Anesthesia Guidebook

Adrian Moran, MD, MBA currently serves as the Chief Medical and Transformation Officer of MaineHealth, a not-for-profit, integrated health system with over 2000 providers and 23,000 care team members serving patients across Maine and New Hampshire. Dr Moran joined me to talk about his views on transformational leadership and his professional journey from a pediatric cardiologist at Boston Children’s Hospital to executive organizational leadership roles. I’m excited to share his story with you because we don’t talk enough about how to transition from being specialized clinicians to working in healthcare leadership. I asked Dr Moran to join me for this interview given his unique vantage point and journey to executive leadership. MaineHealth’s flagship level 1 trauma center, Maine Medical Center, is where I serve as the Director supporting the Department of Anesthesiology and Perioperative Medicine. Over the last decade, I’ve watched Dr Moran move from his clinical role as a pediatric cardiologist to MaineHealth board member to Associate Chief Medical Officer. I then saw him leave MaineHealth to take on a system level CMO role for a large health system in Wisconsin and then back to MaineHealth as the Chief Medical and Transformation Officer. Over the years, I’ve seen his leadership style in action and recently heard him describe how the principles of high reliability organizing and servant leadership inform his work, which are ideas we’ve talked about here on the podcast over the last year or so. In this conversation, we talk about: the challenges facing healthcare organizations today and what leaders can do to be effective in supporting their teams what transformational leadership looks like the value of gaining practical experience and credibility as a healthcare leader when and why additional education, like an MBA, might make sense for leaders what motivates Dr Moran and what he sees as his core purpose In full transparency, this interview was imbedded in a qualitative research course I’m taking as part of the PhD in Leadership & Organizational Develop at the University of Southern Maine. My goal was to explore the narrative arc of Dr Moran’s professional story and hear more about his leadership philosophy and work with MaineHealth. I think yall are really going to enjoy this episode. Dr Moran is a remarkable leader, a pretty good story teller and incredibly generous for taking time out of his busy schedule to meet with me and share a bit of his story. With that… let’s get to the show! MaineHealth Announces Adrian Moran, MD, MBA as Chief Medical and Transformation Officer

This is part 3 of a 3 part series titled The Pressure is On: Enhancing Anesthesia Care for Parturients with Hypertensive Disorders of Pregnancy. In the first episode, Joe Navarrete walked us through the baseline physiologic changes of pregnancy. In the last episode, David Barksdale covered the pathophysiology of hypertensive disorders of pregnancy. And in this episode, Isabella Sosa is here to tell us what to do about it. Isabella, Joe & David are each SRNAs at Yale New Have Hospital’s Nurse Anesthesia program and are completing this 3-part series as their doctoral project for anesthesia school. Isabella was a nurse in the cardiac-surgical ICU at Montefiore Medical Center in the Bronx, NY. She decided to pursue anesthesia because she saw what a positive difference anesthesia providers can make on what is the hardest day of many patient’s lives. When she did her OB rotation, she saw the direct impact CRNAs make in the delivery process and how we impact outcomes in these high risk patients. She was inspired by how we can improve the quality of care and birthing experience for patients. Her and her colleagues who produced this series, Joe Navarrete and David Barksdale, are all advocates of women’s health and through this doctoral project hope to empower other providers to cultivate excellence at their facilities when caring for patients with hypertensive disorders of pregnancy.  This three part series will equip anesthesia residents and providers alike with the core knowledge to effectively manage hypertensive disorders of pregnancy. Many thanks to Joe, David & Isabella for putting this series together! Please see below for full show notes and references. Show Notes: #124 – How to Manage Hypertensive Disorders of Pregnancy with Isabella SosaDownload

This is part 2 of a 3 part series on hypertensive disorders of pregnancy. Part one with Joe Navarrete covered the baseline physiologic changes with pregnancy. In this episode, David Barksdale is going to walk us through the pathophysiology of hypertensive disorders of pregnancy. And in the next episode, Isabella Sosa joins us to walk through how to manage hypertensive disorders of pregnancy as anesthesia providers. David Barksdale is a Nurse Anesthesia Resident at Yale New Haven Hospital School of Nurse Anesthesia and Central Connecticut State University. Before CRNA school, he worked for three years as a Surgical Intensive Care Unit nurse at Rhode Island Hospital and is a combat veteran. He served in the United States Army from 2012-2015 as a combat engineer. In 2013, he deployed to East Paktika Province, Afghanistan, conducting route clearance operations to provide freedom of movement to the infantry and local populations. David framed his doctoral project around this topic to deepen his understanding of hypertensive disorders of pregnancy and to explore how podcasting can support learning for anesthesia providers. This three part series will equip anesthesia residents and providers alike with the core knowledge to effectively manage hypertensive disorders of pregnancy. Many thanks to Joe, David & Isabella for putting this series together! References: 1.     American College of Obstetricians and Gynecologists. Gestational hypertension and preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-e260. doi:10.1097/AOG.0000000000003891 2.     Dimitriadis E, Rolnik DL, Zhou W, et al. Pre-eclampsia. Nat Rev Dis Primers. 2023;9(1):8. doi:10.1038/s41572-023-00417-6 3.     Torres-Torres J, Espino-Y-Sosa S, Martinez-Portilla R, et al. A narrative review on the pathophysiology of preeclampsia. Int J Mol Sci. 2024;25(14):7569. doi:10.3390/ijms25147569 4.     Sibai BM, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005;365(9461):785-799. doi:10.1016/S0140-6736(05)17987-2 5.     Hall JE. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia, PA: Elsevier; 2020.\Chestnut DH, Wong CA, Tsen LC, et al. Chestnut’s Obstetric Anesthesia: Principles and Practice. 6th ed. Philadelphia, PA: Elsevier; 2019.

This episode is part of a three-part series on titled “The Pressure is on: Enhancing Anesthesia Care for Parturients with Hypertensive Disorders of Pregnancy.” In this first installment, Joe Navarrete, a third-year student registered nurse anesthetist (SRNA) at the Yale New Haven Hospital School of Nurse Anesthesia, delivers a high-yield, system-by-system breakdown of the expected physiologic changes of pregnancy. Part 2 will be #123 – Pathophysiology of Hypertensive Disorders of Pregnancy with David Barksdale Part 3 will be #124 – How to Manage Hypertensive Disorders of Pregnancy with Isabella Sosa In this episode, Joe Navarrete guides listeners through changes in the respiratory, gastrointestinal, renal, endocrine, musculoskeletal, nervous, hematologic, and cardiovascular systems, with an emphasis on how these changes impact anesthetic management. Joe covers pertinent topics including airway considerations, anesthetic requirements, dilutional anemia, hypercoagulability, neuraxial anesthesia, cardiac output, and fluid shifts throughout pregnancy. The episode concludes with a brief recap of clinical pearls for anesthesia providers to remember when caring for obstetric patients.             This is an in-depth review for SRNAs, CRNAs, and all anesthesia providers alike looking to refresh their understanding of maternal physiology. Whether providers are preparing for clinical rotations, board exams, or managing complex obstetric cases in practice, this review attempts to cover the bases.             At the time of this recording, Joe Navarrete was a 3rd-year SRNA at the Yale New Haven Hospital School of Nurse Anesthesia in Connecticut, pursing his Doctor of Nurse Anesthesia Practice (DNAP) degree. He earned his Bachelor of Science in Nursing from Rhode Island College in 2019. Joe began the first year of his nursing career on the surgical stepdown unit at Rhode Island Hospital (shoutout to 5 stepdown!).              Within his first year of nursing practice, the COVID-19 pandemic transformed the stepdown unit into a COVID ICU. There, Joe gained experience in managing critically ill patients and often worked alongside anesthesia providers during emergent intubations. These experiences sparked his interest in nurse anesthesia, and he never looked back. He went on to work in the Surgical Intensive Care Unit for 2.5 years before matriculating into anesthesia school and moving to Connecticut with his significant other Rebekah and their beloved cat, Bubba.  References Chestnut DH. Chestnut’s Obstetric Anesthesia: Principles and Practice. 6th ed. Philadelphia, PA: Saunders; 2020. Bleeser T, Vally JC, Van de Velde M, Rex S, Devroe S. General anaesthesia for nonobstetric surgery during pregnancy: A narrative review. European Journal of Anaesthesiology and Intensive Care. 2022;1(2). doi: 10.1097/EA9.0000000000000003 Bauer ME, Arendt K, Beilin Y, et al. The society for obstetric anesthesia and perinatology interdisciplinary consensus statement on neuraxial procedures in obstetric patients with thrombocytopenia. Anesth Analg. 2021;132(6):1531-1544. doi:10.1213/ANE.0000000000005355 #122 – Physiologic Changes of Pregnancy Show NotesDownload

What’s up y’all! I’m back at it after a summer hiatus. I actually wrote/recorded this episode back in May 2025, but then summer hit with camping trips, work projects, grad school, home renovations… you know, life! I’m pumped to bring this episode to you finally and this will be followed pretty quickly by a three-part series on hypertensive disorders of pregnancy, which is going to be stellar! Check out these continuing education conferences with Encore Symposiums if you want to connect in person, as I’ll be speaking at each of them: 2025 October 20-23: New England at the Cliff House, Maine 2026 October 19-22: Autumn in Bar Harbor, Maine 2026 November 14-18: O’ahu Turtle Bay, Hawaii (Ritz Carlton) This episode dives into tactical empathy: how to turn resistance into momentum in your conversations. This could be useful whether you’re negotiating with your 4-year old on taking a bath, rebooking a flight after yours got canceled or in the boardroom trying to implement a new project or proposal. In this episode, we’ll walk through: The role of loss aversion in negotiation Techniques of tactical empathy: naming, mirroring The power of “yes, and…” (a tool from improv comedy) How to “start with no” in a negotiation by asking “how am I supposed to do that?” in a kind, vulnerable way. Why listen to this episode? If you want to become a better communicator, get the best deal in a negotiation or learn how to have entertaining conversations from over the drapes in the OR to a cocktail party, this is for you. Tactical empathy is about leveraging what really matters to you and other people with clarity when communicating. Don’t hesitate to reach out with questions, comments or feedback. Remember, the work you do is extremely important and incredibly valuable. You are the provider your patients need. Keep up the hard work. Be well and enjoy the journey! References Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement. https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com Camp, J. (2002). Start with no: The negotiating tools that the pros don’t want you to know. Crown Currency.  Heifetz, R. A., Grashow, A., & Linsky, M. (2009). The practice of adaptive leadership: Tools and tactics for changing your organization and the world. Harvard business press.  Kahneman, D. (2011). Thinking, fast and slow. Farrar, Straus and Giroux.  Voss, C., & Raz, T. (2016). Never split the difference: Negotiating as if your life depended on it. Random House. 

Want to work on changing things? Want to learn about your team and listen better? Interested in a pretty good pathway to do that? Appreciative Inquiry is process of: Discovering what’s working well Dreaming about what could be Designing for future change & success Realizing the Destiny that this process will bring about In this podcast, we’re gonna walk through Appreciative Inquiry and Theory U and how these 2 organizational development processes meld together to create a powerful tool for listening to and helping to improve the work your team does. It’s so good! Our CRNA team at Maine Medical Center worked through this process – really, we’re still working through it – this spring. The full story is in the podcast. I made a video for this podcast but I haven’t been able to get it loaded to YouTube yet and apparently, it’s too big for this website. In the meantime, you can see the core show notes to the podcast in the PDF below. There’s photos of the Theory U and our list of 10-questions we developed as our Appreciative Inquiry survey we used at Maine Medical Center. I hope this episode gives you some very practical tools for how to engage with your team better. I’ve found appreciative inquiry to be a great way to have a conversation with groups and find a new way forward. Let me know how it goes for you! #120 – Appreciative InquiryDownload References Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. John Wiley & Sons. Hollnagel, E. (2020). Synesis: the unification of productivity, quality, safety and reliability. Routledge. Scharmer, O. (2016). Theory U: Leading from the future as it emerges. Berrett-Koehler Publishers. Scharmer, O. (2025). Theory U process of co-sensing and co-creating. Presencing Institute. https://www.presencing.org Whitney, D., & Cooperrider, D. (2005). Appreciative inquiry: A positive revolution in change. Berret-Koehler Publishers.

Yo yo! Today, we close out our 3-part series on systems thinking with this episode on psychological safety & just culture. Part 1 (Episode 117) introduced systems thinking & high reliability organizations. Part 2 (Episode 118) walked through resilience engineering, safety differently and synesis. Part 3 (this episode) threads these topics together with psychological safety & just culture. This three part series invites you to think about your home team and professional practice. How does your team handle errors & mistakes? Are you safe to fail and be honest about mistakes & near misses? Are mistakes and mishaps talked about? Do you usually take feedback well and look for ways to grow or get defensive and think it’s always someone else’s fault? What about the other folks on your team? Psychological safety is about the freedom to speak up without fear of embarrassment or punishment. Psychological safety doesn’t just happen. Organizational leaders need to talk about it and normalize it – truly, make it part of your team norms. Psychological safety doesn’t skirt accountability. Accountability is a key part of a psychologically safe culture. We’ll talk more about it in the show. Just culture extends the idea of psychological safety to the organizational environment and the team’s approach to errors and mistakes. Just culture encourages teams to look at systems factors for why things break down. People don’t make mistakes willfully. Willful harm with malicious intent is recklessness or sabotage. That’s not a mistake. Mistakes are always unintentional because people don’t show up to work planning how they’re going to accidentally drop the ball and screw things up. Just culture looks at mistakes from the standpoint that perhaps the system is broken and sets frontline staff up for failure. A systems fix is like a rising tide that lifts all boats. Just culture sees the systems as the usual point of failure, not the frontline worker. Front line workers are often the source of resilience and capacity within systems. We talk about these things and more in the podcast as we thread all three parts of this series together. As a reminder, I’ll be in Hilton Head, SC next month teaching with Encore Symposiums and back at the Cliff House in Maine this October with Encore. Come check us out if you’re looking for a great continuing education conference! Your values build your system, your system creates your culture, your culture generates your results. References Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202 Dekker, S. (2016). Just culture: Balancing safety and accountability. crc Press.  Dekker, S. W., & Leveson, N. G. (2015). The systems approach to medicine: controversy and misconceptions. BMJ quality & safety, 24(1), 7-9.  Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation, and growth. John Wiley & Sons.  Edmondson, A. C. (2023). Right kind of wrong: The science of failing well. Simon and Schuster.  Schein, E. H. (2010). Organizational culture and leadership (Vol. 2). John Wiley & Sons.  Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. Broadway Business.  Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world. John Wiley & Sons.  Willink, J. (2017, February 2, 2017). Extreme Ownership TEDx, TEDx Talks. https://www.youtube.com/watch?v=ljqra3BcqWM

This is Part 2 of a 3 part series on organizational development – how we work and live together as teams in healthcare so we can do our best work, master our craft, take amazing care of patients and actually enjoy the work we do. (no big deal) In the first part (Episode 117), we talked about systems thinking and patterns of high reliability organizations (HROs). Systems thinking helps us zoom out to consider the complexity of situations and the various levers that influence outcomes. High reliability organizations adopt specific systems thinking practices to achieve consistent success in safety-critical, complex environments. Resilience engineering builds on systems thinking and HRO theory by teaching us how to develop adaptive capacity, build for success (not just avoiding error) and bounce back when things don’t go well. Safety differently is about seeing safety as not the absence of mistakes and errors but the capacity for the right thing to happen. It also recasts the worker not as the weak link in a complex system (the point of failure), but as the source of resilience and capacity. Front-line healthcare workers – you and me – are often the ones who find the workarounds and get the job done despite suboptimal conditions. No one shows up to their job with the intention to make mistakes, get hurt or put patients at risk. Mistakes are always unintentional. Willful acts of harm are something totally different. Blaming and shaming workers (forms of punishment & embarrassment) are counterproductive and stem from leaders who do not understand what’s actually going on or the best ways to run their organizations and build thriving teams. Synesis, which sounds like a scary word, stems from the same Greek word that system and synergy come from and is actually kind of a cool idea. It’s the way we balance the often competing interests of productivity, safety, reliability and quality. We need to figure out how to do all of these things concurrently in healthcare. I’ll share some stories and examples of how to do that as an anesthesia provider in this episode. So that’s where we’re headed with this podcast! In Part 3, we’ll come back and talk about psychological safety and just culture, which thread all three episodes in this little mini-series together. As a reminder, I’m teaching with Encore Symposiums next month in Hilton Head, South Carolina and back at the Cliff House in Maine this October. If you’re looking for a continuing education conference where we’ll talk more about all of this – or if you’re a resident or graduate student looking to check off one of your state/national meetings, come check us out! I’d love to see you there! As always, you can come work with us at MaineHealth – Maine Medical Center. We have a phenomenal team of CRNAs, physician anesthesiologists, surgeons, OR nurses & CSTs, anesthesia techs and admin specialists. If you want to be part of a growing team of providers doing world class work at a level 1 trauma center in a spectacular city, check us out! References Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202 Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303.  Hollnagel, E. (2020). Synesis: the unification of productivity, quality, safety and reliability. Routledge.  Larouzee, J., & Le Coze, J.-C. (2020). Good and bad reasons: The Swiss cheese model and its critics. Safety science, 126, 104660.  Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. Broadway Business.  Sutcliffe, K. M. (2011). High reliability organizations (HROs). Best practice & Research clinical anaesthesiology, 25(2), 133-144.  Wears, R., & Sutcliffe, K. (2019). Still not safe: patient safety and the middle-managing of American medicine. Oxford University Press.  Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world. John Wiley & Sons.  World Health Organization. (2021). Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care (9240032703). 

