It's Airway Adventure time! In this episode of The Nurse Anesthesia Podcast, Jeremy dives into Volume II of Airway Management Adventures with four senior nurse anesthesia students. He discusses with each of them, their airway adventure from locations that include the ICU to the Operating Room. Each case illustrates critical decision-making under challenging circumstances, where key actions by both the nurse anesthesia student and CRNA are essential.

The cases include information on videolaryngoscopy including flexible intubation (VIFI), preparing for an awake intubation…but then suddenly changing the plan, how to manage a massive goiter, and what it feels like to save the airway in the ICU.

Buckle up, because it’s AIRWAY TIME!

Resources/information discussed in podcast

· Anesthesia Patient Safety Foundation – Emergency Tracheostomy Management: https://www.apsf.org/article/keeping-patients-safe-during-emergency-tracheostomy-management/

· National Audit Project 4 (NAP 4): https://www.rcoa.ac.uk/research/research-projects/national-audit-projects-naps/nap4-major-complications-airway-management

· 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 with the most up-to-date information.

· Nurse Anesthesia Residents…you will receive a steep discount on our Crisis Management Video Series. Simply email us at info@thenurseanesthesia.com tell us what nurse anesthesia program you’re in, and we’ll send you a discount code.

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

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, 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, and Zohn then break down the characteristic EEG frequencies encountered during anesthesia. They talk about burst suppression, the density spectral array (DSA), and how recognizing patterns may allow clinicians to titrate anesthetics more thoughtfully and individualize care rather than relying exclusively on MAC values, vital signs, or traditional dosing strategies.

The takeaway is simple: let’s start looking at the EEG! Put the monitor on, observe the changes from induction through emergence, correlate the patterns with anesthetic interventions, and begin developing the skills necessary to use brain monitoring as another tool for individualizing anesthesia care.

References

1. Aldecoa C, Bettelli G, Bilotta F, et al. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol. 2024;41(2):81-108. doi:10.1097/EJA.0000000000001876

2. Jegarl AM, Walline MC, Goldstein PA, Safavynia SA. Is Electroencephalographic Burst-Suppression Good, Bad, or Indifferent for Brain Health? Context Matters. Anesth Analg. 2026;142(6):1169-1179. doi:10.1213/ANE.0000000000007739

3. Purdon PL, Sampson A, Pavone KJ, Brown EN. Clinical Electroencephalography for Anesthesiologists: Part I: Background and Basic Signatures. Anesthesiology. 2015;123(4):937-960. doi:10.1097/ALN.0000000000000841

4. Xu A, Arnaout B, Scott DA, McGuigan S. Intraoperative electroencephalogram-derived measures and their association with postoperative delirium: a systematic review and meta-analysis. Br J Anaesth. 2025;135(6):1684-1703. doi:10.1016/j.bja.2025.08.038

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! Advanced Anatomy, Physiology, and Pathophysiology is coming soon.

CRNAs & RN’s get CE credits when they purchase & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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

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

• Giannas E, et al. Perioperative management of renin-angiotensin system inhibitors in patients undergoing elective major noncardiac surgery: a mixed model investigation using systematic review, meta-analysis, multicentre service evaluation, and national survey. Br J Anaesth. 2025;135:861–869.

• 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery. Circulation. 2024. DOI: 10.1161/CIR.0000000000001285. [Supersedes 2014 ACC/AHA Guideline]

• Kidney Disease: Improving Global Outcomes (KDIGO) 2024 CKD Guideline — perioperative RAS inhibitor management recommendations. https://kdigo.org/guidelines/ckd-evaluation-and-management/

• Keshock M, et al. Hold ACE inhibitors and ARBs before noncardiac surgery? Emerging evidence suggests a patient-specific approach. Cleve Clin J Med. 2025;92(10):619–626.

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 & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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

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, and promoting salivation stimulants such as gum or a lollipop both before and after surgery. Tune in to check out these new guidelines and decide for yourself if it’s time to shake things up!

