcardiac Surgery. Indian J Crit Care Med. 2018;22(3) 168-173.
3. Hosseinian L. Methylene Blue: Magic Bullet for Vasoplegia. Anesthesia and Analgesia. 2016;122(1):194-201.
4. Levy B. Vasoplegia Treatments: The past, the present and the future. Critical Care. 2018;22(1):52.
5. 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

[email protected]

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

1. 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. 
2. 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. 
3. 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.  
4. 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. 
5. Nissen P, et al. Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit Care. 2010 Feb;12(1):17-23. 
6. 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. 
7. 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. 
8. 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. 
9. Simons C. The Safety and Efficacy of Peripherally Administered Norepinephrine during the Perioperative Period. AANA J. 2022;90(5):387-395.
10. Thiele R, et al. The physiologic implications of isolated alpha(1) adrenergic stimulation. Anesth Analg. 2011 Aug;113(2):284-96. 
11. 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 

Episode Summary 

Point of care ultrasound (POCUS) assessments of the airway is simply awesome! By utilizing POCUS during our preoperative airway examination, we can now determine with a greater certitude the level of difficulty of a patient’s airway as well as locate anatomical structures (such as the cricothyroid membrane) and endotracheal tube positioning within the airway. 

In today’s episode Jeremy and Mark go over basic ultrasound skills and then discuss the various POCUS airway assessments. They then discuss two POCUS techniques for locating the cricothyroid membrane and finish up with a discussion on how to determine where the endotracheal tube is positioned using POCUS. It most definitely is POCUS “Go Time”! 

Link to Ultrasound Images: https://www.mdpi.com/2075-4418/13/9/1541 

(Click on “Browse Figures”) 

References 

1.    Lin J, et al. Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review. Diagnostics (Basel). 2023;13(9):1541. Published 2023 Apr 25. 

2.    Gomes SH, et al. The Use of Ultrasound in Airway Management: Video in Clinical Anesthesia. Anesth Analg. 2024;139(4):887-890. 

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 

Episode Summary

Every fourth episode we will release a podcast where we ask and answer questions about an anesthesiology or pharmacological topic and we’ll call it ANESTHESIA Q&A. We do this to help our community solidify their learning! We also produce these episodes because nurse anesthesia students and practicing CRNAs are all engaged in answering questions whether it be on exams during anesthesia school or for CRNA recertification.

In today’s episode we focus on reversal medications for opioids, benzodiazepines, and neuromuscular blocking drugs…all medications commonly used in ICUs and during anesthesia practice. This is Anesthesia Q&A Round 4!

Resources/information discussed in podcast:
• 2023 American Society of Anesthesiologists Practice Guidelines for Monitoring and Antagonism of Neuromuscular Blockade: https://pubs.asahq.org/anesthesiology/article/138/1/13/137379/2023-American-Society-of-Anesthesiologists

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

We are currently developing anesthesia content! Learn more about The Nurse Anesthesia 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

We all experience acute stress. Sometimes on a daily basis. In this episode Jeremy breaks down acute stress and talks about the anatomy and physiology of stress. He reviews a theory on how highly stressful situations can both physiologically and psychologically affect our thinking and performance. He also points out how a certain amount of acute stress is actually helpful.

Then Jeremy discusses the meaning of BVM and how breathing, body position, visualizing success, speaking positively and motivating oneself with a mantra can help us deal with acute stress and come out on top. Got stress? BVM it!

References

1. David Grossman –On Combat: The Psychology and Physiology of Deadly Conflict in War and in Peace by Lt.-Col. Dave Grossman and Loren W. Christensen, PPCT Research Publications, 2004. 
2. A good site to see a representation of Grossmans’ Graph of how stress affects one’s psychological and physiological response: https://emcrit.org/emcrit/on-combat-by-grossman/
3. Marcus, H. et al. “Practice makes perfect? The role of simulation-based deliberate practice and script-based mental rehearsal in the acquisition and maintenance of operative neurosurgical skills.” Neurosurgery vol. 72 Suppl 1 (2013): 124-30. 
4. Sanders, CW. et al. “Comparing the effects of physical practice and mental imagery rehearsal on learning basic surgical skills by medical students.” American journal of obstetrics and gynecology vol. 191,5 (2004): 1811-4. 
5. Cryder, S. et al. “Guided, motor, and mental imagery adjuncts to teaching central venous access.” AEM education and training vol. 7,2 e10867. 11 Apr. 2023, doi:10.1002/aet2.10867
6. Hatzigeorgiadis, et al. Self-Talk and Sports Performance A Meta-Analysis. Perspectives on Psychological Science. 2011 6(4), 348–356. 
7. Tod, D., et al. Effects of self-talk: A systematic review. Journal of Sport and Exercise Psychology. 2011 33(5), 666. 