Yo! This episode introduces the concepts of systems thinking and high reliability organizations. It’s the first part in a 3 part series. Part 2 is gonna dive into resilience engineering and safety differently. Part 3 is all about psychological safety and just culture. These 3 shows unpack crucial intel for front-line providers, equipping them to understand their roles and how to develop their clinical impact. It’s also for organizational leaders and practice managers and will help you think about how to design better systems and support your team so they can thrive. Systems thinking is the process of zooming out beyond simple cause-and-effect understanding (i.e. linear causality models) of how errors happen. It encourages people to consider the complexity of their environments and the power of leveraging changes in your processes and systems. In this episode we cover: Learning organizations and their 5 characteristics: Personal mastery Mental models Shared vision Team learning Systems thinking High reliability organizations and their characteristics Preoccupation with failure Reluctance to simplify Sensitivity to operations Commitment to resilience Deference to expertise How these ideas link to resilience engineering and safety differently “Every organization is perfectly designed to get the results it gets” (Batalden, 2015). If you don’t like the results you’re seeing, you need to change the system. Whether this is your anesthesia team, hospital/OR or your personal life. If the outcomes are not what you desire, you need to adopt a systems thinking approach to change. This episode will walk you through how to do that. The values you embrace shape your culture. Your culture builds your systems. Your systems generate your results. Quick reminder: I’m teaching at Encore Symposium’s Hilton Head conference May 19-22 and then again with their fall conference at the Cliff House here in Maine that runs October 20-23, 2025. I love seeing y’all in person at these conferences. If you come because you heard about it here on the show or are just there and have checked the show out before, come holler at me! I’d love to chat with you about what you’re up to and what your practice is like. Be sure to check out Part 2 and 3 of this series and I’ll see you there! References Batalden, P. a. C., E. (2015). Like Magic? (“Every system is perfectly designed…”). Institute for Healthcare Improvement https://www.ihi.org/insights/magic-every-system-perfectly-designed?utm_source=chatgpt.com Conklin, T. (2025). PAPod 540 – Swiss Cheese Actually In PreAccident Investigation Podcast.https://podcasts.apple.com/us/podcast/preaccident-investigation-podcast/id962990192?i=1000702329202 Epstein, R. M., & Krasner, M. S. (2013). Physician resilience: what it means, why it matters, and how to promote it. Academic Medicine, 88(3), 301-303.  Hollnagel, E. (2020). Synesis: the unification of productivity, quality, safety and reliability. Routledge.  Larouzee, J., & Le Coze, J.-C. (2020). Good and bad reasons: The Swiss cheese model and its critics. Safety science, 126, 104660.  Senge, P. M. (2006). The fifth discipline: The art and practice of the learning organization. Broadway Business.  Sutcliffe, K. M. (2011). High reliability organizations (HROs). Best practice & Research clinical anaesthesiology, 25(2), 133-144.  Wears, R., & Sutcliffe, K. (2019). Still not safe: patient safety and the middle-managing of American medicine. Oxford University Press.  Weick, K. E., & Sutcliffe, K. M. (2015). Managing the unexpected: Sustained performance in a complex world. John Wiley & Sons.  World Health Organization. (2021). Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care (9240032703).  If you don’t like the results you’re seeing, you gotta change the system! Every system is perfectly designed to get the results it gets!

On the corner of Skyland Drive and 23 in a little town called Sylva in Western North Carolina, sit’s PJ’s gas station. One hot summer day back in 2005, I was filling up the tank in a convalescent transport van on my very first day as an EMT-Basic. That’s the most basic, entry-level certification of working as an Emergency Medical Technician or EMT.  My convalescent transport van had a wheelchair ramp and my role as an EMT-B was not to do 911 calls, but to drive this glorified shuttle bus. My role was to transport people to and from their doctor’s appointments. Maybe to help them get home after being discharged from the hospital. If you were too sick for a taxi but not quite sick enough for an ambulance, I was your guy. The guy training me that day, a senior paramedic, was actually a good friend of mine and happened to also be my boss at a local outdoor education company. Everyone affectionally called him “the Padj,” a shortened third-person version of his last name, Padgett. The Padj ran Landmark Learning, which offers wilderness medicine educational courses for outdoor guides and enthusiasts and eventually became the Southeast training center for NOLS Wilderness Medicine. Pretty much everyone who taught for NOLS Wilderness Medicine had a part time gig working in EMS and so that became my path too and this was my first day on the job. I felt supremely important because of two things: as part of my standard issue uniform, on my thick polyester blue shirt, I was wearing a chrome name badge that said “J. Lowrance, Since 2005” and I had a big, heavy, professional walkie talkie. We had no more checked out the van and driven a mile down the road from base to fill up with gas at PJs when the tones went off on the walkie talkie, indicating a serious 911 call had just been dispatched. As I was pumping gas and the Padj was relaxing in the passenger seat, the radio crackled with the call: there was an unresponsive patient about a half mile down the road from where we were. We looked at each other and shrugged, knowing that even though we were essentially in a shuttle bus with next to no medical supplies, we wanted to see if we could help. We hurriedly paid for the gas, jumped in the van and ended up beating the ambulance to the house where the 911 call came from. We were met by a distraught woman in her 60’s who told us she couldn’t wake her husband up. We went in the house through the side door, immediately finding ourselves in her kitchen. The bedroom was just off the kitchen and walking in, I remember the time on the bedside clock – one of those little rectangular digital clocks with red numbers: the time was 10:10 in the morning. Photo credit: OpenAI (2025). ChatGPT 4o version. [Large language model]. https://chatgpt.com. The man was large, heavy and not moving. He looked like he was still asleep except he was a deep shade of purple… not quite blue yet, but definitely not alive-looking.  The Padj called out to him and checked a pulse. Nothing. My heart, however, was racing.  As my palms began to sweat, the Padj looked at me serious, which he never did, and said quietly out of respect for the man’s wife, standing in the doorway, “dead on arrival or do you wanna run the code?” I could hear the sirens of the ambulance approaching the house. “Let’s do it.”  We heaved the man onto the floor… he was heavier than I thought he would be. It dawned on me that dead people don’t try to help you like our wilderness medicine students do when they’re trying to act like patients in simulated scenarios. This was not a scenario. Padj said he’d get the O2 tank in the van and that I should start CPR. I knelt down, looked left and right for our jump bag, which contained a bag-valve mask or BVM, which we used to breathe for patients in cardiac arrest. We left the jump bag in the kitchen. I was in rescue mode. No time to waste. I looked at the man, zeroed in on those purple lips and scrubby, lifeless face, pinched his nose and leaned in to do mouth-to-mouth resuscitation. As time slowed down and I leaned in to my new career in EMS, a paramedic shouted from the front door, “STOP,” shaking his head. He had arrived just in time to yell at me and snarled, “JLo, we don’t do that! Somebody get him a BVM.” A bag-valve-mask was thrown at me from the kitchen. I quickly pumped two breaths with the bag into the man and started chest compressions. We all worked together as hard as we could to save that man’s life but our efforts were in vain. Who knows when he had died before his wife found him that morning. We ran the code, started an IV, intubated him and did CPR the mile and half back up the road to the hospital, where the code was called. I walked out as his wife, crying, walked in to see him. It was my first day on the job. It would be her first day without him. Two

Hey y’all! First of all: thank you to those of you who have subscribed to the website and get these posts right to your email inbox. That’s all that happens: the podcast is free and subscription to the show just means you get the content straight to you as soon as it’s live. I never sell or use your contact info for any other means. I’m just simply thrilled to have your support and interest in the show as the whole thing is geared to support you and help you thrive in your career as an anesthesia provider. Thank you! This podcast covers a run down on the NBCRNA’s Maintaining Anesthesia Certification (MAC) Program. The MAC Program is how CRNAs maintain and rectify their license with the National Board of Certification and Recertification for Nurse Anesthetists (NBCRNA). The MAC Program launched in 2024 as a revamped version of the old CPC (Continued Professional Certification) Program. There are some substantial changes that CRNAs should be aware of. First off, you need to know if you’re in the MAC Program yet. Most CRNAs (new grads and those who’ve re-licensed after 2024) ARE in the new MAC Program. This show will coach you on how you can log into NBCRNA’s website to see where you’re at and what you need to know about MAC Ed (Class A) & MAC Dev (Class B) credits and the quarterly MAC Check exam questions that you can take on an app on your phone. All the details are in the show! For the truth of what’s up with the MAC Program and your license, as always, check with NBCRNA! Things change over time. Be sure NBCRNA has an updated email for you. 30% of the emails they send to CRNAs bounce back as invalid addresses. That’s insane! Updatechur email! You can follow along with the podcast by checking out the attached PDF that outlines the show with lots of helpful graphs and more info than what I spoke about in the podcast. Two last points: First: Overall, I think the MAC Program is a really healthy and needed evolution to the CPC Program. NBCRNA has listened to CRNAs and made needed adjustments to the continuing education/relicensure program. We have to have a continuing education/certification program for the CRNA license to have meaning and value. The current iteration is the best it’s been, so there’s that. Second: Remember that your STATE Board of Nursing may require additional steps for you to re-license as a CRNA. For instance, NBCRNA does NOT require pharmacology-specific continuing education credits (MAC-Ed/Class A); however, the State of Maine (where I’m at) does! For example, Maine CRNAs must obtain 60 MAC-Ed/Class A and 40 MAC-Dev/Class B credits for recertification with NBCRNA every 4 years but we have to have 50 credits every 2 years, 15 of which (every 2 years) must be pharmacology credits, to re-license as CRNA in the State of Maine. So the requirements to re-license as a CRNA in the State of Maine are slightly more stringent (and more frequent) than to maintain the national license with NBCRNA. Follow along with the powerpoint for more details: MAC Program Overview – Anesthesia GuidebookDownload Go get you some deliberate practice!

This podcast is for leaders, clinicians, residents & students who need to get wildly important things done. It’s about how to prioritize when so much of your work seems important. How to find balance when so much seems to be coming at you. How to get started at achieving your biggest goals. This episode will walk you through the 4 Disciplines of Execution by Chris McChesney, Sean Covey & Jim Huling.  I have no financial relationship with these folks, the book or their publishers. It’s just a great concept that will help you get organized, identify your wildly important goal and figure out the work you actually need to do and CAN do to accomplish your goals. The 4 Disciplines of Execution (4DX) model will ask you to identify your wildly important goal. You’ll then create several lag measures (subgoals) and several lead measures (objectives) for each lag measure. These lead and lag measures are where the real work is. The wildly important goal may seem out of reach. Even the lag measures (which lag behind the work you’ll do in the lead measures) may seem a bit ambitious. That’s ok. The lead measures should be the specific actions you will take on a daily or weekly basis that will chip away at the lag measures. As you put the work in on the lead measures, your lag measures will come into sight and slowly be realized. As you stack up achieving the lag measures, your wildly important goal will become within reach. The next components of the 4DX model is the scoreboard where you track your progress on each lead & lag measure. This can be any relevant metric on any kind of progress tracker: a list on a whiteboard, a data point in an Excel file, the pounds on the scale, dollars in the investment account or left on the loan. Whatever. Lastly, is the cadence of accountability. You need to either personally set up a check in on your progress with yourself or you need to set this up with your team, mentor or coach. The authors of the 4DX model recommend this be a short weekly meeting where you review progress from the last week and plan actions for the coming week. Accountability is about follow through, taking steps (as small as they might be) and slowly, setting up the cadence of consistency. I was on the Peloton last night and heard Matt Wilpers say that the order of priorities in exercise is developing consistency, then duration, then load. You can’t go out hard all of a sudden and expect big results. Develop consistency. Show up a little bit each day or each week. Then put the time in. Build the duration of your investment towards your goals. Then you’ll know when to put the extra effort in. Check out the show and if you want to dig deeper, definitely check out the 4 Disciplines of Execution. McChesney, C., Covey, S., & Huling, J. (2012). The 4 disciplines of execution: Achieving your wildly important goals. Simon and Schuster. What’s your Wildly Important Goal?

Matt & Alison Moody took a year off of working as CRNAs to live and travel in Spain with their then 4-year old daughter. This is part of that story. Matt & Alison Moody in Granada, Spain The two were living and working as CRNAs in Asheville, North Carolina when they caught the idea to take a year off of work and live in Spain. Their journey to Spain went from the fall of 2023 to the fall of 2024 and over the last few months, they’ve been re-integrating back to the United States and Western North Carolina and back to their careers as CRNAs. Part of their inspiration to take a year off work came from listening to the episode I did with Kyle & Jen Steen on their decision to sell everything, build out a sprinter van and hit the road. That story is in episode 73. Side note: Kyle & Jen took about 18 months off from work before Kyle returned to his career in anesthesia through locum assignments. They’re still in the van full time and still crossing off new places to live & explore. I hope to have them back on the show soon! Matt & Alison wanted to head to Spain to work on their Spanish language skills and take time to connect with each other as a family. What they discovered along the way may surprise you. In this conversation with Matt, he walks us through what they set out to do and how that changed over time – from before they left through how their experience evolved while they were over in Spain. I think you’ll enjoy this story and hopefully find some inspiration for yourself to think outside of the box and consider what might be possible in your own life. It doesn’t have to be taking a sabbatical or selling everything and hoping in a custom built Sprinter van. It might be about re-prioritizing your work-life balance in other ways. It might be going back to school or picking up pottery like my wife, Kristin. It might be about moving to that area of the country you’ve always wanted to live in or finding a new way to explore your passions. Finding a way to prioritize your own story, dreams and aspirations along the way is possible and I loved chatting with Matt to hear how he & Alison arranged their life to pursue their goals. Matt grew up in coastal North Carolina; went to college and nursing school at UNC Chapel Hill; and then received his CRNA degree at Wake Forest. His heart and soul have always belonged in the Pacific Northwest, so after graduate school he moved west and started his career at the University of Washington Medical Center in Seattle, WA. Eventually, the pull of family brought him back to NC, and he has called Asheville home since 2017. Thus far in his career, Matt has had the fortune to gain experience in many practice areas – from major trauma hospitals to small surgery centers – and has experience in many subspecialties of anesthesia. In his free time, Matt loves to spend time being active outdoors, but he’s especially passionate about rock climbing and skiing. Lately, he and his wife, Alison, have been experiencing the joys (and frustrations!) of introducing their 5 year-old daughter to these activities. While in Spain, Alison created an Instagram page that they invite you to follow. It’s @ La Moody Aventura. @lamoodyaventura Matt also offers his email to anyone who might have questions about how they did what they did. In the show, he talks about how they felt like they were the only ones crazy enough to do something like this but then actually met several folks abroad – including another CRNA family from the States – who were pursuing similar dreams. Matt would love to help you take the next step and you can reach him at [email protected]. And with that, let’s get to the show! – Jon Want to share this episode with your community? Click the link below! Subscribe Subscribing to the website lets you get these posts as soon as they’re live! We never sell or distribute your info and it’s always free! Jon Lowrance | Anesthesia Guidebook

