The Nurse Anesthesia Podcast

In this episode of The Nurse Anesthesia Podcast, host Jeremy Heiner, is joined by co-host Mark Gabot, and special guest Zohn Centimole, PhD, CRNA, for a practical discussion about moving “beyond the BIS Index number” and using electroencephalography (EEG) to better understand the brain’s response to anesthesia. The conversation explores how raw and processed EEG can provide anesthesia professionals with a real-time window into the organ they are actually anesthetizing—the brain. Jeremy, Mark,...

Hypotension can occur during surgery and anesthesia in patients with a history of hypertension who take angiotensin converting enzyme inhibiting (ACEI) or angiotensin receptor blocking (ARB) medications. In this episode Jeremy and Mark talk about what the current evidence says about holding or allowing patients to take their ACEI or ARB on the day of surgery. This has been a hot topic in the anesthesia community with no clear guidelines…until now. Tune in to find out! References ...

We spend a lot of time and effort attempting to prevent aspiration during anesthesia, and advising patients to avoid eating or drinking before surgery is an established practice. In this episode, Jeremy and Mark discuss new guidelines from an international multidisciplinary panel that challenges some long established NPO practices. Some of the big shake-ups include allowing clear liquids up to the time of surgery, permitting a small amount of milk in coffee and still calling it a clear liquid...

In this episode of The Nurse Anesthesia Podcast, Jeremy explores the supporting evidence, mechanisms, and clinical applications of high flow nasal oxygenation (HFNO) in anesthesia practice with Simon McDonald and Amanda Virginia. These experts share their insights on how HFNO technology enhances patient safety during airway management, procedural sedation, and extubation. During their conversation, Jeremy, Simon, and Amanda discuss the development of HFNO, the mechanisms that provide si...

It's Q&A time with Sass and Jeremy...where they willingly subject themselves—and you—to the intellectual equivalent of laryngoscopy without topicalization! In this episode they dive headfirst (cephalad to caudad of course) into the pharyngeal and laryngeal anatomy that every anesthesia provider thinks they remember… until they don’t. From the classic “wait… is that CN IX or CN X?” moment, to realizing the posterior cricoarytenoid is the only muscle keeping that airway open—this episode ro...

In this episode of The Nurse Anesthesia Podcast, Jeremy talks with Roxane McMurray, DNP, CRNA, APRN who is the creator of the McMurray Enhanced Airway (MEA). The MEA is in a new airway device classification known as “Distal Pharyngeal Airways” or DPAs. Her innovative device is placed orally to help maintain a patent airway in patients who are at risk for upper airway obstruction while under anesthesia or even during airway emergencies. The MEA facilitates ventilation in several airway m...

Episode Summary Jeremy and Sass discuss the anesthetic management for a thyroidectomy in this 43rd episode of The Nurse Anesthesia Podcast. They first review the physiology and signs and symptoms of both hyperthyroidism and hypothyroidism, and then review the essential case management strategies for this front of neck procedure. A key part of the anesthesia management is the pharmacology that’s involved, and knowing what type of medication to give and when is crucial when caring for these pat...

Episode Summary In this episode of The Nurse Anesthesia Podcast Jeremy discusses the medications used to block/inhibit/blunt the sympathetic response to laryngoscopy and intubation. He discusses the mechanisms of how lidocaine, fentanyl, esmolol, or dexmedetomidine can be used to limit or even prevent the tachycardia and hypertension that can occur from placing a laryngoscope blade into the hypopharynx. Gear up…because we’re about to explain how to do laryngoscopy without the hyperdynam...

Jeremy & Mark focus on another potential anesthesia critical event in this 41st episode of The Nurse Anesthesia Podcast…the rare but frothy crisis known as Negative Pressure Pulmonary Edema (NPPE). They discuss the clinical presentation, signs and symptoms, etiology, pathophysiology, and most importantly…the management of this potential problem that can occur after general anesthesia or even during the critical care of certain patients. Tune in and catch-up on the important points y...

Episode Summary Over the past few weeks, we’ve taken a bit of a break from the podcast. But we're back for our first episode of 2026! We wanted to start out the year by reviewing some of the best papers in 2025. In this episode Mark and Jeremy each select two of their favorite papers from the past year. They discuss preoxygenation and anesthesia case management using high flow nasal oxygenation, review ultrasound guided neuraxial anesthesia, and explore the updates from the Difficult Ai...

One of the best ways we learn is by answering questions. In this episode of The Nurse Anesthesia Podcast Jeremy and Sass cover several Hypermetabolic Syndromes in Round 8 of our Q&A format. We like to periodically host these episodes as a way to sharpen our thinking, reinforce the fundamentals, and keep our clinical decision-making strong. Answering questions about content we’ve learned in the past helps our brains develop the neural connections that makes information stick. This is activ...

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...

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 ...

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 educ...

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 ...

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: ...

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 anest...

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 educat...

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 cricot...

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 ...

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 d...

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 ...

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, cricothyroto...

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 pa...

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...

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): ...

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 h...

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. ...

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 r...

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...

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 POCU...

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 f...

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 m...

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 Aleksandrova LR, et al. Antidepressant effects of k...

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 Lin J, Bellinger R, Shedd A, et al. Point-of-Care ...

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 i...

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 cardiovas...

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 (EMA...

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 pie...

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 Wilkins MC. Residual bacterial contamina...

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...

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 Macy E. Penicillin and B-lactam allergy: Epidemiology and diagnosis. Curr Allergy Asthma Rep. 2014;14(11):476.Sadleir PHM, et al. Anaphylaxis. To neuromuscular blocking drugs: Incidence an...

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 pharmac...

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 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...

We’ve heard from a lot of anesthesia students, RNs, and CRNAs about how they want some question-and-answer episodes…so we’re here to deliver! This is the first Anesthesia Q&A, and we’re calling it Round 1 (ding! ding! ding!). What better way to start Anesthesia Q & A than with some respiratory anatomy and physiology. We’ve had extensive experience writing questions for anesthesia students, CRNAs, and for national certifying exams. So put the gloves on, it’s time to jump into the...

Episode Summary Laryngoscopy and intubation are core skills that anesthesia providers need to perfect. In this episode Jeremy and Sass discuss some of the keys to direct laryngoscopy and intubation. They start by identifying the primary keys when preparing to perform a direct laryngoscopy called “SOAP ME”. They then discuss the keys used when actually performing direct laryngoscopy and intubating the trachea. Spoiler alert…it’s all about “Epiglotoscopy”! About The Nurse Anesthesia For ...

Episode Summary Jeremy and Mark begin this episode by discussing the history of anesthesia gases. They discuss how volatile agents work and why we actually call them “volatile agents”. They discuss the pharmacokinetics and pharmacodynamics, get into the mechanism of action and discuss those test heavy topics of Oil:Gas and Blood:Gas Partition Coefficients. Phew! They round it out by talking about both adverse effects and contraindications. This is a great discussion about some core medication...

Episode Summary In this episode you’ll learn about the pathophysiology of malignant hyperthermia (MH), talk about prevention, and then review the managing techniques for this critical event. We review the use of Dantrolene for treatment of MH and talk about potential complications. If you’re currently learning or practicing anesthesia…this is a crisis you need to review! References Elisha, S., Heiner, J. S., & Nagelhout J. J. (2023). Nurse Anesthesia (7th ed.) Elsevier Saunders.www....