A recently identified genetic mutation, passed down on the maternal line, can cause otherwise healthy patients to develop severe and often permanent neurological injury after routine sevoflurane exposure. This episode breaks down the underlying mitochondrial mechanism, why TIVA with propofol is the safer anesthetic strategy, and the family history red flags every provider should be screening for.

• A newly identified genetic mutation that turns routine sevoflurane exposure into catastrophic, permanent neurological injury
• The mitochondrial mechanism behind it, and why some patients have zero reserve capacity to absorb the hit
• Why TIVA with propofol becomes the clear anesthetic choice once you understand what spares Complex I

Source: Sanz-Pons J, et al. "Effects of a Mitochondrial Genetic Variant on Sevoflurane Hypersensitivity." Anesthesiology 2026;144:1286–98.

FREE RESOURCE FOR THIS EPISODE:

GPCR Cheat Sheet — G-protein coupled receptors decoded for anesthesia. Head to atomicanesthesia.com/freebies/gpcr-cheat-sheet to grab it free.

MORE FREE STUDY RESOURCES:

SEE/NCE Study Plan — A structured, week-by-week plan to pass your boards

Non-Opioid Pharmacology Cheat Sheet — Every non-opioid analgesic you need to know, on one page

Malignant Hyperthermia Reference Guide — Recognize MH fast. Treat it faster — one-page reference

WANT THE FULL PLATFORM?

Atomic Anesthesia is the all-in-one study platform built specifically for SRNAs — lessons, quizzes, flashcards, and more. Start your free trial at atomicanesthesia.com.

Mentioned in this episode:

💜 PARTNERS: The Incomologists®

https://theincomologists.com/ You work hard caring for others—let us take care of you. Whether you’re a W-2 employee or transitioning to a 1099 role, we understand the unique challenges healthcare professionals face, from insurance coverage to financial planning. That’s where we step in. Like you, we are a team of healthcare providers who understand your needs and help you find tailored insurance plans and financial strategies without the hassle or pressure. And we’re a partner you can rely on, today and in the future. We evaluate all available options and resources in the market to protect our clients, so contact us, and we’ll get started! - Jake Bevilacqua, CRNA (jake@theincomologists.com)

Propofol, a cornerstone in anesthesia practice, functions as a positive allosteric modulator at the GABA-A receptor. This episode explores its receptor pharmacology, the mechanisms behind its dose-dependent clinical effects, and addresses common questions like propofol infusion syndrome and pain on injection.

• Receptor pharmacology and allosteric modulation
• Pharmacokinetics and context-sensitive half-time
• Cardiac and respiratory effects
• Risk and management of propofol infusion syndrome
• Handling egg allergy concerns
• Strategies to reduce pain on injection

FREE RESOURCE FOR THIS EPISODE:

GPCR Cheat Sheet — G-protein coupled receptors decoded for anesthesia. Head to atomicanesthesia.com/freebies/gpcr-cheat-sheet to grab it free.

MORE FREE STUDY RESOURCES:

SEE/NCE Study Plan — A structured, week-by-week plan to pass your boards

Non-Opioid Pharmacology Cheat Sheet — Every non-opioid analgesic you need to know, on one page

Malignant Hyperthermia Reference Guide — Recognize MH fast. Treat it faster — one-page reference

WANT THE FULL PLATFORM?

Atomic Anesthesia is the all-in-one study platform built specifically for SRNAs — lessons, quizzes, flashcards, and more. Start your free trial at atomicanesthesia.com.

Mentioned in this episode:

💜 PARTNERS: The Incomologists®

https://theincomologists.com/ You work hard caring for others—let us take care of you. Whether you’re a W-2 employee or transitioning to a 1099 role, we understand the unique challenges healthcare professionals face, from insurance coverage to financial planning. That’s where we step in. Like you, we are a team of healthcare providers who understand your needs and help you find tailored insurance plans and financial strategies without the hassle or pressure. And we’re a partner you can rely on, today and in the future. We evaluate all available options and resources in the market to protect our clients, so contact us, and we’ll get started! - Jake Bevilacqua, CRNA (jake@theincomologists.com)

Welcome to the Atomic Anesthesia podcast hosted by CRNA professor Dr. Rhea Temmermand and Co-Founder Sachi Lord. On this show, you'll hear clear, clinically grounded discussions designed for nurse anesthesia residents and CRNAs who want to feel more confident in complex pharmacology, physiology, and real-world anesthesia decision-making.

Want more content like this? Become a member of our learning platform: http://atomicanesthesia.com

In this episode:

• The critical distinction between high spinal and total spinal that everyone can define but few can actually tell apart
• Why a negative aspiration on a labor epidural doesn't guarantee the catheter isn't sitting in CSF
• The board favorite scenario where a spinal stacked on a failed epidural top off becomes one of the highest risk setups for total spinal
• Why blood pressure stays normal in over half of total spinal cases and what the earliest reliable warning sign really is

💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.

• SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards
• Non-Opioid Pharmacology Cheat Sheet — every non-opioid analgesic you need to know, one page
• GPCR Cheat Sheet — G-protein coupled receptors decoded for anesthesia

💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at hello@atomicanesthesia.com, follow us on social media, and sign up for our newsletter.

Mentioned in this episode:

💜 PARTNERS: The Incomologists®

https://theincomologists.com/ You work hard caring for others—let us take care of you. Whether you’re a W-2 employee or transitioning to a 1099 role, we understand the unique challenges healthcare professionals face, from insurance coverage to financial planning. That’s where we step in. Like you, we are a team of healthcare providers who understand your needs and help you find tailored insurance plans and financial strategies without the hassle or pressure. And we’re a partner you can rely on, today and in the future. We evaluate all available options and resources in the market to protect our clients, so contact us, and we’ll get started! - Jake Bevilacqua, CRNA (jake@theincomologists.com)