References

1. Rüggeberg A, El-Boghdadly K, Bilotta F, et al. Peri-operative fasting in adults: an international, multidisciplinary consensus statement. Anaesthesia. Published online February 9, 2026. doi:10.1111/anae.70130

2. MENDELSON CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191-205. doi:10.1016/s0002-9378(16)39829-5

3. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999;90(3):896-905. doi:10.1097/00000542-199903000-00034

4. Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration. Anesthesiology. 2023;138(2):132-151. doi:10.1097/ALN.0000000000004381

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 & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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 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 significant physiological benefits for oxygenation, and most importantly…the clinical applications of this therapy in anesthesia practice.

For anesthesia providers who want to take their practice to the next level of advanced oxygenation for patients, this is a must listen!

References

1. Patel A, Nouraei SA. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70(3):323-329. doi:10.1111/anae.12923

2. Thiruvenkatarajan V, Sekhar V, Wong DT, Currie J, Van Wijk R, Ludbrook GL. Effect of high-flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta-analysis. Anaesthesia. 2023;78(1):81-92. doi:10.1111/anae.15845

Fisher & Paykel Healthcare: https://www.fphcare.com/us/hospital/optiflow-thrive/anesthesia/

About The Nurse Anesthesia

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're here for you. 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 & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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

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 rocks the upper airway questions in all the right ways.

But here’s the deal—this isn’t just an academic exercise. There’s a method to the madness.

Question-based learning is one of the most powerful, evidence-based learning strategies out there. Retrieval practice (aka forcing your brain to recall information under pressure) strengthens memory pathways and improves long-term retention far better than passive review.

And let’s be honest… if you’re a CRNA, you’re already living this life thanks to the NBCRNA's MAC program. Quarterly questions aren’t optional—they’re part of the deal. So, let’s get to it and train like we play!

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 & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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 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 management situations and solves many of the problems we encounter with basic airway devices such as oral pharyngeal airways (OPAs) and nasal pharyngeal airways (NPAs), by being better positioned at the junction of the oro- and hypo-pharyngeal space or distal pharyngeal space…thus bypassing the areas that cause upper airway obstruction.

Roxanne has reimagined basic airway management. Her device is being used in critical care areas, EMS, and in anesthesia for monitored anesthesia care cases and difficult airway management situations. If you have not heard of the McMurray Enhanced Airway, and even for those who have…this is a must listen!

References

1. For more information about the McMurray Airway: https://www.mcmurraymed.com/

3. Daniel C, Feeney M, Gordon L. A New Distal Pharyngeal Airway Device Associated with a Reduced Need for Chin-Lift and Jaw-Thrust Maneuvers in Sedated Patients. AANA J. 2024 Apr;92(2):115-120. PMID: 38564207.

4. DuCanto J. Sudden Hypoxemia in GI Procedure Relieved by a New Distal Pharyngeal Airway (DPA): Case Report. Anesthesia Patient Safety Foundation (APSF). 2023 Jul16. https://www.apsf.org/article/sudden-hypoxemia-in-gi-procedure-relieved-by-a-new-distal-pharyngeal-airway-dpa-case-report/

5. McMurray R, Becker L, Olsen KF, McMurray M. Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results. AANA J. 2020 Apr;88(2):123-129. PMID: 32234203.

6. McMurray RR, McMurray MR. Introducing the First Distal Pharyngeal Airway. A A Pract. 2023;17(6):e01691. Published 2023 Jun 19. doi:10.1213/XAA.0000000000001691

About The Nurse Anesthesia

We’re seasoned educators and practicing CRNAs who know anesthesia and our goal is provide the very best in anesthesia education and to build a commUNITY of learning in anesthesia and critical care!

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 & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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

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 patients. This is an episode packed full of anesthesia pearls that you won’t want to miss!

References

1. Bajwa SJ, Sehgal V. Anesthesia and thyroid surgery: The never ending challenges. Indian J Endocrinol Metab. 2013;17(2):228-234. doi:10.4103/2230-8210.109671

2. Biello A, Kinberg EC, Menon G, et al. Thyroidectomy. [Updated 2024 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563279/

3. Guzzetti L, Inversini D, Bacuzzi A. Anaesthesia for thyroid and parathyroid surgery. BJA Educ. 2024;24(8):270-276. doi:10.1016/j.bjae.2024.04.004

4. Elisha S, Boytim M, Bordi S, Heiner J, Nagelhout J, Waters E. Anesthesia case management for thyroidectomy. AANA J. 2010 Apr;78(2):151-60. PMID: 20583462.

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 & complete this series.

Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com to get your discount code.

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