Episode 39: Q&A Round 8 - Hypermetabolic Syndromes

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 active recall in action…where we not only recognize information, but retrieve it, apply it, and turn it into something we can use in the operating room.And for CRNAs, this now part of our professional lives. Through the NBCRNA’s Maintenance of Anesthesia Certification, or MAC program, we’re expected to stay engaged with our knowledge by answering anesthesia-related questions every three months as part of our recertification. So, put on those headphones and let’s get right to it!About The Nurse AnesthesiaWe 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 CoursesOur CRISIS MANAGEMENT SERIES is currently available! CRNAs & RN’s get CE credits when they purchase this series.Resident Registered Nurse Anesthesiologists will also find value in taking these courses!Learn more about our courses at www.thenurseanesthesia.com  Follow us on Instagram @thenurseanesthesiaLegal DisclaimerThe Nurse Anesthesia Podcast is 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 

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.References1.    Elisha S. “Anesthesia Case Management for Excision of a Pheochromocytoma.” Case Studies in Nurse Anesthesia. 1st ed. Elsevier, 2021.2.    Elisha S. “The Endocrine System and Anesthesia.” In Elisha S, Heiner JS, Nagelhout JJ. Nurse Anesthesia. 7th ed. Elsevier 2023.3.    Fagundes GFC, Almeida MQ. Perioperative Management of Pheochromocytomas and Sympathetic Paragangliomas. J Endocr Soc. 2022;6(2):bvac004. Published 2022 Jan 14. doi:10.1210/jendso/bvac004 4.    Kamath AS, Singh K. Perioperative Management of Pheochromocytoma. [Updated 2023 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. About The Nurse AnesthesiaWe 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 CoursesOur CRISIS MANAGEMENT SERIES is currently available! CRNAs & RN’s get CE credits when they purchase this series.Resident Registered Nurse Anesthesiologists will absolutely find value in taking these courses!Learn more about our courses at www.thenurseanesthesia.com Follow us on Instagram @thenurseanesthesiaLegal DisclaimerThe Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.  Music by Alex Grohl 

In this episode of the Nurse Anesthesia Podcast, Jeremy sits down with two SUPERSTAR ultrasound and acute pain management educators…Nicolette Hooge, DNP, CRNA, FAANA and Christian Falyar, DNAP, CRNA, FAANA from the Middle Tennessee School of Anesthesia. They talk about the core ultrasound-guided anesthesia nerve blocks that every CRNA should learn and have available as part of their skill set for anesthesia practice. If you’re interested in peripheral nerve blocks and ultrasound-guided regional anesthesia…this is an amazing conversation with so many gems and take-aways…you absolutely will want to listen! Resources/information discussed in podcast1.    Acute Surgical Pain Management Fellowship at Middle Tennessee School of Anesthesia at this link: https://mtsa.edu/admissions/fellowship/2.    Nurse Anesthesia 7th edition  About The Nurse AnesthesiaWe provide continuing education for CRNAs and RNs, and our goal is to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. Let's do this together. It's Go Time!Sign up for The Nurse Anesthesia CoursesOur CRISIS MANAGEMENT SERIES is currently available! CRNAs & RN’s get CE credits when they purchase this series.Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia Legal DisclaimerThe Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.  Music by Alex Grohl 

Our guests in this episode are Christian Falyar, DNAP, CRNA, FAANA and Nicolette Hooge, DNP, CRNA, FAANA from the Middle Tennessee School of Anesthesia. They are some of the top educators of regional anesthesia in the country, and direct the only Acute Surgical Pain Management Fellowship for CRNAs. They literally are the rock stars of regional anesthesia! Jeremy had the opportunity to sit down with them and talk about the state of the state regarding ultrasound-guided regional anesthesia education.  You can find more information about them and the Acute Surgical Pain Management Fellowship at Middle Tennessee School of Anesthesia at this link: https://mtsa.edu/admissions/fellowship/ References1.    Nurse Anesthesia 7th edition    About The Nurse AnesthesiaWe provide continuing education for CRNAs and RNs, and our goal is to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia CoursesOur CRISIS MANAGEMENT SERIES is currently available! CRNAs and RN’s get CE credits when they purchase this series.Learn more about it at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia Legal DisclaimerThe Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.  Music by Alex Grohl Mixed & Edited by Next Day [email protected]