About The Nurse Anesthesia

We are building a commUNITY of learning in anesthesia and critical care. We want to set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your critical care and nurse anesthesia learning. It's Go Time!

Sign up for The Nurse Anesthesia Courses

We’re excited to introduce THE NURSE ANESTHESIA CRISIS MANAGEMENT SERIES! This series is designed to equip you with the tools and strategies to handle high-stakes moments in the OR and ICU. Pick it up 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
[email protected]

In Episode 15 of the Nurse Anesthesia Podcast, Jeremy and Sass dive into the pharmacological world of ketamine. They talk about all the anesthesia situations where it can be useful. They discuss the pharmacology of ketamine, appropriate dosing, what the current evidence really shows about its use with increased intracranial pressure, and how it is frequently used for analgesia. It really is the Swiss army knife of anesthetic meds!
References

1. Aleksandrova LR, et al. Antidepressant effects of ketamine and the roles of AMPA glutamate receptors and other mechanisms beyond NMDA receptor antagonism. J Psychiatry Neurosci. 2017 Jul; 42(4): 222–229. 
2. Bar-JosephG, et al. Effectiveness of Ketamine in Decreasing Intracranial Pressure in Children With Intracranial Hypertension. J Neurosurg Pediatr. 2009 Jul;4(1):40-6. 
3. Farrell A, Bendo D. Perioperative Management of Severe Traumatic Brain Injury: What Is New? Curr Anesthesiol Rep. 2018; 8(3): 279–289. 
4. Ghojazadeh M, et al. Using Ketamine and Propofol for Procedural Sedation of Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Adv Pharm Bull. 2019 Feb;9(1):5-11.
5. Hashimoto K. Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective. Psychiatry Clin Neurosci. 2019 Oct; 73(10): 613–627. 
6. Jankauskas V, et al. A review of ketamine’s role in ECT and non-ECT settings
7. Neuropsychiatr Dis Treat. 2018; 14: 1437–1450. 
8. Liriano F, et al. Ketamine as treatment for post-traumatic stress disorder: a review. Drugs Context. 2019; 8: 212305. 
9. Merelman AH, et al. Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. West J Emerg Med. 2019 May; 20(3): 466–471. 
10. Porter S. Perioperative ketamine for acute analgesia and beyond. Rom J Anaesth Intensive Care. 2019 Apr; 26(1): 67–73.  

Sign up for The Nurse Anesthesia Courses

We are currently developing anesthesia content! Learn more about The Nurse Anesthesia 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

Mixed & Edited by Next Day Podcast
[email protected]

In this episode Jeremy and Mark focus on the cricothyroid membrane. They discuss the anatomy, sizing, vasculature and orientation of this important airway landmark. They then highlight techniques for palpating the cricothyroid membrane, and finish up with a discussion that explains how to use Point of Care Ultrasound (POCUS) to mark where exact position of this membrane is on the neck. This is an episode you won’t want to miss!

References

1. Lin J, Bellinger R, Shedd A, et al. Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review. Diagnostics (Basel). 2023;13(9):1541. Published 2023 Apr 25. doi:10.3390/diagnostics13091541 
2. Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth. 2016 Sep;117 Suppl 1:i39-i48. doi: 10.1093/bja/aew176. Epub 2016 Jul 17. PMID: 27432055. 
3. Rai Y, You-Ten E, Zasso F, De Castro C, Ye XY, Siddiqui N. The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review. J Crit Care. 2020 Dec;60:161-168. doi: 10.1016/j.jcrc.2020.07.030. Epub 2020 Aug 13. PMID: 32836091. Journal of Anaesthesia, Volume 117, Issue suppl_1, September 2016, Pages i39–i48, https://doi.org/10.1093/bja/aew176
4. Hung KC, Chen IW, Lin CM, Sun CK. Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: a meta-analysis. Br J Anaesth. 2021 Jan;126(1):e9-e11. doi: 10.1016/j.bja.2020.08.012. Epub 2020 Sep 28. PMID: 32896429.
5. Kristensen MS, Teoh WH. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access. Br J Anaesth. 2021 Jan;126(1):22-27. doi: 10.1016/j.bja.2020.10.004. Epub 2020 Oct 31. PMID: 33131758.
6. Siddiqui N, Arzola C, Friedman Z, Guerina L, You-Ten KE. Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy: A Randomized Control Trial. Anesthesiology. 2015 Nov;123(5):1033-41. doi: 10.1097/ALN.0000000000000848. PMID: 26352376.

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

We are currently developing anesthesia content! Learn more about The Nurse Anesthesia 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

Mixed & Edited by Next Day Podcast
[email protected]

In today’s podcast Jeremy and Mark review several anesthesia concepts that were covered in previous episodes…specifically Malignant Hyperthermia, Pulse Oximetry, and Adrenal Crisis. 

