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

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

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 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&

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 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 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 @thenurseanesthesia

Legal Disclaimer

The 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