Ep 43: Anesthesia for a Thyroidectomy

Episode SummaryJeremy 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!References1.    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.2024.04.0044.    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 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 & complete this series.Resident Registered Nurse Anesthesiologists get a steep discount! Email us at [email protected] to get your discount code.Learn more about our courses 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 

Episode SummaryIn 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 hyperdynamic drama! References1.    Chung KS, et al. “A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction.” doi:10.1007/BF030082872.    Gurulingappa, et al. “Attenuation of Cardiovascular Responses to Direct Laryngoscopy and Intubation-A Comparative Study Between iv Bolus Fentanyl, Lignocaine and Placebo(NS).” doi:10.7860/JCDR/2012/4070.2619 3.    Hassani V, et al. “Comparison of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anesthesia. doi:10.5812/aapm.64424.    Mendonça FT, et al. “Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial.” doi:10.1016/j.bjane.2021.01.0145.    Mulimani SM, et al. “Efficacy of a Bolus Dose of Esmolol and Bolus Dose of Lignocaine for Attenuating the Pressor Response to Laryngoscopy and Endotracheal Intubation in General Anesthesia: A Comparative Study.” . doi:10.4103/aer.AER_31_196.    Qi DY, et al. “Efficacy of intravenous lidocaine versus placebo on attenuating cardiovascular response to laryngoscopy and tracheal intubation: a systematic review of randomized controlled trials.” 7.    Qin J, et al. “Effects of intravenous lignocaine on haemodynamic responses to laryngoscopy and tracheal intubation in adults under general anaesthesia: A systematic review and meta-analysis.” doi:10.4103/ija.ija_201_25 8.    Saleh A, et al. “Effects of Dexmedetomidine vs Esmolol on Postintubation Hemodynamics: A Meta-Analysis.” doi:10.2344/23-00599.    Sharma S, et al. “Comparison of Esmolol and Dexmedetomidine for Suppression of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation in Adult Patients Undergoing Elective General Surgery: A Prospective, Randomized Controlled Double-blinded Study.” . doi:10.4103/aer.AER_226_1710. Teong, Cheng Yeon et al. “The Haemodynamic Response to Endotracheal Intubation at Different Time of Fentanyl Given During Induction: A Randomised Controlled Trial.” doi:10.1038/s41598-020-65711-9 Resources/information discussed in podcast  About The Nurse AnesthesiaFor 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 & complete this series.Resident Registered Nurse Anesthesiologists get a steep discount! Email us at [email protected] to get your discount code.Learn more about our courses at www.thenurseanesthesia.com   Follow us on Instagram

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 you need to know to effectively manage this possible emergency.About The Nurse AnesthesiaWe provide continuing education for CRNAs and RNs. Our goal is provie 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! 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 a ton of value in taking these courses!Learn more about our courses 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 

Episode SummaryOver 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 Airway Society's 2025 Unanticipated Difficult Airway Guidelines. Giddyap for this EBP Roundup…it’s go time!References1.    High Flow Nasal Oxygenation (HFNO) for preoxygenation at various flow rates: Sjöblom, Albin et al. “Preoxygenation with high-flow nasal oxygen at various flow rates in elective surgical patients: a prospective, randomised, single-blind clinical trial.” British journal of anaesthesia, S0007-0912(25)00816-5. 18 Dec. 2025 2.    HFNO use during general anesthesia: Frassanito, Luciano et al. “High-Flow Nasal Oxygen versus Mechanical Ventilation Through a Laryngeal Mask During General Anesthesia Without Muscle Paralysis: A Randomized Clinical Trial.” Anesthesia and analgesia vol. 141,5 (2025): 1116-1125.3.    Ultrasound-guided neuraxial anesthesia: de Carvalho, Clístenes Crístian et al. “Efficacy and safety of ultrasound-guided versus landmark-guided neuraxial puncture: a systematic review, network meta-analysis and trial sequential analysis of randomized clinical trials.” Regional anesthesia and pain medicine vol. 50,9 737-746. 4 Sep. 2025a.    If you want to see great images on US-guided neuraxial anesthesia check out this article: https://link.springer.com/article/10.1007/s40140-021-00456-34.    Updated Difficult Airway Society Unanticipated Difficult Airway Guidelines: Ahmad, Imran et al. “Difficult Airway Society 2025 guidelines for management of unanticipated difficult tracheal intubation in adults.” British journal of anaesthesia vol. 136,1 (2026): 283-307. 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 passionate 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. 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 & complete 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 @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

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