SPINE SURGERY WITHOUT LOSING YOUR NERVE │ EP131

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trialWelcome 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.Your hernia patient shows up with an intrathecal pump, a spinal cord stimulator and a neck injection last month. In this members-only Week 6 episode of our SEE/NCE series, we walk you through the interventional pain procedures your patients have had, so you know what to do with each device and which complications to watch for.In this episode:Interlaminar vs transforaminal epidural steroid injections, and why the side door is where the risk livesParticulate vs nonparticulate steroids and the safety rules for cervical injectionsMedial branch blocks and radiofrequency ablation for facet painSympathetic blocks from top to bottom: stellate ganglion, celiac plexus, lumbar sympathetic, superior hypogastric and ganglion imparSpinal cord stimulators and intrathecal pumps, including what to do with each on the day of surgeryAnticoagulation timing, contrast and intravascular injection safetyWant more content like this? Become a member of our learning platform💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], follow us on social media, and sign up for our newsletter.

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trialWelcome 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.Your fusion patient's pain gets worse every time you give more hydromorphone. Is she tolerant, or did the opioid make it worse? In Week 6 of our SEE/NCE series, we explain what changes in the nervous system when pain becomes chronic, so you can build a plan that actually works for your chronic pain patients.In this episode:The four steps of pain (transduction, transmission, modulation and perception) and a memory trick to keep them straightNociceptive vs neuropathic pain, plus allodynia vs hyperalgesiaPeripheral and central sensitization, wind-up, and the magnesium "bouncer" at the NMDA receptorChronic postsurgical pain, CRPS and the Budapest criteria, phantom limb pain, postherpetic neuralgia and fibromyalgiaOpioid tolerance vs opioid-induced hyperalgesia, and what to do when more opioid makes the pain worseA perioperative plan and multimodal toolbox mapped to each step of the pain pathwayWant more content like this? Become a member of our learning platform💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], 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 ([email protected])

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trial 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. A six-level fusion, a patient prone on a frame all day, real blood loss, and a neuromonitoring team at the head of the bed. Where does your plan even start? In Week 6 of our SEE/NCE series, we break spine surgery into the pieces the boards love to test, so you can protect the eyes, the cord and the blood volume with confidence. In this episode:Turning prone safely, and what the prone position does to venous return, oxygenation and bleedingPostoperative visual loss, ischemic optic neuropathy vs central retinal artery occlusion, and the six ION risk factorsSpinal cord blood supply, the artery of Adamkiewicz, and why SSEPs can miss anterior spinal artery syndromeSSEPs vs MEPs, and how volatiles, TIVA and muscle relaxants change your signalsWhat to do when the signals drop, the wake-up test, blood conservation and venous air embolismExtubation decisions and multimodal pain control after spine surgery Want more content like this? Become a member of our learning platform 💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards 💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], 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 ([email protected])

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trialWelcome 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.Your patient is mid-lobectomy, the SpO2 is sliding from 94 to 88, and the surgeon wants that lung to stay down. In this members-only Week 5 episode of our SEE/NCE series, we walk you through one-lung ventilation from tube choice to physiology to rescue. You'll leave with a stepwise plan for exactly that moment, so you know what to check first and what to do next.In this episode:Spill, leak and wash: the three buckets of absolute indications for lung isolationDouble-lumen tube vs bronchial blocker, and why a left-sided DLT is the go-to for both right and left chest casesConfirming DLT position with fiberoptic bronchoscopy, and why auscultation alone misses so many malpositionsWhere gas and blood go in the anesthetized lateral patient, and how hypoxic pulmonary vasoconstriction cuts the shunt in halfWhat weakens HPV, plus a lung-protective setup for the ventilated lungA stepwise rescue plan for desaturation, including why CPAP to the nonventilated lung is the single most effective moveWant more content like this? Become a member of our learning platform💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], follow us on social media, and sign up for our newsletter.

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trial 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. Your patient with asthma starts wheezing a minute after intubation, and you have a whole cart of drugs within reach. In week 5 of our 12-week SEE/NCE series, we build every respiratory drug around one airway smooth muscle cell, so the mechanisms, side effects and the order of treatment finally fall into place. In this episode:How cyclic AMP relaxes and calcium tightens airway smooth muscle, and where every bronchodilator fitsBeta-2 agonists, why a LABA never travels alone in asthma, and the "shaky, speedy, low K" side effectsAnticholinergics, methylxanthines, steroids, leukotriene modifiers and mast cell stabilizers, and when each one helpsWhy propofol, ketamine and sevoflurane are friends of the reactive airway, and why desflurane isn'tThe step-by-step treatment of bronchospasm under anesthesia, and the look-alikes to rule out firstDrugs that can trigger bronchospasm, from nonselective beta blockers to histamine releasers Want more content like this? Become a member of our learning platform 💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards 💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], 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 ([email protected])