What’s up y’all! This is Jon Lowrance and this is episode 112 – How to Transition from Clinician to Chief CRNA. Y’all are going to love this conversation. So… I almost don’t know where to begin cause there’s so much to talk about… This is an episode about chief CRNAs but so much more. It’s like when you watch one of those food documentaries about the best pizza kitchens in the world and you’re like: oh, a documentary about pizza, but then it’s really about the experience of chefs, small business owners, friendship and passion. This episode is like that. It’s about chief CRNAs. And we have a couple of guests that are going to talk with us about an article they published on the research they did into the professional experience of chief CRNAs. But this story is really about the transition that most healthcare providers take when they take the step from expert provider to clinician-leader, practice manager or owner. You’re going to see this through the lens of what these 2 researchers saw when they did a qualitative analysis of chief CRNAs across the state of North Carolina. But you might take something away from this about the physician who leads your team or the CMO or health system president that runs the show where you’re at. If you work in healthcare, cause you probably do – again, unless you’re my mom, who listens to all these podcasts – hey Gail! But for the rest of you, if you’re in healthcare, this episode will likely help you understand your clinical leaders better. I never set out to be a chief CRNA or practice manager. I wanted to be the best clinician I could. I wanted to stand in the gap between the chaos and the outcome. I wanted to master my craft as an anesthesia provider and take the best care of patients possible. Literally, like 6 months before our chief CRNA announced that he was going to step down after 8 years in his role, I had the opportunity to become a daily shift supervisor – like a board runner in the OR. I was like: I’m never going to do that. It seems way too hard. Then our chief stepped down and his role opened up and I was like… wellllllllll… This episode hopefully will be relevant to any clinician who, like me, has stepped into a role or is thinking about taking on a clinical practice leadership role that maybe they’re not totally ready for. You’re not alone. So we’re going to talk with Austin Cole and Robert Whitehurst, co-authors of an article about the competencies & professional development needs of chief CRNAs that was published in April 2024 in the AANA Journal. Austin framed his doctoral project at Duke University around this study. Austin Cole, DNP, CRNA began his career after graduating from the school of nursing at UNC-Chapel Hill. Following graduation, he spent two years as a Registered Nurse in a cardiothoracic critical care unit. He received his DNP and nurse anesthesiology training at Duke University and currently practices as a CRNA at Duke Regional Hospital in Durham, NC. Robert Whitehurst is the President of Advanced Anesthesia Solutions, a CRNA practice providing anesthesia services to a variety of outpatient practices. He graduated in 1997 from East Carolina University School of Nursing with his Bachelor of Science in Nursing and in 2004 from Duke University School of Nursing with his Master of Science in Nursing. Bob Whitehurst is also the Chairperson for the North Carolina Association of Nurse Anesthetist’s Political Action Committee and he’s passionate about patient access to high quality anesthesia care. He’s happily married to Amy Whitehurst; they have 4 children and in his spare time he enjoys hanging out with his family and playing tennis with friends. Austin & Bob’s paper is titled “A mixed-methods exploration of competencies and professional development needs among chief Certified Registered Nurse Anesthetists.” For the study, the authors contacted 85 chief CRNAs across North Carolina and conducted structured interviews and qualitative analysis with 10 of them. They set out to understand the competencies and professional development needs of chief CRNAs. I gotta say, when I read their article, so much of it resonated with me as a chief CRNA. The path for so many practice managers – including physician anesthesiologists and other Advanced Practice Providers, like PAs & NPs, is that a senior clinician with several years of clinical experience often steps into a practice management & leadership role that’s been vacated and their learning curve in leadership happens through on the job training. That’s kinda suboptimal. Yet it’s pretty rare for groups or hospitals to have dedicated mentorship and professional development programs established and to encourage clinicians to develop as practice leaders. It’s even more rare for cl

What’s up yall! This is Jon Lowrance and this is episode 111 – How to Prepare for Medical Mission Trips with Stacey Such, MSN, CRNA. (Stacey pronounces her last name, Such, like “Suke/Duke.”) Before we get to this show, I’d like to give a quick shout out to the CRNAs, SRNAs & physician anesthesiologists who made it to Encore’s conference in Bar Harbor back in October as well as the Maine and Arizona State Association of Nurse Anesthesiology conferences, which were also in October. I had the privilege of speaking at all three of these conferences and really loved getting to see some of you out there. We had 2 SRNAs in Bar Harbor from different programs who came to that conference because they heard about it right here on the podcast, which is awesome! Somebody else in Bar Harbor let me know that after they listened to the episode on how ondansetron prevents spinal induced hypotension – which I recorded way back in 2021 with Jenny Li in episode 16, this guy went and did his own deep dive on the topic, ended up presenting on it at his group and they changed their whole practice as a group in managing c-sections. That’s amazing. I have so much respect for yall out there on the front lines, working to master your craft and make a difference for your patients. So, it’s always a blast to get to hang out with you in person at these conferences. On that note, for 2025, I’ll be back with Encore Symposiums down in Hilton Head, South Carolina in May and back at the Cliff House in October. That’s May 19-22 at Hilton Head Island in South Carolina and October 20-23 at the Cliff House Resort in Cape Neddick, Maine and those are with Encore Symposiums. All right, in this episode, Stacey gives us a run down on how healthcare providers can prepare for short term medical mission work. Stacey has been a CRNA since 2012 when she completed her Master of Science at Middle Tennessee School of Anesthesia. She worked as a CRNA for just over 10 years prior to returning to graduate school to complete her Doctorate in Nurse Anesthesia Practice at Virginia Commonwealth University. She framed her doctoral project around short term medical mission trips, their impact on global health and how healthcare providers can prepare to engage in this work. In this show, you’ll hear what motivate Stacey to engage with this work following a deeply personal tragedy. You’ll hear stories about her time serving with Mercy Ships, Samaritan’s Purse and the World Health Organization. Stacey walks listeners through her 8-step guide for how to prepare for medical mission work. This is an excellent introduction to short term mission work and will hopefully inspire you to get involved in serving others in new ways and give you a guide for where to start. Stacey included her 1-page guide to preparing for medical mission work in the show notes to this episode. She’s titled this Global Anesthesia Outreach: A Comprehensive guide To Preparing for Medical Mission Work. Global Anesthesia Outreach: A Comprehensive guide To Preparing for Medical Mission WorkDownload If this kind of work interests you, be sure to check out episodes 61 & 62 of Anesthesia Guidebook. These are 2 episodes I did with Dr Mason McDowell on how to do anesthesia for global outreach. Mason talks about his full-time service as an anesthesia provider and educator in Béré, Chad and you can learn a ton through those two shows and the one that you’re about to check out. And with that, let’s get to the show!

What up yall. This is Jon Lowrance with Anesthesia Guidebook. This is episode #110 – How we do interviews with Alison Kent, MSN, CRNA & April Bourgoin, DNAP, CRNA. In this episode, April, Alison & I talk about how we conduct CRNA interviews as a leadership team with our Department of Anesthesiology at MaineHealth – Maine Medical Center. Maine Med is the only level 1 trauma center in the state of Maine with 700-licensed beds. We run around 60 anesthesia sites of service a day with a staff of just over 130 CRNAs, 50 physician anesthesiologists, a physician residency & fellowship program and have clinical affiliations with 4 different nurse anesthesiology training programs. Alison Kent is the Manager of CRNA Services at Maine Medical Center and completed her Master of Nursing in anesthesia at the University of New England in 2006. She’s been at Maine Medical Center as a CRNA for nearly 20 years and has served in the Manager role since 2017. April Bourgoin is one of two Supervisors of CRNA Services at Maine Medical Center and completed her Master of Science and Doctor of Nurse Anesthesia Practice degrees at Virginia Commonwealth University in 2017. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army as flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major. April joined me on episode 93 of Anesthesia Guidebook where we talked about OR fires and this is Alison’s first, but certainly not last, appearance on the show! These 2 folks are part of the core CRNA leadership team at Maine Medical Center. Together, they truly make the world go round for our team and are like the glue that holds everything together. It’s an absolute privilege to get to work closely with these folks on a daily basis and I couldn’t be more thrilled to have pulled them in on this podcast about how we do interviews. So, let’s tee this up a bit. In today’s anesthesia market, you can go anywhere and make a great money and do interesting cases but the thing that will differentiate your experience with a group is the culture of the team. And your experience of that culture begins with your interview. It actually begins a little earlier than that, even, with how the reputation of the team reaches you – maybe through things like this podcast, or when you reach out to inquire about a group or talk with friends & colleagues who may work or have worked with a particular group. But a really important deep dive into the culture of the team will come on interview day. You should meet some core folks on the team – CRNAs, physicians, trainees, administrative specialists. You should get in the operating rooms and actually see the staff do the work that you’re looking to join them in. You should leave the interview with a very clear idea of what you’re potentially getting yourself into, both in terms of culture and with a thorough run down of the benefits and compensation package. If you’re listening to this and you’re a practice manager or thinking about getting into a role in which you support your team as a leader, hopefully you find this podcast super helpful. Alison, April & I talk through our process & structure for interviews, what kinds of questions we ask, what we look for in candidates and how we work to both recruit folks and protect our culture by making sure we’re bringing in people who are a good fit for the team. A few years ago another chief CRNA asked me if I had any tips on how to conduct interviews. When we talked then, I of course knew that I wanted to get around to doing a podcast on the topic to share the same advice with you. And here it is! Oh, by the way, what we describe is our process as a leadership team. Our opinions expressed here are our views and do not necessarily represent the views or opinions of our employer. Seth Godin has this great definition of culture where he says, “people like us do things like this.” This is how we do interviews as a leadership team. We hope you enjoy our story. If you’d like to apply to work with our team as a CRNA, please reach out to chat or drop your application here: https://www.careersatmainehealth.org/jobs/search Search for the CRNA roles at Maine Medical Center in Portland, Maine. And with that, let’s get to the show.

What’s up yall! This episode dives into fundamental concepts related to leadership and casts a message for why it matters to all of us. Whether you’re primarily a clinical CRNA/physician anesthesiologist, resident/SRNA, a practice leader/manager, business owner, educator, researcher or policy advocate, leadership has a fundamental role in your day to day life. In this episode, we talk about: The art & science of leadership Position, power, influence Leadership & management  Leadership & followership Culture, and how we influence it  The Servant Leadership Model  Jocko’s leadership principles I’m pulling from my time as an instructor with Landmark Learning and NOLS (National Outdoor Leadership School), both outdoor education schools that thread leadership principles through their risk management and wilderness medicine programs. I’m also pulling from my experience as the chief CRNA at Maine Medical Center, a level 1 trauma center with over 200 staff in the anesthesia department. And some of the content is coming from the work I’m doing as I pursue a PhD in organizational leadership with a research focus on how high performance teams operate in emergencies. Hopefully you’ll find something you can hang your hat on here. Leadership is the art and science of influencing others to achieve shared goals. There’s a ton of different leadership styles & theories out there and I’ll touch on some in the podcast. My personal approach is the Servant Leadership Model, which flips the traditional organizational chart – a pyramidal/triangular structure – on its head and puts the leader at the bottom of the triangle and the most important staff up at the top. The most important folks in any organization are those who are doing the front line work to deliver on the mission and vision of the organization. In the Servant Leadership Model, these folks are the top and the leaders and managers are positioned below them. The job of leaders and managers is to support and empower the folks above them to do their best work in robust and resilient environments where the capacity for the right thing to happen flourishes. No big deal right? To find out more, check out the podcast! Servant Leadership ModelDownload Leadership Tactics By Jocko Willink Be humble  Don’t act like you know everything  Listen, ask for advice & heed it Treat people with respect  Take ownership of failures Pass credit for success up & down the chain of command Work hard  Have integrity – do what you say, say what you do Be balanced – avoid extreme actions/opinions Be decisive  Build relationships = this is the main goal of a leader Get the job done Willink, J. (2023). Leadership strategy and tactics: field manual expanded edition. St. Martin’s Press. Thank you to everyone who subscribes to the website & podcast… wherever you do that! YOU are the reason Anesthesia Guidebook is here. Take care and have fun out there! Jon Lowrance

What up yall! This is a quick shout out to those of you headed to the AANA conference this weekend, August 2nd, 2024 in San Diego. I hope that yall have an incredible time and meet tons of new colleagues, see old friends and have fun gettin’ your learn on. I was talking to one of the SRNAs from the University of New England this morning in clinical and she’s was getting psyched for the conference this weekend. AANA Annual Congress is one of those times where you can kind of lift your head up from the daily grind and look around & see thousands of other CRNAs & SRNAs or RRNAs from around the nation who are all out there doing their thing in anesthesia. It’s such an inspiring time! While I will NOT be there reppin’ Anesthesia Guidebook, my clinical team from Maine Medical Center and MaineHealth will be.   So first, why am I not putting up a booth and talking about Anesthesia Guidebook… first & foremost, I’m not trying to sell you something. Anesthesia Guidebook is still anchored in the concept of free open access medical education. There’s no subscription fee and I’m not trying to make money off of CE credits. There’s a hundred other ways out there for you to make Class A credit and that just hasn’t become a professional focus on mine. Which brings up the reminder that any anesthesia related podcast you listen to will qualify for free Class B credit in the CPC program. If you’re a CRNA and you routinely listen to anesthesia podcasts, all you have to do is self-report your credits to the AANA and you’ll rack up those Class B credits super fast. I actually did a brief podcast on this topic way back in Episode #9 of the podcast if you want to hear more about how to do that. So while there’s no Anesthesia Guidebook table at AANA Annual Congress, you CAN go meet my good friends and colleagues from Maine Medical Center in the exhibition hall. April Bourgoin, Jill Guzzardo and Danielle Beaumont will be there staffing the MaineHealth booth to tell yall about the amazing career opportunities within MaineHealth. We have everything from level 1 trauma center work with my team at Maine Medical Center where I serve as chief CRNA to a full independent practice location in Conway, NH to several other smaller town medical centers throughout Maine, including Pen Bay Medical Center in Rockland, where Jill is the chief CRNA. So April Bourgoin will be out there this weekend. Dr April Bourgoin one of our CRNA Supervisors at MMC, and she’s been on the show before talking about OR fires back in episode 93. I actually just recorded an episode that I’m editing now with April and our CRNA Manager, Alison Kent, on how we do interviews as a leadership team at MMC. That show is targeted towards other practice managers out there but is obviously also probably valuable for SRNAs as it gives you a behinds the scenes look at how we plan team interviews for people applying to be on our team. So April’s out there… you can also meet Danielle Beaumont, our SRNA Clinical Coordinator at Maine Medical Center. Danielle is amazing in that role as she supports SRN As from the University of New England and Middle Tennessee School of Anesthesia. Danielle also just helped us establish clinical affiliations with Boston College and Northeastern University. We’re pumped to start welcoming primary anesthesia trainees from BC and NU in 2025. And then last but not least is Jillian Guzzardo. Jill is one of our per diem CRNAs at MMC but she also serves as the Chief CRNA at one of our MaineHealth sister hospitals, Pen Bay Medical Center in Rockland, Maine. If you’re looking for a small town, coastal Maine community hospital to practice at, Jill is your girl! Pen Bay is literally on a bluff overlooking the Atlantic Ocean. You have close up water views from work. It’s amazing…. I mean, you can also see the ocean from the top floors of Maine Medical Center, but at Pen Bay, you can probably see what the lobstermen are having for breakfast as they motor by in the morning… it’s right there. Jill is one of my favorite CRNAs… after a few years of holding down the fort at Pen Bay as the chief CRNA, she reached out to me and asked if she could come work off shifts and weekends at Maine Medical Center to keep her high acuity patient care skills up. She literally asked if I would give her the shifts that my core team doesn’t want to work… nights, evenings and weekends. I was blown away. All three of this CRNAs – April, Danielle and Jill – are baller clinicians.  I would let any of them take care of me or my family and just love working alongside them in the OR.  They’re also incredible CRNA leaders with a deep passion for helping SRNAs & CRNAs thrive in their practices. And they’re generally just inspiring, friendly humans…  Kind, generous, optimistic people… who are wicked smahat as we say here in New England. So if you’re headed to AANA Annual Congress, even if you’re not looking to move your practice to Maine, do yourself a

What’s up yall this is Jon Lowrance and this is episode 107 – No Peace In Quiet with Keli Rueth. I’m pumped to bring you this conversation with Keli where we discuss her first published novel, No Peace In Quiet. This episode was so much fun to record and I think you’re really going to enjoy it.  It’s a story that is worth sharing on an anesthesia podcast because it’s a story about how we as anesthesia providers explore the rest of our lives…  how we can step out from our clinical roles as anesthesia providers to express our creativity and joy in a different way than being mixologists and potion makers in the OR.   In this episode, Keli and I talk through her process and approach to finding her passion for writing and how she has snuck that in to the nooks and crannies of her life between working as a mother, full time CRNA and professor of anesthesiology at the University of New England.   Keli Rueth is the pen name of Dr Keli Scrapchansky, who, by the way, was one of my favorite people on planet earth even before I knew she was a novelist.  Keli started her career at Maine Medical Center just a few months before my wife, Kristin, and I did back 2015.  She graduated with her Master’s in Anesthesia from Old Dominion University in 2014 and went on to complete her Doctor of Nursing Practice at the University of North Florida.  Keli is one of those people who shows up anywhere with a smile on her face and brightens up the room she walks into.  It’s incredibly difficult to get through a conversation of any length with her without laughing about whatever topic is on the table.  She’s an easy conversationalist, a masterful clinician and educator and now, a published novelist.   No Peace In Quiet is Keli Rueth’s first novel in a trilogy, the next volume of which has a planned release for later this summer.  I thoroughly enjoyed reading No Peace In Quiet and literally couldn’t stop turning the pages as the story developed and unfolded in the small town and surrounding mountains of Quiet, North Carolina. You can check out Keli’s book at kelirueth.com. And with that, let’s get to the show!