As educators we know it’s important to revisit and review anesthesia concepts in order to help with long term memory retention. There’s actually a learning technique called 

spaced learning (or spaced repetition) where information is reviewed at increasing intervals over time, instead of being crammed in a single session. 

This method leverages the psychological spacing effect, where learning and retention are more effective when study sessions are spread out. And in the context of learning anesthesia concepts, spaced learning helps learners more efficiently memorize and deeply understand complex topics by reinforcing the material at various intervals, allowing for better long-term retention.

Also, since all CRNAs will need to recertify their credential in the future with the NBCRNAs new MAC questions…these episodes will help with that too! 

References

1. Bruder EA, Ball IM, Pickett W. 2015. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. doi 10.1002/14651858. 
2. Chabre O, et al. 2017. Epidemiology of primary and secondary adrenal insufficiency. Ann Endocrinol. 78(6):490-494.
3. Chan ED, et al. Pulse oximetry: understanding its basic principles 
    facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99. 
4. Elisha, S., Heiner, J. S., & Nagelhout J. J. (2023). Nurse Anesthesia (7th ed.) Elsevier Saunders.
5. Elshal MM, et al. Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021 Oct 1;8:651909. 
6. Liu M., 2017. Perioperative steroid management. Anesthesiology, 127(1), 166-172.
7. www.mhaus.org 
8. Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4. 

Resources/information discussed in podcast

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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

Mixed & Edited by Next Day Podcast
[email protected]

In today’s episode Jeremy and Sass start by diving into normal physiologic function of the Hypothalamic-Pituitary-Adrenal (HPA) Axis. They then review how it’s regulated and the pathology/medications that can alter the HPA Axis. After that, it’s all about the adrenal glands, and Jeremy and Sass differentiate between Acute Adrenal Crisis and Adrenal Insufficiency. They talk about why chronic steroid use puts patients at risk for Adrenal Crisis and why cortisol is necessary for proper cardiovascular function and a whole lot more. This is definitely the nuts and bolts of “What you need to know”!

References

1. Bruder EA, Ball IM, Pickett W. 2015. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. doi 10.1002/14651858. 

2. Chabre O, et al. 2017. Epidemiology of primary and secondary adrenal insufficiency. Ann Endocrinol. 78(6):490-494.

3. Liu M., 2017. Perioperative steroid management. Anesthesiology, 127(1), 166-172.

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com

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. Click here to share your comments and 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 

Episode Summary

Nitrous oxide is one the OG of anesthesia gases and is one of three gases pipped into our anesthesia gas machine. It’s known on the anesthesia workstation by the color blue. In this episode Jeremy and Mark discuss the current use of nitrous oxide and both it’sdesirable and undesirable effects. Gear up to review or learn about the “Original Blue Gas”!

Resources/information discussed in podcast

You can pick up a copy of Emergency Management in Anesthesia and Critical Care (EMACC) on Amazon, or from Elsevier:https://evolve.elsevier.com/cs/product/9780443106934?role=student   

About The Nurse Anesthesia

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

We are currently developing anesthesia content! Learn more about The Nurse Anesthesia 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

This is a special episode where Jeremy & Sass talk with the one and only Dr. John Nagelhout, PhD, CRNA, FAAN. They talk with him about what it was like when he first went to anesthesia school, his transition into academics, how he gathered a group of CRNAs together to write the very first Nurse Anesthesia textbook, and the thousands of lives he’s influenced with his pharmacology lectures. 

There’s a reason we call him the “Grand Master of Nurse Anesthesia Education” and this is a piece of history you won’t want to miss!

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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 

Mixed & Edit by Next Day podcast

Episode Summary

The pulse oximeter is a primary anesthesia and critical care monitor. Not only does it help identify hypoxemia, but it provides several other pieces of essential information when monitoring a patient during anesthesia and surgery. 

In this episode, we go over how the pulse oximeter functions, the current advantages and disadvantages, and other practical considerations that make pulse oximetry monitoring simple awesome!

References

1. Wilkins MC. Residual bacterial contamination on reusable pulse oximetry
    sensors. Respir Care. 1993 Nov;38(11):1155-60. PubMed PMID: 10145923.
2. Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4. PubMed PMID: 18957149.
3. van Genderen ME, et al. Peripheral perfusion index as an early predictor for central hypovolemia in awake healthy volunteers. Anesth Analg. 2013 Feb;116(2):351-6. PMID: 23302972.
4. Elshal MM, et al. Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021 Oct 1;8:651909. doi: 10.3389/fmed.2021.651909. PMID: 34660615 
5. Chan ED, et al. Pulse oximetry: understanding its basic principles
    facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99.
    PMID: 23490227
6. Abdelnasser A, et al. Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index. Br J Anaesth. 2017 Aug 1;119(2):276-280. doi: 10.1093/bja/aex166. PMID: 28854539.