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trialWelcome 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.Pulmonary hypertension can feel like a pile of numbers, groups and drug names, but board questions keep coming back to one idea: protect the right ventricle. In week 5 of our 12-week SEE/NCE series, we start with a patient on daily sildenafil whose blood pressure falls after propofol, and we show you how to recognize the RV failure spiral and what to do first.In this episode:The current definition of pulmonary hypertension and how wedge pressure and PVR separate precapillary from postcapillary diseaseThe five WHO groups, plus a memory trick to place any patientThe RV failure spiral and why systemic hypotension is so dangerousWhat raises PVR (hypoxemia, hypercarbia, acidosis, hypothermia, pain) and what lowers it, including why nitrous oxide is the gas to avoidManaging acute right ventricular failure on induction with vasopressors, inotropes and inhaled nitric oxideWhy nitroglycerin is dangerous in a patient taking sildenafilWant more content like this? Become a member of our learning platform💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], 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 ([email protected])

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trialWelcome 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.Every capnogram reports on three things at once: metabolism, circulation and ventilation. Change any one of them and the waveform changes. In this members-only Week 4 episode of our 12-week SEE/NCE series, we learn to read the normal waveform, then name the abnormal ones, with a worksheet to practice on.In this episode:Capnometry vs capnography, and sidestream vs mainstream monitorsThe normal capnogram: phases I to III and the alpha and beta anglesETCO2 vs PaCO2, and hypoventilation vs hyperventilationBronchospasm and obstructionWhen the baseline won't return to zero: rebreathing, an exhausted absorber, incompetent valvesWhen CO2 disappears: esophageal intubation, disconnection and sudden cardiovascular collapseThe curare cleft, and a method for reading any capnogramWant more content like this? Become a member of our learning platform.💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], follow us on social media, and sign up for our newsletter.

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trial 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. Your patient's SpO2 reads 100 percent, but they were just pulled out of a house fire. Can you trust it? In Week 4 of our 12-week SEE/NCE series, we break down the assumptions behind that number so you can predict every misleading reading the boards throw at you. In this episode:What SpO2 measures, and why a perfect number doesn't rule out anemia or low cardiac outputThe Beer-Lambert law, red vs infrared light at 660 and 940 nm, and how the AC/DC ratio finds the pulseFunctional vs fractional saturation and the oxyhemoglobin curve landmarksWhy SpO2 can hide a big drop in PaO2 and can't monitor ventilationCarboxyhemoglobin, methemoglobin and the dyes that fool the probeLow perfusion, venous pulsation, probe site and response time Want more content like this? Become a member of our learning platform. 💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards 💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], 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 ([email protected])

🚀 Try the Atomic Anesthesia platform free for 3 days: Start your free trial 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. How many minutes of oxygen are left in that tank? Why does the nitrous gauge read full when the tank is almost empty? In Week 4 of our 12-week SEE/NCE series, we take every gas law straight to a patient and then give you a memory trick so it actually sticks. In this episode:Boyle's, Charles's and Gay-Lussac's laws, from a pneumothorax at altitude to a cylinder near a fireWhy the ideal gas law lets an oxygen gauge tell you what's left, plus quick E-cylinder mathCritical temperature, and why the nitrous gauge reads full until the tank is nearly emptyDalton's and Henry's laws: partial pressure, desflurane at altitude and dissolved oxygenDiffusion with Graham's and Fick's laws, and why nitrous expands a pneumothorax or an obstructed bowelLaminar vs turbulent flow, Poiseuille's law, heliox and the Venturi mask Want more content like this? Become a member of our learning platform. 💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan — a structured, week-by-week plan to pass your boards 💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], 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 ([email protected])

Want more content like this? Become a member of our learning platform.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.Your patient can't come off bypass, the pressors are climbing, and the surgeon wants a balloon. In this members-only episode of our SEE/NCE series, we break down the intra-aortic balloon pump, ventricular assist devices and ECMO with three questions you can use for every device: what does it support, how much, and for how long?In this episode:Why mechanical support is used, and where it fits when a patient can't come off bypassIABP placement, counterpulsation, and the four timing errors (and which two are dangerous)IABP contraindications and complicationsLVAD physiology: preload dependence, afterload sensitivity, suction events and the right ventricleWhy your LVAD patient may have no palpable pulse, and how to assess perfusionVA vs VV ECMO, LV distention, differential hypoxia, the Impella and the anesthesia plan for LVAD patients💜 FREE DOWNLOADS: Grab your copy of customized study plans & worksheets.SEE/NCE Study Plan: a structured, week-by-week plan to pass your boards💜 CONNECT: 📥 Email questions, comments or topic suggestions to Rhea or Sachi at [email protected], follow us on social media, and sign up for our newsletter.