What’s up yall! I am back after a few months off from the podcast. This is episode 106 – following up: what we know about anesthesia school formatting with Cassie Capps. This is a follow up show to the episode that Cassie brought to us back in December on the effects of anesthesia school didactic formatting on resident wellbeing… whether in-person, online, synchronous or asynchronous styles have any effect on your wellbeing as a trainee. Before we get to this show, I’ve got a couple updates for you… our crew at Maine Medical Center has been on a bit of tour this spring attending conferences, job fairs and universities telling the story about our team and why we may be where you want to invest your career as an anesthesia provider. Cat Godfrey & April Bourgoin were just down at AANA’s Mid Year Assembly in Washington D.C. and then Cat made her way on to University of North Carolina at Greensboro to chat with the residents at Terry Wick’s program. She followed up dropping in on UNC-G with a virtual lunch & learn session with Mary Baldwin University’s anesthesia program over in Virginia. And then, Kristin and I just returned last week from Florida International University’s job fair down in Miami. We were so happy to know that even the locals thought it was super hot cause oooooooo….eeeeeeee… it was swimmy humid and all kinda hot down in the Sunshine State. We were stoked to meet a bunch of FIU anesthesia residents and tell yall about our absolutely gorgeous summers and four season climate up in Maine and how we’re probably where you want to start your career if you’re looking for a top notch level 1 trauma center to be at where you’re treated with respect, well-supported and want to join a thriving team that has a ton of fun working together. Just saying. Part of my intention with Anesthesia Guidebook is to help CRNAs make a successful transition to practice and if you’re looking to do high acuity work in a busy tertiary medical center surrounded by an amazing team and in a phenomenal location, drop me a line and we can chat. I’d love to tell you more about our crew and see if we’re a good fit for where you’re headed. In other news, this fall I’m teaching at Encore Symposium’s Autumn in Bar Harbor and Acadia National Park conference. If you’re looking for a spot to come knock out some continuing education this year, Encore is headed back to Bar Harbor, Maine, which is just outside of Acadia National Park, from October 14-17. If you’ve never been to Acadia, or Bar Harbor or Maine… this is your chance. Come check it out. Acadia in October is simply stunning… a national park, on an island, in Maine. With your anesthesia friends! You’ll be hard pressed to find a cooler spot to come get your learn on. Hope to see you there! All right… with that, let’s get to this show. Cassie Capps is back. We first heard from Cassie in late December 2024 on episode 99 of Anesthesia Guidebook and now she’s back to walk us through the impact of anesthesia school didactic formatting on resident wellbeing. Thank to everyone who took Cassie’s survey and provided your insights… the data was actually a bit surprising so let me re-introduce Cassie to you and then she’s gonna get right to it. This podcast was part of Cassie Capps’ Doctor of Nursing Practice in anesthesiology program at the University of Arizona. Prior to anesthesia training, Cassie was a CVICU Registered Nurse for 8 years and worked in the cath lab for 5 years before that. Prior to nursing school, Cassie completed a Master’s degree in music with a focus on Piano Performance & Pedagogy. Cassie continued to teach piano on the side while completing her doctorate in anesthesiology at the University of Arizona. Her unique experience with anesthesia school included moving through her program as a single mom of an 11 year old daughter. She also continues to play a big role in the lives of her two former stepdaughters, who are now young adults.  This podcast is coming out in May of 2024 and with that, let’s get to the show! References Alajmi, B., & Alasousi, H. (2019). Understanding and motivating academic library employees: theoretical implications. Library management, 40(3/4), 203-214. https://doi.org/10.1108/LM-10-2017-0111 Baqutayan, S. M. S. (2015). Stress and Coping Mechanisms: A Historical Overview. Mediterranean Journal of Social Sciences; Vol 6, No 2 S1 (2015): March 2015. https://www.mcser.org/journal/index.php/mjss/article/view/5927/5699 Berry, G. R., & Hughes, H. (2020). Integrating Work-Life Balance with 24/7 Information and Communication Technologies: The Experience of Adult Students With Online Learning. The American journal of distance education, 34(2), 91-105. https://doi.org/10.1080/08923647.2020.170

What’s up yall! This is Jon Lowrance and this is episode 105 of Anesthesia Guidebook – the impact of precepting on clinical learning with Jennifer Heiden. This episode is coming out on February 21, 2024. Jennifer Heiden is completing her Doctor of Nursing Practice in anesthesiology at the University of Arizona and this podcast is part of her doctoral work. In this episode, we’re going to walk through the behaviors, tips & techniques preceptors can do in order to positively impact the clinical learning outcomes of anesthesia residents. Jennifer wants to hear about your experiences either as an anesthesia trainee or as a clinical preceptor in the survey that is attached to this episode. The link is in the show notes. It’s a quick survey, totally anonymous and will be used to help Jennifer complete her doctoral project at the University of Arizona. Survey Link is Here: https://uarizona.co1.qualtrics.com/jfe/form/SV_88sSJwSor8yDoGy Prior to anesthesia training, Jennifer worked in medical, surgical and cardiac ICUs for 8 years on the East and West coasts. Prior to nursing school, Jennifer completed a bachelor’s degree in finance from Boston University and lived in Colorado for almost twenty years hiking, running and climbing in the mountains. She currently lives in Temecula, California, and has been working through anesthesia school as a single mom to her 14-year-old son. She still enjoys climbing, running and spending time with her son and all their animals. I hope you enjoy this show. The mission of Anesthesia Guidebook is to help you master your craft as a provider. The art & science of clinical precepting is foundational to raising the next generation of highly competent providers. I’m thrilled to take a fresh look at precepting with Jennifer and you can find lots of other shows on Anesthesia Guidebook that touch on clinical education with links to each of those in the show notes to this episode. And if you’d like to get the show notes to these podcasts straight to your inbox, along with being the first to know when a new episode drops, subscribe to the show on the website. All that does is send you the episode & show notes, nothing more & no hidden agenda. It’s totally free and I will never sell or distribute your email. So if you want to be the first to know and have all the links right at your finger tips, subscribe to show at AnesthesiaGuidebook.com! #8 – How to master precepting with Will C0hen #21 – Best practices in precepting with Obinna Odumodo #22 – The demo-do teaching technique #55 – Incivility in the Workplace with Joshua Lea, DNP, MBA, CRNA & Kelly Gallant, PhD, CRNA #74 – Thrive in Training: how to crush clinical #75 – Thrive in Training: communicating with preceptors

Chuck Biddle PhD, CRNA is a Professor Emeritus of anesthesiology at Virginia Commonwealth University and served as the editor in chief of the AANA Journal for 35 years.  His anesthesia education & master’s degree are from Old Dominion University and he completed his PhD in Epidemiology at the University of Missouri.   Chuck is one of my favorite people in the world of anesthesiology.  He’s one of those folks who have put the time in over decades to develop a true, deep mastery of their profession while at the same time bringing with them a level of authenticity, integrity and humility that garners true respect.  He’s a guide.  He’s helped countless physician & nurse anesthesiology trainees develop and gain a love of the work we do.  And one of the central focuses of his career has been fervently working to understand the things that put our patients at risk and develop research and insights for practice to advance patient safety. Which brings us to this show.   In this episode, Dr Biddle turns our attention to what happens to patients after they go home from day surgery. We talk about a study his team did at VCU where they sent patients home with pulse oximeter monitors and tracked their course for 48 hours following day surgery. We talk how novel this idea is in that very few studies have actually looked at what happens to patients following ambulatory surgery and that a certain segment of these patients – those who have obstructive sleep apnea are at particular risk for devastating postoperative complications. Chuck points to Jonathan Benumof’s, MD 2016 article in the Canadian Journal of Anesthesia titled Mismanagement of patients with obstructive sleep apnea may result in finding these patients dead in bed (full article below). Dr Benumof is a world-renowned physician anesthesiology and expert in airway management and pulmonary physiology. He is a professor of anesthesiology at the University of California – San Diego’s School of Medicine. Over the 15 years prior to the publication of Dr Benumof’s article in which he served as an expert witness in litigation cases, he testified on 12 cases where OSA patients died within 48 hours of surgery. In the article, he unpacks each of those cases and provides the following prototypical dead in bed OSA patient: “A 58-yr-old continuous positive airway pressure (CPAP)-compliant male (170 cm, 120 kg, body mass index 40 kgm-2) with polysomnography (PSG)-proven severe OSA undergoes orthopedic, upper airway, or abdominal surgery under general anesthesia. The patient has an uncomplicated stay in the postanesthesia care unit until discharged to an unmonitored bed without CPAP or oxygen. After receiving small (and within standard of care) doses of narcotics for pain for 11 hr, the patient is found DIB [dead in bed]. Advanced cardiac life support is either not attempted or fails to return the patient to their baseline state of life (Benumof, 2016).” This episode is one of those discussions that makes you see the work you do in a whole new light and gives you a renewed sense of ownership over making sure you and your colleagues are doing the right thing for your patients.  This show is coming out on 28 January 2024 and was originally recorded at VCU’s studio with a table top microphone back in the summer of 2017.  I apologize that the audio is a little hazy but the power of Dr Biddle’s research and passion for this topic are still very much relevant to providers today.  So with that, let’s get to the show! Benumof, J. L. (2016). Mismanagement of obstructive sleep apnea may result in finding these patients dead in bed. Canadian Journal of Anesthesia, 63(1), 3.Download Benumof, J. L. (2015). The elephant in the room is bigger than you think: finding obstructive sleep apnea patients dead in bed postoperatively. Anesthesia & Analgesia, 120(2), 491. Hill, M. V., Stucke, R. S., McMahon, M. L., Beeman, J. L., & Barth Jr, R. J. (2018). An educational intervention decreases opioid prescribing after general surgical operations. Annals of surgery, 267(3), 468-472. Biddle, C., Elam, C., Lahaye, L., Kerr, G., Chubb, L., & Verhulst, B. (2021). Predictors of at-home arterial oxygen desaturation events in ambulatory surgical patients. Journal of Patient Safety, 17(3), e186-e191.

What’s up folks! This is Jon Lowrance with Anesthesia Guidebook and this is episode 103… a deep dive on dexmedetomidine with Eliana Zimmerman. This episode is coming out on January 21, 2024. Before we get to the show I want to remind folks that I’ll be speaking in person at the Encore Symposiums’ Autumn in Bar Harbor & Acadia National Park conference running October 14-17 of this year. If you have never been to Maine, this is a great excuse to make it up here. And even if you have been or if you live here in vacationland… there’s scarcely a better place to be than Bar Harbor in October. It’s absolutely stunning. Peak leaf season usually hits in October for Bar Harbor, which is a coastal village just outside the entrance to Acadia National Park. Just google those key words… Acadia National Park – October. Or peak leaf season Bar Harbor. Then sign up for the conference ASAP because this one usually sells out quick. It’s Encore Symposiums’ Autumn in Bar Harbor & Acadia National Park conference, running October 14-17. I’m looking forward to bringing fresh perspectives on what’s new in anesthesia, pharmacology, ERAS, airway management & more for this conference. You’ll also get to meet a bunch of my friends & crew from Maine Medical Center, as this is one our team’s favorite conferences to attend… it’s close to home and has absolutely breath-taking scenery. I hope to see you there! This is the second show I’ve done specific to dexmedetomidine… you’d have to go back a full 100 episodes… way back to episode #2 for the other show, which I did with Matt Poirier who I continue to work alongside at Maine Medical Center. In this show, Eliana Zimmerman joins me to unpack the literature on perioperative use of dexmedetomidine, specifically focusing on the clinical impacts of dexmedetomidine in colorectal surgery. As part of her doctorate research at Northeastern University, Eliana completed a series of expert panel inquires, synthesized with current literature, to arrive at recommendations for best practice concerning the use of dexmedetomidine in colorectal surgery. Her infographic and resources are provided in the show notes. Eliana Zimmerman graduated Wesleyan University with a degree in Neuroscience in 2017, and University of Pennsylvania with a degree in Nursing in 2018. She worked as an ICU nurse at Jefferson Methodist Hospital from 2019 – 2022. She is currently a nurse anesthesia doctoral student at Northeastern University with an anticipated graduation of May 2025. In her limited free time she likes to backpack, run, and spend time outdoors. Her fiancé, two cats, and dog have kept her sane during the long days of anesthesia training. References Chen, C., Huang, P., Lai, L., Luo, C., Ge, M., Hei, Z., Zhu, Q., & Zhou, S. (2016). Dexmedetomidine improves gastrointestinal motility after laparoscopic resection of colorectal cancer: A randomized clinical trial. Medicine (Baltimore), 95(29), e4295–e4295. https://doi.org/10.1097/MD.0000000000004295 Chen, H., & Li, F. (2020). Effect of Dexmedetomidine with Different Anesthetic Dosage on Neurocognitive Function in Elderly Patients After Operation Based on Neural Network Model. World Neurosurgery, 138, 688–695. https://doi.org/10.1016/j.wneu.2020.01.012 Cheung, C. W., Qiu, Q., Ying, A. C. L., Choi, S. W., Law, W. L., & Irwin, M. G. (2014). The effects of intra‐operative dexmedetomidine on postoperative pain, side‐effects and recovery in colorectal surgery. Anaesthesia, 69(11), 1214–1221. https://doi.org/10.1111/anae.12759 Ge, D.-J., Qi, B., Tang, G., & Li, J.-Y. (2015). Intraoperative Dexmedetomidine Promotes Postoperative Analgesia in Patients After Abdominal Colectomy: A Consort-Prospective, Randomized, Controlled Clinical Trial. Medicine (Baltimore), 94(37), e1514–e1514. https://doi.org/10.1097/MD.0000000000001514   He, G.-Z., Bu, N., Li, Y.-J., Gao, Y., Wang, G., Kong, Z.-D., Zhao, M., Zhang, S.-S., & Gao, W. (2022). Extra Loading Dose of Dexmedetomidine Enhances Intestinal Function Recovery After Colorectal Resection: A Retrospective Cohort Study. Frontiers in Pharmacology, 13, 806950–806950. https://doi.org/10.3389/fphar.2022.806950 Lu, Y., Fang, P.-P., Yu, Y.-Q., Cheng, X.-Q., Feng, X.-M., Wong, G. T. C., Maze, M., & Liu, X.-S. (2021). Effect of Intraoperative Dexmedetomidine on Recovery of Gastrointestinal Function After Abdominal Surgery in Older Adults A Randomized Clinical Trial. JAMA Network Open, 4(10), e2128886–e2128886. https://doi.org/10.1001/jamanetworkopen.2021.28886 Qi, Y.-P., Ma, W.-J., Cao, Y.-Y., Chen, Q., Xu, Q.-C., Xiao, S., Lu, W.-H., & Wang, Z. (2022). Effect of Dexmedetomidine on Intestinal Barrier in Patients Undergoing Gastrointestinal Surgery–A Single-Center Randomized Clinical Trial. The Journal of Surgical Research,  Sun, W., Li, F., Wa

Brad & Madisson Marcum join me to talk about the dynamics of being married and going to anesthesia school together. They met in nursing school, had divergent paths professionally for a bit, with Brad starting nurse practitioner school and Madisson considering anesthesia school. They ended up sharing the same goal of becoming CRNAs and we talk through their approach to applying together, getting into the University of Evansville together and working through the program alongside one another. In episode 15, I talked with Jenny & Robert Montague about what it’s like for the significant others of anesthesia residents. Jenny has her Master of Science in Nutrition and works as a Registered Dietitian and supported Robert and their 2 kids while he attended the University of New England’s anesthesia program. In epsisode 50, I caught up with Lein & Nate Woodin to talk specifically on parenting in anesthesia school. Nate is a family therapist and supported Lein and their 2 kids while she went through the University of New England’s anesthesia program. In this episode, Brad & Madisson Marcum talk about what it’s like to both get into and work through anesthesia school together. We’re planning for this to be the first in a series of conversations with them as they progress through their program. They’re just finishing their first year of training and have yet to start clinicals. I plan to touch base with them down to the road to see how that phase of the program goes. Folks are often making difficult decisions around when to do anesthesia school. For a couple in my program, the husband went through school 2 years ahead of his wife, who was in my class, and they overlapped for just one semester. A local couple here in Portland stacked their programs end to end with one of them fully completing the program and a semester after that, the other starting anesthesia school. That stretched their anesthesia training experience to a full six years as a couple. My hope is that this conversation with Brad & Madisson helps you and your partner think through the considerations around what you want to do or how it’s going for you if you’re currently in a program. Brad hails from Salem, Illinois and spent 5 years as a critical care Registered Nurse in the cardio thoracic & transplant ICUs at Mayo Clinic prior to starting anesthesia school in the University of Evansville’s DNAP program. His clinical interests are regional anesthesia and opioid sparring anesthetic techniques with an emphasis on pharmacology and pharmacogenetics. Madisson is from Effingham, Illinois and also spent 5 years as a critical care Registered Nurse in the trauma surgical ICU at Mayo Clinic in Rochester prior to anesthesia training. Her clinical interests are regional anesthesia and difficult airway management. They are focusing their doctoral project on the functionality and effectiveness of virtual reality training in anesthesia programs and plan to utilize Peter Stallo’s SIMVANA VR platform for research. You may remember my conversation with Peter in episode 96 on SIMVANA and virtual reality in anesthesia education. It’s a fascinating discussion on what will likely become a central element to anesthesia education in years to come. Long term, Brad & Madisson intend to become involved in medial mission trips and create a pediatric charity foundation to provide basic necessities to children in need in their local area following anesthesia school. Brad and Madisson Marcum

This is an incredibly special podcast that I’m thrilled to pull forward from our old show, From the Head of the Bed, to Anesthesia Guidebook. I love that this episode is number 101 because EKG lead selection should be 101-level knowledge for anesthesia providers, yet so many folks have not mastered this fundamental knowledge as part of their practice. I hope you get as much from this as I have over the years. Dr Mark Kossick was a full professor of anesthesia at Western Carolina University when my wife, Kristin, and I attended the program and he actually just retired in late 2023 from that university. Kristin arranged for Dr Kossick to contribute his expertise to this podcast while we were still in the program back in early 2015 and this episode was released as one of the original group of podcasts that launched From the Head of the Bed that year. Dr Kossick will give a more detailed introduction of his professional background at the start of this show – and, I’m thrilled to have Kristin’s voice on the podcast with all her pre-Mainer southern drawl – as she introduces him. Dr Kossick was known as an incredibly challenging yet supportive professor. His area of expertise was intra-operative monitoring and the uptake and distribution of volatile anesthetics. He had a passion for the many beautiful curves of the science of anesthesia, whether it was the oxyhemoglobin dissociation curve, the Fa/Fi curve or one of the many other curves that define the science behind what we do every day. Kristin and I and so many other CRNAs from WCU, the University of Alabama at Birmingham and others have learned so much from Dr Kossick and consider ourselves fortunate to have sat in and survived his classes. This is an incredibly thorough review of the very basics of EKG lead placement, selection and monitoring for anesthesia care. This is a skill and knowledge set that, unfortunately, many anesthesia providers and perioperative nursing staff overlook and blaze past. As Dr Kossick says in the show, simply having a EKG pattern on the screen from careless placement of EKG leads is not enough for safe monitoring. Dr Kossick walks us through the core data on EKG monitoring, including some modified leads, so this show is excellent for both trainees and experienced providers alike.