In this episode Jeremy talks about a powerful dual-technique for intubation that blends two modern airway tools — the video laryngoscope and the single-use flexible intubating scope — into a single, coordinated approach.He calls this method Videolaryngoscopy Including Flexible Intubation, or VIFI. This airway technique combines the visibility of the videolaryngoscope with the precision of the flexible intubating scope. During this episode Jeremy talks about some patient conditions and situations where VIFI may be useful as well as a step-by-step description on how to perform this technique. This is one you definitely should check out!  References1. Hu, Hui-Zhong et al. “A visual laryngoscope combined with a fiberoptic bronchoscope improves intubation outcomes in patients with predicted difficult airways in thoracic surgery.” BMC pulmonary medicine vol. 24,1 558. 7 Nov. 2024, doi:10.1186/s12890-024-03369-z2. Ottoveggio, Gaetano et al. “Combined videolaryngoscope and fiberoptic intubation for difficult airways in head and neck surgery: A prospective observational study.” Current problems in surgery vol. 70 (2025): 101852. doi:10.1016/j.cpsurg.2025.1018523. Strayer RJ, Caputo N. “How to Use Video-Assisted Flexible Endoscopic Intubation.” ACEP Now: The Official Voice of Emergency Medicine. November 11, 2022. https://www.acepnow.com/article/how-to-use-video-assisted-flexible-endoscopic-intubation/?singlepage=14. Stein, M L et al. “Efficacy of a hybrid technique of simultaneous videolaryngoscopy with flexible bronchoscopy in children with difficult direct laryngoscopy in the Pediatric Difficult Intubation Registry.” Anaesthesia vol. 78,9 (2023): 1093-1101. doi:10.1111/anae.16049 About The Nurse AnesthesiaWe provide continuing education for CRNAs and Nurses which the goal of building a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and clinicians who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, practical know how to give you the most current and relevant anesthesia content available. We’re here for you!For anyone who wants to learn or if you just review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you want to be. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia CoursesOur CRISIS MANAGEMENT SERIES is currently available! CRNAs and RNs get CE credits when they purchase this series.Learn more about it at www.thenurseanesthesia.com Follow us on Instagram @thenurseanesthesia Legal DisclaimerThe Nurse Anesthesia Podcast is for educational and informational purposes only. It does not constitute medical or professional advice. While we strive for accuracy, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.  Music by Alex Grohl Mixed & Edited by Next Day [email protected]

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

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

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 AnesthesiaWe are building a commUNITY of learning in anesthesia and critical care! We are educators and practicing anesthesia clinicians who want to provide valuable information to anyone interested in anesthesia and critical care. We’re here for you! For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time! Sign up for The Nurse Anesthesia CoursesOur CRISIS MANAGEMENT SERIES is currently available! RN’s get CE credits when they purchase this series.Learn more about it at www.thenurseanesthesia.com  Get our FREE Crisis Management Checklists at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia Legal DisclaimerThe Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party. Music by Alex Grohl 

The Nurse Anesthesia Team gets together on this episode to talk all things cricothyrotomy in preparation for the AANA Annual Congress in Nashville! Jeremy, Sass, and Mark will be hosting and running the Advanced Airway Skills Workshop at the Annual Congress. Part of that workshop includes practicing several cricothyrotomy techniques. In this episode, they discuss the three cricothyrotomy techniques that include: (1) percutaneous needle cricothyrotomy; (2) percutaneous wire-guided cricothyrotomy; & (3) the surgical bougie-assisted cricothyrotomy. Even though this is a rare procedure, it is absolutely essential to have an understanding of these techniques and to regularly practice them so that you’ll be ready if you’re ever in an emergency airway situation where you cannot intubate and cannot ventilate/cannot oxygenate.  References1.Apfelbaum JL, et al. 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway. Anesthesiology. 2022;136(1):31-81. 2.Cook TM, et al. Fourth National Audit Project. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: anaesthesia. Br J Anaesth. 2011 May;106(5):617-31. 3.Joffe AM, et al. “Management of Difficult Tracheal Intubation: A Closed Claims Analysis.” Anesthesiology vol. 131,4 (2019): 818-829. 4.Law JA, et al. “Canadian Airway Focus Group updated consensus-based recommendations for management of the difficult airway: part 1. Difficult airway management encountered in an unconscious patient.” Canadian journal of anaesthesia vol. 68,9 (2021): 1373-1404.5.Infographic on the bougie-assisted cricothyrotomy - Price TM, et al. “Emergency front of neck access in airway management.” BJA education vol. 19,8 (2019): 246-253.  Sign up for The Nurse Anesthesia Courses!Our CRISIS MANAGEMENT VIDEO SERIES is currently available! RN’s get CE credits when they purchase this series.Learn more about it at www.thenurseanesthesia.com   We also have a book of FREE Crisis Checklists Come get them at www.thenurseanesthesia.com   Follow us on Instagram @thenurseanesthesia

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