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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 

This is our second Q&A episode and in this one, we review the anesthesia gas machine! We go over all the different pressure systems, variations in some of the anesthesia machines, we talk about some monitoring issues, and review content that falls within the anesthesia technology category…basically we talk about the stuff you will be tested on. There are sure to be some pearls you won’t want to miss!

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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 

Mixed & Edited by Next Day Podcast

[email protected]

Episode Summary

In today’s episode Jeremy and Sass talk about the anaphylactic shock state. They discuss the most common triggers for anaphylaxis, how it occurs at the cellular level, the signs and symptoms associated with anaphylaxis, and most important…how to manage this critical event. 

References

1. Macy E. Penicillin and B-lactam allergy: Epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014;14(11):476.
2. Sadleir PHM, et al. Anaphylaxis. To neuromuscular blocking drugs: Incidence and cross reactivity in Western Australia from 2002-2011. British Journal of Anaesthesia. 2013;110(6):981-87.
3. Dewachter P, et al. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology. 2009;111:1141-50. APSF Newsletter, June 2018.
4. Tazazawa T, et al. Sugammadex and rocuronium induced anaphylaxis. J Anesth. 2016;30:290-97.
5. Reber LL, et al. The pathophysiology of anaphylaxis. J Allergy Clin Immunol. 2017;140:335-48.

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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 

Mixed & Edited by Next Day Podcast
[email protected]

Anesthesia induction agents are essential anesthesia medications that anesthesia providers need to learn about and understand so they can select the correct medication for the right patient/situation. The primary induction agents used in today’s anesthesia practice include: Propofol, Etomidate, and Ketamine…we refer to these as “The Knock Out Buch!” 

Without a doubt, propofol is used more often than any other anesthesia induction agent. 

In today’s episode, we talk about the pharmacokinetics, pharmacodynamics, mechanism of action, and clinical indications of each one of the anesthesia induction medications. Get ready, because this is an episode filled with key concepts and important information used for exams that is hard to find!

References

1. Nagelhout J, Intravenous Induction Agents. Elisha S, Heiner J, Nagelhout J, eds. Nurse Anesthesia. 7th ed. Elsevier; 2023:101-117.
2. Hailu S, et al. Effectiveness of ketofol versus propofol induction on hemodynamic profiles in adult elective surgical patients: A Randomized Controlled Trial. International Journal of Surgery Open. Vol 37, 2021.
3. Carlson P. Spreading depolarization in acute brain injury inhibited by ketamine: a prospective, randomized, multiple crossover trial. J Neurosurg. 2018 May 25;1-7.
4. Albanese J., et al., Ketamine Decreases Intracranial Pressure and Electroencephalographic Activity in Traumatic Brain Injury Patients during Propofol Sedation . Anesthesiology 1997; 87:1328–1334 doi: https://doi.org/10.1097/00000542-199712000-00011
5. Gregers M., et. al., Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review. Neurocrit Care. 2020 Aug;33(1):273-282. doi: 10.1007/s12028-020-00975-7. 

About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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 

Mixed & Edited by Next Day Podcast
[email protected]

In this episode we highlight the various difficult airway algorithms and failed airway checklists developed by professional airway organizations. These tools used by anesthesia providers to develop their personal airway management plans and to help guide decision making in the event of a difficult or failed airway. 

References

1. Apfelbaum JL, et.al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022 Jan 1;136(1):31-81. doi: 10.1097/ALN.0000000000004002. PMID: 34762729. 
2. Frerk C, et al. Difficult Airway Society intubation guidelines working group. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015 Dec;115(6):827-48. doi: 10.1093/bja/aev371. 
3. Jung H. A comprehensive review of difficult airway management strategies for patient safety. Anesth Pain Med (Seoul). 2023 Oct;18(4):331-339. doi: 10.17085/apm.23123. 
4. Law JA, et. al. Canadian Airway Focus Group. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 2. Planning and implementing safe management of the patient with an anticipated difficult airway. Can J Anaesth. 2021 Sep;68(9):1405-1436. doi: 10.1007/s12630-021-02008-z. 
5. Law JA, et. Al. Canadian Airway Focus Group. Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient. Can J Anaesth. 2021 Sep;68(9):1373-1404. doi: 10.1007/s12630-021-02007-0. 

Resources/information discussed in podcast

 | Ariadne Labs OR Crisis Checklists: https://www.ariadnelabs.org/safe-surgery-safe-systems/surgical-safety/or-crisis-checklists/or-crisis-checklist-download/
Stanford Emergency Manual: https://emergencymanual.stanford.edu/ 
The Nurse Anesthesia Failed Airway Checklist: 
 
 
About The Nurse Anesthesia

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

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com  

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. Click here to share your comments and 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 

Mixed & Edited by Next Day Podcast
[email protected]