Have you noticed how stoked podcasters get about their one hundredth episodes? It’s kind of a thing. If you want to hear interesting shows – check out the hundredth episodes.  Or 200th.  Or 1000th.   Podcasters usually get super stoked about hitting triple digits with their shows and often set up the number 100 episode as some sort of tribute to themselves by taking a look back over their favorite episodes. Don’t get me wrong… I’m pumped about number 100. But this isn’t going to be a look back at all the best shows or highlight moments. I’d rather hit on the why behind Anesthesia Guidebook. Some of you all might just be joining us. Maybe this is the first time you’ve heard Anesthesia Guidebook and you’re taking a look around. Maybe you’ve been listening since From the Head of the Bed… either way, I’d like to hit on where we came from and where we’re going. I love when one year turns over to another. I’m not big on new year’s resolutions and my wife and I don’t even stay up any more to see the clock tick over midnight on New Year’s Eve. We’ve got a 2-year old who’s potty training this weekend and his 9 month old brother is crawling all over the place. So we generally go to bed early to wake up and keep pace with these little dudes. But I do get stoked when a year comes to a close and another begins. It helps mark a rhythm in our lives. Just after the winter solstice, the longest night and shortest day of the year. Then we turn to a new year where new things will happen and the best of the old things are brought with us. So there’s the 100th episode and there’s the new year… it’s like toast with Nutella and bananas. Doubly amazing. In this show, I touch on what Anesthesia Guidebook means to me and what I hope it means for you. I’ll hit on a couple of upcoming shows headed your way in 2024 and then we’re out. Happy New Year and thanks for checking the show out and getting after it out there! In Memory of Peter Strube, DNP, MBA, Lt Col (ret), CRNA, FAANA. Matt Zinder wrote an amazing eulogy here and copied below: The profession of nurse anesthesiology has lost one of its greatest advocates. Peter Strube, DNP, MBA, Lt Col (ret), FAANA passed away peacefully in his home Monday, December 11, 2023 following a brief illness. Dr. Strube’s dedication to colleagues, students, residents, and to the profession of nurse anesthesiology was evident in his tireless efforts to promote and educate all those who had the good fortune to work with him. Dr. Strube earned his BA in Nursing from Luther College in 1994 and his Master’s in Nurse Anesthesia from St. Mary’s University in 2006. He went on to earn his Doctor of Nursing Practice degree from Rosalind Franklin University in 2017 and his MBA from Edgewood College in 2019. Dr. Strube retired from the US Army Nurse Corps after 21 years of service, having achieved the rank of Lieutenant Colonel. He deployed four times, which included service in both Iraq and Afghanistan. He earned the War on Terrorism medal, the Enduring Freedom medal, the Mobilization Armed Forces Reserve medal, the Iraqi Freedom and Global War on Terror medal, and held numerous certificates of achievement, appreciation, and training from the United States Army. Dr. Strube was an Assistant Professor at Newman University School of Nurse Anesthesia and was a developer of the pharmacology CPC Modules for multiple CRNA education programs. His teaching background included serving as an Assistant Program Director at the University of Wisconsin Oshkosh, an Associate Professor at Saint Mary’s University of Minnesota, and an Assistant Professor at Rosalind Franklin University of Medicine and Science. Peter was the CEO of Strube Educational Services, where he provided invaluable tutoring services to nurse anesthesiology residents, enabling them to excel in their studies and succeed in their anesthesia board exams. His tutoring program has assisted over 500 residents with their success in their medical training. Furthermore, he authored numerous professional articles and shared his expertise as both a national and international speaker. He successfully guided and contributed to over 10 doctoral projects. Beyond his professional accomplishments, Dr. Strube was deeply committed to his community. He served as a member of the Mount Horeb Board of Education, acted as a Commissioner on the Dane County Ethics Board, and offered crucial mentorship to veterans in crisis through court appointments. Furthermore, he proved to be an active and dedicated CRNA representative and advocate, having served on the Wisconsin state association board, AANA Region 3 Director, and most recently, being honored with induction into the esteemed AANA 2023 Class of Fellows. Dr. Peter Strube left an indelible mark on his profession and everyone with whom he collaborated. He was a great friend and family man and will be sorely missed. He is survived by his wife, Rebecca, and children, Noah, 23, Xander, 21,

Cassie Capps, BSN, SRNA joins me to talk about the effects of didactic formatting in anesthesia training on resident wellbeing including stress, anxiety, confidence and academic performance. Her specific focus is on the mix of online versus in-person course work for nurse anesthesia trainees. Cassie overviews what the literature says about this topic and is looking for YOU to join her efforts by completing a very quick survey about your experience at the end of this podcast. The survey HAS CLOSED. Cassie is completing her Doctor of Nursing Practice in anesthesiology at the University of Arizona and this study is part of her doctoral work. Prior to anesthesia training, Cassie was a CVICU Registered Nurse for 8 years and worked in the cath lab for 5 years before that. Prior to nursing school, Cassie completed a Master’s degree in music with a focus on Piano Performance & Pedagogy. She continues to teach piano on the side while completing her doctorate in anesthesiology at the University of Arizona. Her unique experience with anesthesia school included moving through her program as a single mom of an 11 year old daughter. She also continues to play a big role in the lives of her two former stepdaughters who are now young adults. This podcast is coming out on December 26, 2023. I hope you’ve had an amazing year and am thrilled to bring this episode to you. Please take a moment and complete the survey and help Cassie get some solid data for her project. Stay tuned because I plan to reconnect with Cassie in a couple of months after she’s crunched the numbers and see what she’s learned. REFERENCES Alajmi, B., & Alasousi, H. (2019). Understanding and motivating academic library employees: theoretical implications. Library management, 40(3/4), 203-214. https://doi.org/10.1108/LM-10-2017-0111 Baqutayan, S. M. S. (2015). Stress and Coping Mechanisms: A Historical Overview. Mediterranean Journal of Social Sciences; Vol 6, No 2 S1 (2015): March 2015. https://www.mcser.org/journal/index.php/mjss/article/view/5927/5699 Berry, G. R., & Hughes, H. (2020). Integrating Work-Life Balance with 24/7 Information and Communication Technologies: The Experience of Adult Students With Online Learning. The American journal of distance education, 34(2), 91-105. https://doi.org/10.1080/08923647.2020.1701301 Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: a systematic review of quantitative evidence protocol. JBI database of systematic reviews and implementation reports, 13(10), 21-29. https://doi.org/10.11124/jbisrir-2015-2380 Centers for Disease Control and Prevention. (2022). Poor nutrition. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm Columbia University. (2022). How sleep deprivation impacts mental health. https://www.columbiapsychiatry.org/news/how-sleep-deprivation-affects-your-mental-health Conner, M. (2015). Self-Efficacy, Stress, and Social Support in Retention of Student Registered Nurse Anesthetists [Article]. AANA Journal, 83(2), 133-138. http://ezproxy.library.arizona.edu/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=asn&AN=102321364&site=ehost-live Council on Accreditation of Nurse Anesthesia Educational Programs (COA). (2020, 3/22/21). FAQ’s and statement regarding meeting clinical requirements. https://www.coacrna.org/coa-statement-regarding-coronavirus-disease-2019-covid-19/ Council on Accreditation of Nurse Anesthesia Educational Programs (COA). (2022). List of accredited educational programs. https://www.coacrna.org/wp-content/uploads/2022/07/List-of-Accredited-Educational-Programs-July-18-2022-1.pdf Day, C. M. F., Lakatos, K. M., Dalley, C. B., Eshkevari, L., & O’Guin, C. (2022). The Experience of Burnout in the SRNA Population and Association With Situational and Demographic Factors. AANA Journal, 90(6), 447-453.  Desmet, P., & Fokkinga, S. (2020). Beyond maslow’s pyramid: Introducing a typology of thirteen fundamental needs for human-centered design. Multimodal technologies and interaction, 4(3), 1-22. https://doi.org/10.3390/mti4030038 Freitas, F. A., & Leonard, L. J. (2011). Maslow’s hierarchy of needs and student academic success. Teaching and learning in nursing, 6(1), 9-13. https://doi.org/10.1016/j.teln.2010.07.004 Griffin, A., Yancey, V., & Dudley, M. (2017). Wellness and thriving in a student registered nurse anesthetist population. AANA Journal, 85(5), 325-330.  Hale, A. J., Ricotta, D. N., Freed, J., Smith, C. C., & Huang, G. C. (2019). Adapting Maslow’s Hierarchy of Needs as a Framework for Resident Wellness. Teaching and Learning in Medicine, 31(1), 109-118. https://doi.or

Elisabeth Stewart, MSN, MSNA, CRNA focused her Master of Science in Nurse Anesthesia project on the pharmacology of Toradol (ketorolac) and she’s here today to tell us all about it. Elisabeth hails from Wisconsin, holds a BS in Mathematics with a pre-med concentration and engaged in HeLa cell cancer research prior to going to nursing school. She received a Master of Science in Nursing degree at the University of Wisconsin – Milwaukee, where she worked in a transplant ICU while completing her Clinical Nurse Leader degree and certification. Elisabeth followed that with her Master of Nurse Anesthesia degree at the University of New England and received the UNE Outstanding Student Award for her class. Her primary clinical site in training was Maine Medical Center in Portland, Maine. When Elisabeth showed up for day one of clinical, I was serving as the SRNA Clinical Coordinator and by the time she was completing her training, I was a year into my new role as Chief CRNA at Maine Medical Center. Elisabeth was one of the best SRNAs we’ve had roll through Maine Med in years and brought a degree of professionalism, conscientiousness and excellence in clinical care that inspired confidence in her practice and reallllly made me try to recruit her as a clinical staff. As it is, she’s chosen to start her career closer to family in Massachusetts and I wish her the absolute best moving forward. I think you’re really going to enjoy hearing Elisabeth walk through the pharmacokinetics and pharmacodynamics of ketorolac with specific focus on the risk (or lack thereof) of bleeding with the use of ketorolac. Elisabeth focused primarily on the risk of bleeding in adult breast surgery patients. She reviewed 27 research articles to boil down what the literature says about the role of ketorolac in perioperative bleeding risk in breast surgery patients. Her full write up is attached in the show notes to this episode. And with that, let’s get to the show! Careers at Maine Medical Center: If you’re interested in joining our team at Maine Medical Center, reach out to me at [email protected] or apply for one of our CRNA positions in Portland, Maine at https://www.mainehealth.org/careers-job-opportunities References •Afonso, A., Oskar, S., Tan, K.S., Disa, J. J., Mehrara, B. J., Ceyhan, J., & Dayan, J. H. (2017). Is enhanced recovery the new standard of care in microsurgical breast reconstruction? Plastic and Reconstructive Surgery,139(5), 1053-61. https://doi.org/10.1097/PRS.0000000000003235. •Barkho, J. O., Li, Y. K., Duku, E., & Thoma, A. (2018). Ketorolac may increase hematoma risk in reduction mammaplasty: A case-control study. PRS Global Open, 6, 1-5. https://doi.org/10.1097/GOX.0000000000001699 •Blomqvist, L, Sellman, G., & Strömbeck, J. O. (1996). NSAID as pre- and postoperative medication —a potential risk for bleeding complications in reduction mammaplasty. European Journal of Plastic Surgery 19, 26–8.  •Bongiovanni, T., Lancaster, E., Ledesma, Y., Whitaker, E., Steinman, M. A., Allen, I. E., Auerbach, A., & Wick, L. (2021). A systematic review and meta-analysis of the association between non-steroidal anti-inflammatory drugs and surgical bleeding in the perioperative period. Journal of the American College of Surgeons, 232(5), 765-90. https://doi.org/10.1016/j.jamcollsurg.2021.01.005. •Cawthorn, T. R., Phelan, R., Davidson, J. S., & Turner, K. E. (2012). Retrospective analysis of perioperative ketorolac and postoperative bleeding in reduction mammoplasty. Canadian Journal of Anaesthesia, 59(5), 466-72. https://doi.org/10.1007/s12630-012-9682-z. •Conrad, K. A., Fagan, T. C., Mackie, M. J., & Mayshar, P. V. (1988). Effects of ketorolac tromethamine on hemostasis in volunteers. Clinical Pharmacology & Therapeutics, 43(5), 542-546. •Corsini, E. M., Zhou, N., Antonoff, M. B., Mehran, R. J., Rice, D. C., Roth, J. A., Sepesi, B., Swisher, S. G., Vaporciyan, A. A., Walsh, G. L., & Hofstetter, W. L. (2021). Postoperative bleeding and acute kidney injury in esophageal cancer patients receiving ketorolac. Annals of Thoracic Surgery, 111, 1111-7. https://doi.org/10.1016/j.athoracsur.2020.07.028. •Dowbak G. (1992). Personal experiences with Toradol. Plastic and Reconstructive Surgery, 89(6), 1183. https://doi.org/10.1097/00006534-199206000-00051. •Firriolo, J. M., Nuzzi, L. C., Schmidtberg, L. C., & Labow, B. I. (2018). Perioperative ketorolac use and postoperative hematoma formation in reduction mammoplasty: A single-surgeon experience of 500 consecutive cases. Breast, 142(5), 632e-8e. https://doi.org/10.1097/PRS.0000000000004828. •Garcha, I. S., & Bostwick, J. (1991). Postoperative hematomas associated with Toradol. Plastic and Reconstructive Surgery, 88(5), 919-20. https://doi.org/10.1097/00006534-199111000-00050. •Gobble, R. M., Hoang, H. L., Kachniarz, B., & Orgill, D. P. (2014). Ketorolac does not increase perioperative bleeding: A m

What up folks! This is another short podcast on the idea that safety is a capacity, not an outcome. This idea comes out of Todd Conklin & Sidney Dekker’s work on organizational safety where they discuss two ways of looking at safety: The Safety 1 Perspective or the old way of thinking is that safety is about minimizing errors.  It’s about identifying risks, including human behaviors, and implementing steps to prevent errors from happening.  Success is often measured in low to zero error rates and errors are punishable offenses.   The Safety 2 Perspective doesn’t overlook the need to minimize errors.  But it focuses on building the capacity for the right thing to happen versus a feverish focus on whack-a-moling potential risk and, frankly, whack-a-moling the people who make mistakes. The idea is that safety is not an outcome but rather a capacity that’s built up over time through thoughtful design of systems and careful handling of people and systems both when things go right as well as when errors happen.  It’s about figuring out how humans are doing the work – including all of their workarounds – in order to generate successful outcomes and finding ways to support and foster positive outcomes on a consistent basis.  And when things go wrong, people aren’t punished.  While egregious error or outright negligence is always possible, Safety 2 presumes people are smart and are trying to do the right thing.  So if something goes wrong, there is likely a system input, factor or design that created a high probability that something would in fact go wrong.  So the focus is on understanding how the worker performed in a faulty system and trying to improve that system so there’s a higher likelihood that the right thing happens the next time around. Check out the short podcast for a couple of illuminating stories to bring these principles to life. As always, drop me an email or message on social media if you’d like to connect! Resources: Todd Conklin’s Pre-Accident Investigation podcast Sidney Dekker’s professional website Upcoming conferences I’m speaking at: Maine Association of Nurse Anesthesiology: https://meana.org MEANA Fall Conference in Portland, Maine (virtual option available) Encore Symposium’s New England at the Cliff House, Cape Neddick, Maine October 16-19, 2023 Encore Symposium’s Autumn in Bar Harbor & Acadia National Park, October 14-17, 2024

