Episode Summary

In 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!

References

1. Chung KS, et al. “A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction.” doi:10.1007/BF03008287

2. 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.6442

4. Mendonça FT, et al. “Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial.” doi:10.1016/j.bjane.2021.01.014

5. 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_19

6. 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:10.2344/23-0059

9. 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_17

10. 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 Anesthesia

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

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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 Anesthesia

We 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 Courses

Our 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 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

Over 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!

References

1. 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. 2025

a. If you want to see great images on US-guided neuraxial anesthesia check out this article: https://link.springer.com/article/10.1007/s40140-021-00456-3

4. 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 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 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 Courses

Our 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 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