What up yall this is Jon Lowrance and this is episode 96 – virtual reality in anesthesia education: SIMVANA with Peter Stallo. This show is coming out in early August of 2023. First up: I want to give a quick heads up that our team from Maine Medical Center where I currently serve as chief CRNA will be at the American Association of Nurse Anesthesiology Annual Congress in a couple of weeks in Seattle. If you’re headed to AANA’s Annual Congress this year, be sure to swing by the exhibit hall and check out the MaineHealth booth. My friends & colleagues April Bourgoin, Cat Godfrey & Steve Breznyak will be there to tell you all about career opportunities at our level 1 trauma hospital, Maine Medical Center, and other MaineHealth hospitals. We have everything from independent, CRNA-only practices to a high acuity level 1 trauma center within MaineHealth, so if you’re interested in finding out more about what life looks like in the upper right hand corner pocket of the US, come chat with us! I believe Peter Stallo with SIMVANA – who we’re talking with today on the show – will also be at Annual Congress, so be sure to swing by and tell him you listened to this episode and see what SIMVANA is about in person! This show is very interesting for a couple of reasons: I’m stoked to talk with Peter Stallo. Peter created Prodigy Anesthesia back in 2004. This was probably the very first computer-based anesthesia educational & board preparation study tool. Kids these days can’t imagine getting through anesthesia training without programs like this. And Prodigy is what Kristin & I exclusively used to study for boards back in 2015… so I’m personally very grateful for Peter’s development of that program. (side note… I have no financial ties with Peter, Prodigy or SIMVANA to disclose… this just pure gratitude I’m working with here). I’m also stoked about what we’re going to chat about. Virtual reality simulation will likely become a central aspect of anesthesia training in the future. As the technology becomes more widely available and the user experience further developed and refined, programs like SIMVANA will likely become ubiquitous… just like with Prodigy over the last 20 years. I’m reminded of something Elon Musk stated in a documentary about SpaceX.  Now, I don’t know how you feel about Twitter becoming X & how Elon is reshaping that organization or many of his other decisions.  But I think we can agree on the fact that the man has created & lead some remarkable organizations built on tenacious visions of what’s possible for the future.  In this documentary on SpaceX, Elon talked about how progress isn’t inevitable.  Some people just assume that the future will be better… that space travel will become routine or that will we become a multi planetary species or that we’ll solve for global warming & climate change.  But these things won’t actually happen unless individuals first imagine that they’re possible and then 2) put the work in to bring them into fruition.  Elon is someone who has devoted himself into putting the work into creating paths to a better future. Similarly, Peter Stallo is someone who didn’t stop progressing after he passed boards back in 2004.  I always say that boards is an amazing finish line & culmination of years of preparation & hard work.  We’re in that season again right now as anesthesia programs & residencies wrap up between May, June, July & August.  It’s awesome to watch trainees make that transition from graduation into clinical practice.  So while boards is a finish line of sorts, it’s also a starting line.  It’s when the start gun goes off for the rest of your career.  And back in 2004, just after Peter took boards, he got back to work.  With 2 master’s degrees in healthcare behind him, he set about creating Prodigy Anesthesia.  Then in 2014, he completed a Graduate Certificate in Orchestral Composition for Film and Games from Berkley College of Music… I didn’t even know there was just a thing.  And in 2018, he began developing a virtual reality anesthesia training program which would eventually become SIMVANA.  Peter picked up his third Master’s Degree – yes, his THIRD, in 2021 from the University of Alabama in healthcare simulation and is currently working towards completing a PhD in healthcare simulation from Massachusetts General Hospital Institute for Health Professions.   What’s remarkable, is that Peter’s career has spanned the timeframe from when anesthesia boards was a pen & paper exam, through his development of one of the leading digital board preparation programs and now into the first virtual reality anesthesia simulation program.  Peter has embodied the very idea that Elon Musk talked about:  progress isn’t inevitable.  Having virtual reality as an available tool for anesthesia training – whether you’

Quick 5-Question Post Podcast Survey HERE Today I’m joined by John Fratianni who created the content for this episode as part of his Doctorate in Nurse Anesthesia Practice at Virginia Commonwealth University in Richmond, Virginia. John earned a Bachelor of Science in Nursing at the University of North Carolina at Chapel Hill, a Master of Science in Nursing at the University of Alaska Anchorage, and completed his critical care nursing training with the United States Air Force where he served 7 years on active duty. John conducted a study to determine if ChatGPT, an artificial intelligence (AI) program, can assist us in providing anesthesia care to our patients. I want to give a special shout out to Peter Stallo who founded Prodigy Anesthesia and SIMVANA, both of which are digital educational tools for anesthesia trainees. Peter worked closely with John to grant access to Prodigy’s vast database of board-style anesthesia questions. If you haven’t checked out Prodigy or SIMVANA – which is a virtual reality based anesthesia education platform, links are in the show notes. I also want to personally thank Peter for creating a great board prep program in Prodigy… it’s all my wife and I and several of our classmates used to study for boards and we passed on the first try. Nice job, Peter and thank you! Since this episode is part of John’s doctoral work with Virginia Commonwealth University, he kindly requests that you take a quick survey that’s embedded in the show notes. It’s 5 questions and will literally take you 30 seconds… click the link and give John & me some feedback on how we did with this. With that, let’s get to the show. Quick 5-Question Post Podcast Survey HERE

All right what’s up folks this is Jon Lowrance and it’s May 16, 2023. This is episode 94 – and I’m calling it “shorts: cue ball.”  And I don’t mean shorts like the things you wear but shorts like, this will be brief and there will be more episodes like this to come… you know, shorts. But first… updates! Maine Medical Center will the at the AANA Annual Congress in Seattle this August. We’ll have a table in the exhibition hall and a couple of our CRNAs will be there to tell yall about our sweet gig and you can ask questions and see if where we’re headed is similar to where you want to head. Maybe you can join us. And we’ll join you. And we’ll move in the same direction. If you want practice a wide range of case types as part of a clinically excellent and supportive team while living in a super cool town that’s just big enough but doesn’t come with the downsides of huge metro areas, come check us out! In other news, this fall I’m back on the teaching circuit… well, circuit might be a little generous – I’m teaching at 1 conference this year which is the New England at the Cliff House 2023 Encore Symposium in Cape Neddick, Maine. The dates are October 16 – 19. You can check out the other folks who will be presenting at the conference and register at Encore’s website, which is e-s-crnas.com. Look for “New England at the Cliff House 2023 Encore Symposium” and again the dates are October 16-19. This conference usually sells out by July. Part of the reason is the location… the Cliff House is an iconic resort built in 1872 on a 70-foot cliff overlooking the Atlantic Ocean. So if a fresh cool ocean air, granite cliffs and near by sandy beaches are your thing, this might be a great get-away to come get your learn on. If you come, we’ll get the chance to talk about practical pharmacology for anesthesia providers, leadership in emergencies, best practices in neuromuscular blockage, monitoring & reversal, ERAS, airway management & a run down on what’s new in anesthesia… so much! It’s going to be fantastic. Encore Symposiums – October 16 – 19 – Cliff House. I hope to see you there! All right, with that let me tell you about Neil deGrasse Tyson, the famed astrophysicist, and his take on cue balls. This will blow your mind…

In this episode, I speak with Dr April Bourgoin, DNAP, CRNA about operating room fires – how they can start and how we can respond to them as anesthesia providers. This show was originally released in 4 years ago in February of 2019 on the podcast From the Head of the Bed and was recorded with a table top microphone so the audio is a little suboptimal, but I’m sure you’ll still find this to be a very hot topic that will smolder in your memory for years to come after they key details become seared into your clinical practice. Hopefully, this podcast will really help you turn up the heat on your OR fire prevention practices… and now that we have almost all of the puns put out, let me tell you about Dr Bougoin. Dr Bourgoin completed her Master of Nursing Science (MSN) and Doctorate of Nurse Anesthesia Practice at Virginia Commonwealth University. Prior to becoming a CRNA, she served for eight years as an active duty commissioned officer in the Army with experience as a critical care Registered Nurse and flight nurse with the 82nd Airborne Dustoff medevac team. She served two combat tours prior to transferring to the Army Reserves at the rank of Major and then returned to school for her master’s and doctorate degrees in anesthesia. Dr Bourgoin had a case in which there was an OR fire and we discuss that story in detail in this podcast. She then unpacks OR and airway fires for us, including contributing factors, prevention, crisis management and the importance of critical incident debriefing. Currently, I have the incredible privilege in working closely with April to support our CRNA group at Maine Medical Center in Portland, Maine. April is one of our 2 CRNA Supervisors and an invaluable part of our CRNA leadership team. I think you’re really going to enjoy hearing from her on this topic and in an upcoming episode on the pathophysiology of vaping associated lung injury. In the show notes to this episode we have links to the Anesthesia Patient Safety Foundation’s infographics and video on OR fire prevention and safety, which are excellent resources to share with colleagues & classmates. We also link to a resource called Anesthesia eNonymous, which is a website hosted by faculty from Virginia Commonwealth University’s Nurse Anesthesia program where providers and anesthesia learners can anonymously share and read real stories of near misses, medical errors & other clinical experiences. As it’s been said: good judgment comes from bad judgment and it’s better to learn from others mistakes & bad judgement calls than having to make your own along the way. So be sure to check out the links in the show notes to this podcast that Dr Bourgoin has shared and with that, let’s get to the show! Anesthesia Patient Safety Foundation Fire Safety Video Anesthesia e-Nonymous – Virginia Commonwealth University APSF Fire Safety Video Contributes to 44% Decrease in Intraoperative Fires Since 2011

If you get this post by email: THANK YOU! You’re in a select group of supporters of the show who have followed the posts on the website and I can’t thank you enough. Your interest, feedback and willingness to share these episodes with your friends & colleagues is much appreciated. Shoot me a reply, social media message or email any time… I’d love to hear from you and again, thank you for your support! – Jon My guest today is Dr Brian McGrory, MD. His is an orthopedic joint replacement surgeon at Maine Medical Center in Portland, Maine. This is the second time Dr McGrory has joined me on the podcast, the first being way back in episode 25 when we discussed how to prevent hypothermia during joint replacement surgeries. That episode included a special look at the controversy around various warming devices that are used in the OR and whether any of them are linked to surgical site infections. In this episode, Dr McGrory and I take a more detailed look at how to prevent surgical site infections in periprosthetic joint replacement surgery.  The significance of these infections for patients cannot be overstated.  We discuss the particulars around why a joint infection is often considered a devastating outcome for patients that, at best, results in months of continued, aggressive therapy and at worst, can lead to amputation of the limb or even death.  I’m incredibly grateful for Dr McGrory’s continued focus on improving the quality of care that surgical teams can provide and his willingness to come on this show to speak directly to anesthesia providers concerning our role in helping create great outcomes for surgical patients. Dr McGrory earned his bachelor’s degree in chemistry biology at Cornell, attended medical school at Columbia University, followed by residency in orthopedic surgery at the Mayo Clinic Graduate School where he also earned a Master’s degree in orthopedic research. He then completed a fellowship through Harvard University at Massachusetts General Hospital in adult hip & knee reconstruction. He has served as the research director for orthopedics at Maine Medical Center and the founding editor-in-chief of Arthroplasty Today, which is a publication of the American Association of Hip and Knee Surgeons. References Chaudhry, S. B., Veve, M. P., & Wagner, J. L. (2019). Cephalosporins: a focus on side chains and β-lactam cross-reactivity. Pharmacy, 7(3), 103. Retrieved from https://www.mdpi.com/505180 Hamilton, W. G., Balkam, C. B., Purcell, R. L., Parks, N. L., & Holdsworth, J. E. (2018). Operating room traffic in total joint arthroplasty: identifying patterns and training the team to keep the door shut. American Journal of Infection Control, 46(6), 633-636. Retrieved from https://www.ajicjournal.org/article/S0196-6553(18)30007-5/fulltext McGrory, B. J. (2018). Letter to the Editor on “Hypothermia in Total Joint Arthroplasty: A Wake-Up Call”. The Journal of arthroplasty, 33(9), 3056-3057. Retrieved from https://www.arthroplastyjournal.org/article/S0883-5403(18)30506-0/fulltext Wyles, C. C., Hevesi, M., Osmon, D. R., Park, M. A., Habermann, E. B., Lewallen, D. G., … & Sierra, R. J. (2019). 2019 John Charnley Award: increased risk of prosthetic joint infection following primary total knee and hip arthroplasty with the use of alternative antibiotics to cefazolin: the value of allergy testing for antibiotic prophylaxis. The bone & joint journal, 101(6_Supple_B), 9-15. Retrieved from https://online.boneandjoint.org.uk/doi/abs/10.1302/0301-620X.101B6.BJJ-2018-1407.R1 Zmistowski, Benjamin; Karam, M.D., Joseph A.; Durinka, Joel B; Casper, MD, David S; and Parvizi, Javad MD, “Periprosthetic joint infection increases the risk of one-year mortality.” (2013). Rothman Institute Faculty Papers. Paper 44.https://jdc.jefferson.edu/rothman_institute/44

What up yall. This is Jon Lowrance. I’m still here. We’re still here. This is the first episode of 2023 and the first episode on Anesthesia Guidebook since October – October! I’m so glad to get back to the podcast and bring you this update. This is a re-cap of the last few months of my world. It’s also a reminder of what Anesthesia Guidebook is about and a look forward into 2023. I’ve got some very exiting news to share… my wife is pregnant with our second baby boy, due in March, and I’ve also transitioned in my role at Maine Medical Center from the SRNA Clinical Coordinator and into the role of chief CRNA. In this episode, I talk about that transition and a bit about the philosophy of organizational leadership that I have found to be most compelling that’s shaping my approach to supporting my team and will undoubtedly continue to influence the podcast. Thank you to everyone who reached out in the last couple of months! Your check-in’s, DMs, podcast reviews and emails have been encouraging and much appreciated! I’m honored to share this space with you and to be part of your runs, Peloton rides, commutes, baby naps and all the other times you tune into Anesthesia Guidebook to stay sharp and get your learn on. I want to share the link for the group that I have the opportunity to support as chief CRNA here: Maine Medical Center. Search for the CRNA positions in Portland, Maine. Come work with us… I hope to share more about our team and the why behind what we do a little later in the year. It’s a special place with an amazing team. Reach out and we can talk about it. That said, I will always work to maintain a professional degree of separation between my place of employment and this podcast in terms of the information and opinions I share.  My views and opinions – and those of my guests – do not necessarily represent those of any of our employers.  With any medical education content, you should always consult with other healthcare experts, medical texts and peer-reviewed journals before acting upon anything you hear in a podcast or social media post.  Take care and welcome to 2023! 

Climate crisis is a growing global health problem, one which the field of anesthesia contributes to with its use of volatile anesthetic gases. This podcast is part of the doctoral project of Jacob Bonnema and it aims to increase knowledge and awareness of the environmental effects of volatile gases, particularly desflurane, to empower providers to plan environmentally-conscious anesthetics. As of October 2022, Jacob Bonnema, BSN, RN, CCRN is a senior nurse anesthesia resident at NorthShore University HealthSystem School of Nurse Anesthesia in Chicago, IL. He has a passion for environmentalism and when it came to selecting a topic for his DNP project, wanted to choose a subject that would incorporate that interest. Jacob is conducting a study associated with this podcast and we’re asking for your participation.  Please click the link below to take the pre-survey, then listen to show and follow the same link below to take the post survey. Jacob has made this incredibly easy by imbedding the audio for the podcast directly between the 2 surveys at the link below. Just click the link and you’ll see the pre-survey, then the audio content and then the post-survey all at Jacob’s site… super easy! You can also listen to the audio at Anesthesia Guidebook or wherever you listen to podcasts! Take the Survey Here! QR Link for the survey Here’s 2 reasons you should do these super quick surveys:  the most important is that it will help you learn the content better and make this show stick in your incredibly powerful brain.  By testing your knowledge up front, then listening to the content, the retesting to see what you picked up in the show, you will increase your ability to recall this information so you sound really smart when talking about it with your colleagues & students at work.  And the second reason is that by completing this survey you can feel good about yourself because you’re contributing to science. The more people who complete the pre & post surveys, the better data Jacob will have. And that makes you and Jacob happy. And me. We’ll both be stoked if you pause the podcast now and hit the pre & post surveys. All right, with that, let’s get to the show…  (References available upon request; Jacob’s contact information is available through the survey link.)

What’s up y’all this is Jon Lowrance and this is episode 89 – Distraction in the OR with Heather Turcotte, DO. Y’all, I am so stoked to bring you this conversation… I caught up with Dr Turcotte earlier this summer as she was finishing her residency in anesthesia and I’m pumped to finally get this out to you in early September of 2022. This topic was the focus of her residency project and senior grand rounds presentation and it definitely created a stir in our group as CRNAs, physicians, residents & SRNAs grappled with how to appropriately use cell phones and other technology in their practices. Since it’s late summer, early fall… I gotta give a shout out to all the residents & SRNAs out there who graduated this summer. It’s always fun to see yall wrap up clinicals & residency projects and transition into your new jobs or fellowships. I love getting texts & photos from SRNAs of their board results with the word PASS printed in the middle of the page… It’s such an incredible moment that makes all of the hard work worth it. So thanks to all of you who have reached out by email, text & social media recently with your passing boards photos, positive reviews & ratings of the podcasts and questions. This podcast puts me in touch with so many amazing people… I’ve recently heard from experienced providers to newly minted CRNAs on the day they pass boards, to brand new CA1’s to ICU nurses who found the podcast and are on the path to becoming anesthesia providers. Wherever you are in your own journey, my hope is that Anesthesia Guidebook will be a go-to guide for you as you seek to get your learn on and master your craft. Heather Turcotte, DO joins me in this is fascinating conversation that weaves through the considerations around using cell phones in the OR, checking email/internet, music that’s playing, conversations, door swings and other forms of distraction in the operating room. Dr Turcotte was born and raised in the great state of Maine. She earned a doctorate in physical therapy and practiced as a physical therapist for 4 years before going back to medical school in 2014 at the University of New England. Dr Turcotte finished her residency in anesthesiology at Maine Medical Center in 2022 and entered into private practice. Outside of medicine, she enjoys spending time with her husband and 3 kids, who are 9, 6, and 1 years old at the time of this recording, going to the beach, and drinking lots of coffee! In this conversation, Dr Turcotte brings this discussion to life with a case study where an anesthesia provider settled out of court in a dispute on negligence in a case where the patient experienced hypotension and a PEA arrest, survived the case but died a few days later. The anesthesia provider had used their cell phone and anesthesia station computer to check email and online news stories. Interestingly, an expert anesthesia witness testified that the actions of the anesthesia provider in managing the patient were flawless. But just because the provider had used their cell phone & surfed the internet on the work computer, the legal team advised they settle to avoid a jury verdict on the case. Cell phone use, open internet access including email, music playing the OR and so many other forms of distraction are common elements in operating rooms across the United States. Some institutions create policies that limit cell phone use in the OR. Others have policies that are more vague while others have no formal policies around cell phone use in the OR. There’s legitimate considerations for each of these… On one hand, how does a hospital enforce a policy that is very strict? Does creating a policy set that institution up for compliance issues or litigation? On the other hand, how can hospitals help engineer safe and reliable environments for providers to work in? As technology continues to become more and more central t0 the work we do, the issues of attention span, distraction, user experience of technology and systems engineering to create & maintain safe environments will remain important factors for each provider, group and institution to consider. References Staughton, J. (8 July 2022). Can humans actually multitask. Science ABC. Retrieved from https://www.scienceabc.com/humans/can-humans-actually-multitask.htmlLuthra, S. (13 July 2015). Do cell phones belong in the operating room. The Washington Post. Retrieved from https://www.washingtonpost.com/national/health-science/do-cellphones-belong-in-the-operating-room/2015/07/13/f524e908-1e9e-11e5-aeb9-a411a84c9d55_story.html van Pelt, M., & Weinger, M. B. (2017). Distractions in the anesthesia work environment: Impact on patient safety? Report of a meeting sponsored by the anesthesia patient safety foundation. Anesthesia & Analgesia, 125(1), 347-350. Retrieved from https://www.apsf.org/article/distractions-in-the-anesthesi

This is episode 88 and it’s part 3 off a three-part series with Dustin Degman, a CRNA formerly with the United States Army. In the first episode, we discussed Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012.  We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams. In part two, we discussed the principles of damage control resuscitation. And in this final episode of the series, we talk about the path to becoming a military CRNA, a little bit more about Dustin’s personal journey and the importance of supporting our troops. Now, I know the wars in Iraq and Afghanistan have fortunately come to an official end and that right now in August of 2022 we are in a period of time where United States troops are not in active combat roles. However, the United States still have the world’s largest military with approximately 1.3 million active service members and nearly 200,000 personnel actively deployed oversees. What Degman shares in this episode about how to engage with and support active service personnel is a powerful message for each of us. These individuals continue to make a sacrifice to serve the mission that our nation has given them. That we support them and how we support them matters. And so we’re going to talk a bit about that in this episode. And again, in terms of direct relevance to anesthesia, this episode has incredible traction for those of you who are or want to become military CRNAs or physician anesthesiologists or those of you who work with, are friends with or in families with these individuals. This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging.  At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook.  Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then.  The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today. Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse.  He was honorably discharged and went on to complete his anesthesia training outside of the military.  In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers.  Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon.  In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin.  Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon. I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show! To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004.  The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses.  Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with.  If we each give $10-20, our collective impacts will make a huge difference. Resources: Care behind the battlefield Dustin Degman was featured in Asheville’s Mountain Express in 2013.

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I am so pumped to bring you this series of 3 episodes on Combat Trauma Anesthesia!   This is episode 87 and it’s part 2 off a three-part series with Dustin Degman, a CRNA formerly with the United States Army. In the first episode, we discussed Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012 to 2013.  We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams. In this part – part two, we discuss the principles of damage control resuscitation in the context of forward surgical bases and combat zones. While this discussion is focused on combat trauma anesthesia, the core underlying principles of damage control resuscitation hold true for civilian trauma centers. And then in part three, we’re gonna come back and talk about the path to becoming a military CRNA and the importance of supporting our troops.   This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging.  At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook.  Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then.  The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today. Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse.  He was honorably discharged and went on to complete his anesthesia training outside of the military.  In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers.  Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon.  In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin.  Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon. I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show! To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004.  The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses.  Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with.  If we each give $10-20, our collective impacts will make a huge difference. Resources: #83 – Positive Deviance as a Catalyst for Change with Cherie Burke, DNP, CRNA

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I am so pumped to bring you this next series of 3 episodes!   This is episode 86 and it kicks off a three-part series with Dustin Degman, a CRNA formerly with the United States Army on combat trauma anesthesia.   In this first episode, we discuss Dustin’s experience in Afghanistan serving at a forward operating base in Paktika Province in 2012 to 2013.  We talk about what makes up forward surgical teams and the role of CRNAs as the sole anesthesia provider on these teams. In part two, we discuss the principles of damage control resuscitation and the context of operating in a combat zone. In part three, we talk about the path to becoming a military CRNA and the importance of support our troops.   This series was originally recorded in early 2015, just a year or so after Dustin had returned from Afghanistan and while the war there was still raging.  At the time, I was completing my anesthesia training at Western Carolina University and working on launching From the Head of the Bed… the podcast the preceded Anesthesia Guidebook.  Dustin was one of my professors and clinical faculty at WCU and was kind enough to volunteer his time for these interviews back then.  The reason I’m bringing them forward here is that they’re chock full of wildly fantastic details on the experience of a forward-deployed military anesthesia provider and the principles of trauma anesthesia, which are absolutely relevant today. Dustin served with the Unites States Air Force from 1998 – 2002 as a critical care Registered Nurse.  He was honorably discharged and went on to complete his anesthesia training outside of the military.  In 2010, he re-enlisted with the Army Reserves as a CRNA and was deployed in November 2012 to Forward Operating Base Orgun-E in Paktika Province, Afghanistan where he was the sole anesthesia provider on a forward surgical team providing damage control resuscitation to injured soldiers.  Most recently, Dustin serves as the chief CRNA at PeaceHealth’s Peace Harbor Medical Center in Florence, Oregon.  In 2021, Dustin was awarded the PeaceHealth Mission & Values award and the organization put together an incredible video tribute to Dustin.  Degman is the real deal… he was the real deal a decade ago when he was serving in Paktika Province, Afghanistan, which he talks about in these next 3 episodes and he’s still the real deal as he serves as a CRNA with Peace Harbor Medical Center out on the coast of Oregon. I think you’re going to really enjoy hearing from Dustin on combat trauma anesthesia and with that, let’s get to the show! To close each of these 3 episodes out, I’d like to encourage you to make a donation to the Pat Tillman Foundation in honor of Army Ranger Pat Tillman who was killed in Afghanistan in 2004. The Pat Tillman Foundation awards academic scholarships to military service members, veterans and their spouses. Dustin Degman identified this as one of the several service organizations that he believes in and encourages you to give to either the Pat Tillman Foundation or an organization you connect with. If we each give $10-20, our collective impacts will make a huge difference. Resources: Care behind the battlefield Dustin Degman was featured in Asheville’s Mountain Express in 2013.

Jason McLott, MSN, CRNA developed a mix of medications for doing opioid-free anesthesia that came to be know as the McLott Mix. It’s a combination of dexmedetomidine, lidocaine, ketamine and magnesium. Jason is clear that the McLott Mix helps achieve opioid-free anesthesia, not opioid-free analgesia, recognizing the role of opiates, if needed, in post-operative analgesia plans. Jason completed his anesthesia training at Oakland University’s Beaumont Nurse Anesthesia program and works in a CRNA-only practice at Blue Ridge Hospital in rural North Carolina. He regularly mentors SRNAs from Western Carolina University, giving them exposure to a CRNA-only practice, extensive regional anesthesia experience and opioid-free anesthesia techniques. Jason also instructs regional anesthesia courses with Twin Oaks Anesthesia. If you’ve followed Anesthesia Guidebook for any amount of time, you’ll probably remember that Western Carolina University is my alma mater. I would highly recommend WCU as a premier school for becoming a CRNA. The faculty & clinical sites are top notch and you can’t beat the location down in Asheville, North Carolina. In Part 1 of this conversation, we talked about Jason’s background, what led him to get into opioid-free anesthesia and the details of the McLott Mix and how he suggests it be used. In Part 2 of our conversation, we come back to talk in more detail on the nuances of how Jason uses the McLott Mix in his practice and how providers can instigate change in moving their practices and groups towards opioid-free anesthesia. Part 2 is a prime example of what Randy Moore & Desirée Chappell & I talked about in episode 82 on change management in healthcare. Hopefully these 2 shows with Jason McLott get you thinking about real ways that you can build opioid-free techniques into your anesthesia practice. Schenkel, L., Vogel Kahmann, I., & Steuer, C. (2022). Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology. Hospital pharmacy, 57(2), 246-252.

Jason McLott, MSN, CRNA developed a mix of medications for doing opioid-free anesthesia that came to be know as the McLott Mix. It’s a combination of dexmedetomidine, lidocaine, ketamine and magnesium. In this episode, Mr McLott himself unpacks the story of the mix’s development, efficacy and principles for opioid-free anesthesia. He’s clear that this mix helps achieve opioid-free anesthesia, not opioid-free analgesia, recognizing the role of opiates, if needed, in post-operative analgesia plans. Jason completed his anesthesia training at Oakland University’s Beaumont Nurse Anesthesia program and works in a CRNA-only practice at Blue Ridge Hospital in rural North Carolina. He regularly mentors SRNAs from Western Carolina University, giving them exposure to a CRNA-only practice, extensive regional anesthesia experience and opioid-free anesthesia techniques. Jason also instructs regional anesthesia courses with Twin Oaks Anesthesia. If you’ve followed Anesthesia Guidebook for any amount of time, you’ll probably remember that Western Carolina University is my alma mater. I would highly recommend WCU as a premier school for becoming a CRNA. The faculty & clinical sites are top notch and you can’t beat the location down in Asheville, North Carolina. In Part 1 of this conversation, we talk about Jason’s background, what led him to get into opioid-free anesthesia and the details of the McLott Mix and how he suggests it be used. In Part 2 of our conversation, we come back to talk in more detail on the nuances of how Jason uses the McLott Mix in his practice and how providers can instigate change in moving their practices and groups towards opioid-free anesthesia. Part 2 is a prime example of what Randy Moore & Desirée Chappell & I talked about in episode 82 on change management in healthcare. Hopefully these 2 shows with Jason McLott get you thinking about real ways that you can build opioid-free techniques into your anesthesia practice. Schenkel, L., Vogel Kahmann, I., & Steuer, C. (2022). Opioid-Free Anesthesia: Physico Chemical Stability Studies on Multi-Analyte Mixtures Intended for Use in Clinical Anesthesiology. Hospital pharmacy, 57(2), 246-252.

“Positive deviance is really about… taking those things that people are doing right and sharing them with everyone so that everyone is doing things to improve our patients’ care, our patients’ outcomes.” Cherie Burke, DNP, CRNA Dr Cherie Burke joins me to unpack how positive deviance can be a catalyst for change in healthcare. Positive deviance is all about looking for what’s going right and transferring those lessons to other opportunities, processes & providers to improve performance. Aggressive action & investigation is the norm when something goes wrong. Think about when a sentinel event happens. There’s mandatory reporting, root cause analysis (RCAs), critical incident debriefs and a concerted effort to prevent errors & improve processes in the future. Positive deviance is a process of applying a similar degree of effort to what’s working right. Can we find the high performers, figure out what they’re doing well and transfer those techniques, processes & beliefs to other domains? Cherie Burke, DNP, CRNA completed her Master of Science in Nursing at DeSales (duh-sales) University, her Doctorate in Nursing Practice at La Salle (la-sal) University, a post-doctoral fellowship in patient safety at the VA Medical Center in Philadelphia and is currently a PhD candidate at Duquesne (do-cane) University. Dr Burke and I worked together at Maine Medical Center in Portland, Maine and have also taught alongside one another with Cornerstone Anesthesia Conferences. Cherie is actually who connected me with Jayme Rueter, the CRNA who founded Cornerstone and who gave me my first shot at teaching other CRNAs at continuing education conferences. I think you’re going to enjoy this conversation… learning how to find positive deviance at play in our organizations is key for us to improve the work that we do. This episode was originally released on From the Head of the Bed on January 26, 2016. Resources:  Bradley, E. H., Curry, L. A., Ramanadhan, S., Rowe, L., Nembhard, I. M., & Krumholz, H. M. (2009). Research in action: using positive deviance to improve quality of health care. Implementation science, 4(1), 1-11. Ford, K. (2013). Survey of syringe and needle safety among student registered nurse anesthetists: are we making any progress?. AANA journal, 81(1). Gary, J. C. (2013). Exploring the concept and use of positive deviance in nursing. AJN The American Journal of Nursing, 113(8), 26-34. Lawton, R., Taylor, N., Clay-Williams, R., & Braithwaite, J. (2014). Positive deviance: a different approach to achieving patient safety. BMJ quality & safety, 23(11), 880-883. Prielipp, R. C., Magro, M., Morell, R. C., & Brull, S. J. (2010). The normalization of deviance: do we (un) knowingly accept doing the wrong thing?. Anesthesia & Analgesia, 110(5), 1499-1502. Rosenberg, T. (2013, February 27).  When deviants do good.  The New York Times, Retrieved from http://opinionator.blogs.nytimes.com/2013/02/27/when-deviants-do-good/?_r=0

Randy Moore, DNP, MBA, CRNA and Desirée Chappell, MSNA, CRNA join me to talk about change management in healthcare. They are both on the leadership team with NorthStar Anesthesia, which provides perioperative services at over 200 facilities across 20 states. This conversation focuses on how leaders can navigate change, develop culture and build successful anesthesia practices. We discuss the challenges facing anesthesia providers right now after 2 years of the COVID-19 pandemic and what market forces are at play including provider shortages, pressure from reduced reimbursement rates and lower surgical volumes. This episode will be relevant for any anesthesia provider who’s looking to build value in their career and especially relevant for those practice managers, owners, leaders & entrepreneurs who want – and need – to know how to navigate change, find sustainable & deliberate growth and develop cultures where providers want to invest their careers. Desirée Chappell, MSNA, CRNA is the Vice President of Clinical Quality at NorthStar Anesthesia. Desirée has an extensive background in education and quality improvement in anesthesia. She is the managing editor & lead anchor of TopMedTalk, a podcast on anesthesia, critical care & perioperative medicine with nearly 1600 episodes. She is also adjunct faculty for the Acute Pain Management Fellowship at Middle Tennessee School of Anesthesia and serves on the board of directors for the American Society for Enhanced Recovery. Desirée received her Master of Science in Nurse Anesthesia from Texas Wesleyan University. Desirée Chappell, MSN, CRNA, VP of Clinical Quality at NorthStar Anesthesia Dr Randy Moore, DNP, CRNA, MBA is the Chief Anesthetist Officer at NorthStar Anesthesia. He recently left his role as the Chief Executive Officer of the American Association of Nurse Anesthesiology and has a long background in organizational leadership. He retired as a Major in the United States Army after 22 years where he served as an active duty CRNA with tours in Afghanistan at Forward Surgical Bases. His doctorate of nursing practice is from the University of Alabama, his MBA from Southern Illinois University and Master of Science in Nursing anesthesia from Bradley University. Randy Moore, DNP, CRNA, MBA, Chief Anesthetist Officer at NorthStar Anesthesia

I caught up with Tracy Young, CRNA, MBA & CEO of YPS Anesthesia Services in Houston back in November 2019 to talk about the business of anesthesia. Tracy is one of the most sought-after experts on the business of anesthesia not just at CRNA conferences but throughout the healthcare management & business industry. In this episode we discuss a broad range of topics including anesthesia billing & staffing models, trends in reimbursement, differences between W2 & 1099 work, advice for establishing your first anesthesia staffing contract, how to succeed both in your career as an anesthesia clinician and how to transition into the business of anesthesia, how to maintain balance & wellbeing over the course of your career and other key insights. Tracy covers the origin and mission of his business, YPS Anesthesia Services, which at the time of this interview (8 December 2019) supports over 450 anesthesia providers to staff over 60 endoscopy & ambulatory surgery centers and hospitals across seven states in the United States. Tracy Young, CRNA, MBA, CEO of YPS Anesthesia Services Tracy Young earned his Master of Science in Anesthesia (MSNA) from Texas Wesleyan University in 2000, found YPS Anesthesia Services in 2003 and went on to earn a Master in Business Administration (MBA) from George Washington University in 2008. Leading YPS Anesthesia Services for nearly 20 years has provided Tracy a wealth of first hand experience in the anesthesia and healthcare business world. He enjoys giving back to the anesthesia community through teaching on business related issues for SRNAs at several anesthesia programs and for CRNAs through private conferences across the United States. Tracy also enjoys developing venture capital opportunities with both businesses in and out of healthcare. Tracy has been a long-time active member of the Louisiana State Association of Nurse Anesthetists, serving 2-terms as the president of the association. All of this experience, coupled with Tracy’s easy-going Louisiana style, makes him one of the most sought-after expert presenters on the business of anesthesia. His presentations on business related topics are really some of the best I’ve heard. The power behind his talks comes from his deep personal knowledge coupled with an ability to communicate the relevance of business topics to practicing clinicians, both those working in employed W2 settings and those working in 1099 practices. But it’s not just this deep knowledge and keen teaching ability that Tracy brings to his talks. Perhaps the most powerful aspect of his ability to communicate is his character & integrity and emphasis on professionalism as a key to success in business. Tracy often talks about the 3 A’s of Anesthesia. The Three A’s of Anesthesia: Amicable + Affable + Available He encourages providers to understand that you’re in the service industry and your clients are diverse: it’s not just the patients, but the surgeons, the OR nurses & techs, the hospital administration and other staff. You’re in a service-oriented industry and embracing a positive attitude (being amicable & affable) while being available and supporting the delivery of efficient, high quality anesthesia care are critical aspects of developing a successful anesthesia practice or business. I’m so glad you’ve found this podcast… it’s just an amazing conversation and I think you’re really going to enjoy it. If you want to hear more from Tracy Young, I’ve linked in the show notes to another interview he did on the business of anesthesia with podcast host Jason Duprat of the Healthcare Entrepreneur Academy. I should also mention, if it’s not obvious already, that Tracy is always recruiting physician anesthesiologists & CRNAs to join one of his many clinical sites or expand into new contracts. So if you’re looking for a great team to join with competitive benefits & compensation and flexible work schedules, be sure to drop them a line on their website at YPSAnesthesia.com. Quotable moments: “Some days you’re the bug & some days you’re the windshield.” – Tracy Young “Trust takes a long time to build – 6 months, a year, multiple years to build that trust – but it only takes 5 seconds to loose that trust by one bad decision.” – Tracy Young

What’s up yall, this is Jon Lowrance with Anesthesia Guidebook. This is episode 80 – how to do 1099 anesthesia work with Sandry Gaillard, MSN, CRNA. This is the second episode in a short series on the business of anesthesia. I’m gonna do a little run of interviews and topics on the business of anesthesia in the next few weeks. In the last episode you heard from Navin Goyal, MD & Saket Agrawal, CEO, both with OFFOR Health on how physician anesthesiologists can expand their careers beyond their clinical practice. In upcoming shows you’ll hear from Tracy Young of YPS Anesthesia in an episode covering lots of topics on the business of anesthesia and another episode with Randy Moore & Desirée Chappell of NorthStar Anesthesia on change management & leadership in anesthesia. These conversations are incredibly valuable for anyone in anesthesia even if you have no interest in running your own business or becoming a practice manager or leader. These podcasts are relevant for every staff CRNA, physician anesthesiologist & anesthesia resident because they help you understand the contexts that we all work in. A mentor shared with me that there’s four pillars of anesthesia: your clinical practice, which everyone has at least initially in your career, education & research, advocacy work & the business of anesthesia. While you might anchor yourself solely in your clinical practice as your primary or even only professional interest, it’s helpful to have a basic understanding of the other domains – education & research, advocacy & policy and the business of healthcare – so that you can be a more informed provider and adept at navigating your career. This episode was first released on 14 February 2015. At the time, Sandry Gaillard, MSN, CRNA was working as an independent CRNA in a 1099 practice in rural Western North Carolina. This episode was released as part of the initial launch of From the Head of the Bed, the podcast that preceded Anesthesia Guidebook. It’s an interview between Kristin Lowrance (formerly Kristin Andrejco) who at the time was a SRNA at Western Carolina University. Kristin and I both worked with Sandry while we were SRNAs at WCU and Kristin invited her on the show to talk about the basic difference between working as a W2 employee and 1099 contractor, as well as some of the unique characteristics of working in a small, rural independent CRNA practice. Sandry clearly outlines the key differences between working as a W2 employee and working as a 1099 independent contractor. Her and Kristin discuss the financial & business considerations including filing taxes, hiring an attorney & accountant, setting up a business structure and insurance considerations. They also discuss the personal leap it takes to transition from working as a W2 employee to 1099 work where you have to learn to manage you finances & certain aspects of your career in much greater detail. Sandry shares her story of making this transition and gives some wonderful encouragement for others who might be considering making the switch. Beyond discussing the financial & business considerations of working as a 1099 independent contractor, they discuss the unique characteristics of working in a small, rural CRNA-only practice. It’s important to recognize that you can work as a 1099 “independent contractor” while still working in a group or with an anesthesia care team or with a larger company, whether that is a larger CRNA-only or physician-only group or an anesthesia care team model that includes both CRNAs & physicians. Filing taxes as a 1099 doesn’t mean you work in a CRNA-only or physician-only group. It’s simply a different business structure for your professional life and means you’re not a W2 employee. Working as a 1099 contractor brings certain tax benefits – as well as additional financial responsibilities – that W2 employees don’t have. The bottom line is there are lots of opportunities for setting your work life up depending on what your interests and goals are. Many people prefer the relative ease of working in a W2 setting where an employer offers a benefits & compensation package including health insurance, retirement and professional liability insurance as well as a lot of other administrative support. Others prefer the flexibility and tax advantages of working in a 1099 setting. Layered on top of each of these fundamentally different financial & tax arrangements is the decision around whether you work as an independent provider or as part of an anesthesia care team or group. This episode unpacks all of these considerations and is a great place to start if you’re wondering about what kinds of career opportunities or business structures are available for CRNAs and physician anesthesiologists.

What’s up yall this is Jon Lowrance with Anesthesia Guidebook.  I’m really excited to bring you this episode on the future of healthcare with Dr Navin Goyal and Saket Agrawal of OFFOR Health. This is episode 79 of anesthesia guidebook and it’s coming out on June 24, 2022. This is one of the most interesting conversations I’ve had with contributors to this show.  Navin & Saket are here to discuss what the future looks like – or what it could look like – for physicians in healthcare.  They hit on something that’s not talked about very much in medical school or residency programs or every around the OR amongst your colleagues, which is “what more can you do” as a physician anesthesiologist?  What else is out there?  Graduating from medical school and completing your residency is really just the beginning – or as Navin puts it – fills one particular bucket in your career.  But there are other possibilities out there and now more than ever, he and Saket want to share with you how physicians can engage in new ventures and roles both in the healthcare sector and beyond as a way to leverage the value you bring as a highly trained clinician. They unpack this story and create this invitation to look beyond your clinical practice through sharing the story of OFFOR Health and the path they’ve been on as business partners. So let me tell you a little about each of them and then we’ll get to it… Navin Goyal, MD Navin Goyal, MD is a physician anesthesiologist and a co-founder of SmileMD, a mobile anesthesiology startup that is aiming to change the accessibility of anesthesia to small practices. He is also a co-founder of Loud Capital, a venture capital firm that provides financial support to early-stage startups as well as value-added services such as business development and guidance in scaling sales operations. Navin received his MD from the University of Cincinnati College of Medicine and trained in anesthesiology at the University of Chicago Medical Center. Saket Agrawal Saket is the CEO of OFFOR Health, a company that brings access to specialists closer to home by partnering with local dentists and medical offices to deliver specialized care. Saket became CEO of OFFOR Health in 2016 after working for years in the technology space in Silicon Valley. Sakate graduated from The Ohio State University with training in computer science and engineering, earned his MBA in North Carolina, and worked in tech in San Francisco for nearly 10 years before SmileMD’s mission drew him back to Columbus. So one of the contextual frameworks we worked off of in planning this discussion was physician anesthesiologist burnout. Navin is going to share with you his own story of being over a decade into his clinical practice at a large academic medical center when he began to feel bored with the daily grind and started wondering what else was out there. We talked before we recorded this about the MedScape 2022 Physician Burnout & Depression survey. Now this is a survey I’ve been following for several years and sharing in my own talks at anesthesia conferences on wellness. Each year, Medscape surveys around 13-15,000 physicians across 29 specialities and reports data on burnout, what contributes to burnout and how to mitigate it. In their 2022 survey, they reported that 47% of physicians reported feeling burnt out last year. We certainly know the pandemic has created an incredible degree of stress on everyone’s lives – not just healthcare providers – and has served as a huge lever or catalyst for individuals across sectors to re-evaluate what they’re doing and why.  Physician anesthesiologists, along with CRNAs & other healthcare providers, are right in the middle of this cultural upheaval.   And that’s another reason why I’m so pumped to bring you this talk.  Navin & Saket talk about what motivated them to create OFFOR Health and provide novel solutions – not only for patients in need – but for providers who are looking to shake things up in their own professional lives.  You may remember back in episode 26 I spoke with Paul Samuels, a pediatric physician anesthesiologist about mobile pediatric dental anesthesia.  In that episode, he unpacked the nitty gritty of what SmileMD is all about – which an OFFOR Health company – along with the specific anesthesia considerations for practicing in mobile, pediatric dental settings.  Be sure to check that episode out if you want to hear a little more on SmileMD. Stay tuned for lots of amazing things coming your way on the podcast… I’ve got several more shows on the business of anesthesia headed your way in the coming weeks along with one on the McLott Mix for opioid free anesthesia with Mr Jason McLott himself and ton of more content in the editing phase right now. As always, I’m stoked to hear from you.  Thank you so much for those of you who have reached out

This episode covers advice for the last six months of anesthesia training, transitioning out of training and into the first six months of your anesthesia practice. The year encompassing your last six months of training through boards and your first six months of practice is epic! There’s a huge learning curve you encounter during your first six months of anesthesia practice following the “completion of training.” Finishing training is a bit of a misnomer given that the best providers keep training… keep practicing and developing towards true expertise and mastering their craft. This was the first solo episode I produced on From the Head of the Bed, meaning just me and the mic. I originally published this on February 1, 2016, about 8 months after I completed anesthesia training and passed boards. At the time, I wanted to do a show on transitioning to practice before the lessons of that time faded from my immediate memory. I think there’s three big aspects of the last six months of anesthesia training: completing your research/thesis/DNP or residency project, securing a job and passing boards. For CRNAs, we must pass boards before we begin work. For physician residents, you may start working as a board-eligible physician anesthesiologist and work towards completing boards after you make that transition to practice. I speak a bit about wrapping up training in this episode from the experience side of things… your co-residents will likely scatter to take jobs all across the nation after training. Try to connect with them in the final months and thank your program faculty. They pour a ton of effort into developing you as a provider and launching you into the world. A little gratitude goes a long way towards helping them know their work is appreciated. The first six months of your practice brings a massive learning curve as you’re finally charged with putting all of the pieces together on your own. This is an important time where you must answer the following questions concerning your actual practice: Why do I do what I do?Why do I not do what I don’t do? Sounds simple enough, but you must clarify your decision making around clinical judgments and interventions finally for yourself and not because your program faculty or preceptors prefer you to do or not do something. My encouragement is that you frame your decision making on the latest evidence for best practices and not simply because you taught one way to do things. You must continue to evolve your practice after graduation. I hope you enjoy this show. As always, drop your comments or questions on the website, social media or in an email to me. If you haven’t already, please take 3-5 minutes and drop a review on Apple podcasts. You rating, but especially your written review, helps push the podcast out to more people and helps those individuals trust the show. I mentioned this article in the podcast: Assante, J., Collins, S., & Hewer, I. (2015). Infection Associated With Single-Dose Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Literature Review. AANA Journal, 83(4), 281-288.

In this episode, I talk with Jon Bradstreet, MSN, CRNA who at the time of this recording was the chief CRNA/Director of CRNA Services at Maine Medical Center, Maine’s only level 1 trauma center. Jon was the chief CRNA who gave me my first job in anesthesia. At the time he hired my wife and I, in June of 2015, there were around 50 CRNAs in our group. Seven years later, our group has more than doubled in size with just over 100 CRNAs. Jon has overseen that growth and the development of an incredibly healthy culture within the anesthesia team at Maine Medical Center. We originally recorded this interview in December of 2015. In this episode we talk about how to prepare for the job hunt as a SRNA… everything from what to look for in a job and how to weigh various pros & cons, how to prepare your resume or CV and how to ace the interview & follow up communications with a prospective employer. You’ve worked incredibly hard during anesthesia school to develop the skills & knowledge to become a competent provider; following through with a similar degree of proactive ownership to land your first job is key to making a successful transition into working as an anesthesia provider. This episode will tell how to do just that. Key topics: CV Preparation – what works and what’s fluff on your CVWhen to and how to contact prospective employersTips for interviews including:What chief CRNAs are looking for in your interviewQuestions you should be asking in your interviewThings to consider doing and avoid doing in an interviewWhen to follow up on an interviewTips for promoting yourself as a CRNAAdvice for how to prioritize important aspects of jobs including location, practice type, group culture, compensation packages and moreAdvice for CRNA couples who are in the job hunt together Parting words from Jon Bradstreet, MSN, CRNA: “Have fun… we have a great profession and we have a great lifestyle.  We’re very lucky to do what we do for a living.  Always keep that in mind – how fortunate we are in this profession.  And then finally I think I would say listen to your gut.  It’s taken you very far in life already… don’t repress what it’s telling you as you’re in that interview.”

This episode covers the NBCRNA’s SEE & NCE exams for SRNAs/RRNAs. Get these on lock down. Thrive in training. The Self-Evaluation Exam (SEE) is a 240-question computerized adaptive exam that’s designed for three reasons: help the SRNA gauge their progress in their training programhelp program faculty gauge how well they’re preparing studentshelp SRNAs prepare for the NCE board exam NBCRNA’s website for the SEE is here: SEE Resources. The National Certification Exam (NCE) is the board exam required to become a Certified Registered Nurse Anesthetist (CRNA). The NCE is a 100-170 question computerized adaptive exam that includes 30 random, non-graded questions. All examinees will take at least 100 questions. The exam shuts off between 100 – 170 questions once a minimum passing (or failing) standard is met. The cost of NCE is $995 and is available only to graduates of accredited nurse anesthesiology training programs. NBCRNA’s website for the NCE is here: NCE Resources. The NBCRNA also provides an exam tutorial for the SEE/NCE, which is an extremely valuable resources: SEE/NCE Exam Tutorial. In this podcast, I break down the SEE & NCE in detail and share advice for how to approach both exams. I also go in-depth on preparation for the NCE in episode 14 of Anesthesia Guidebook with expert-exam coach, LTC Peter Strube, DNP, CRNA. Dr Strube has coached nurse anesthesia trainees in passing boards both ahead of their initial try at boards and, most often, after they’ve failed. His insights are invaluable for preparing for boards so I’d definitely recommend checking out that episode. I will also hit on the NCE in an upcoming show about wrapping up training and preparing for the transition to practice. You can watch the trailer for SOMM here. As always, drop me an email, IG/Facebook message or comment here on the website with your questions or comments.