Anesthesia Guidebook

My guest today is Dr Brian McGrory.  His is an orthopedic joint replacement surgeon at Maine Medical Center in Portland, Maine.    He earned his bachelor’s degree in chemistry biology at Cornell, attended medical school at Columbia, followed by residency in orthopedic surgery at the Mayo Clinic Graduate School where he also earned a Master’s degree in orthopedic research. Dr McGrory 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. Today we’re going to talk about preventing hypothermia during total joint replacement surgery. Dr McGrory recently conducted a pilot study at Maine Medical Center evaluating perioperative body temperature in patients undergoing total joint surgery. All patients in the study received pre-operative warming at 41-degrees Celcius with 3M’s Bair Hugger forced air warmer and intraoperatively they received warm cotton blankets out of common blanket warmers and in-line IV fluid warming with 3M’s Ranger fluid warming device. The patients in the study group were also draped in a reflective space blanket as the independent variable. Dr McGrory will discuss the results of this pilot study in the podcast, some of which were published as a letter to the editor in The Journal of Arthroplasty, which I’ve linked to in the show notes. And just to review:  perioperative hypothermia has been linked to numerous bad outcomes for patients including increased infection, delayed recovery, increased blood loss, disruptions in coagulation and cardiac events, not to mention, being cold is uncomfortable for the patient.  Perioperative temperature regulation is also linked to Medicare reimbursement with the goal of one temperature reading of at least 35.5C within 30 minutes immediately before or 15 minutes after the anesthesia stop time.  If hospitals meet this mark, they may see a slight increase in reimbursement and if they miss this mark, they may miss out on a substantial percentage of reimbursement.  So there is significant precedence for maintain perioperative normothermia.  During the podcast, we’re going to hint at the controversy with forced hot air warmers that’s been widely discussed in peer reviewed, as well as popular news, publications. I want to roll through the conversation with Brian uninterrupted so you can hear how one surgeon has approached that controversy and still achieved normothermia for his patients intraoperatively, but at the end of the show, I’ll unpack & clarify the backstory on Bair Huggers so you know where that stands. It’s a crazy story that twists through legal battles, medical literature, FDA statements and popular news media… so stay tuned to the end. References Carlson, J. (2018 December 8). Legal war engulfs 3M device.  StarTribune.  Retrieved from https://www.startribune.com/legal-war-engulfs-mmm-operating-room-device/502063131/?refresh=true.  Carlson, J. (2018 December 9). A closer look at the scientific evidence for and against 3M’s Bair Hugger.  StarTribune.  Retrieved from  https://www.startribune.com/a-closer-look-at-the-scientific-evidence-for-and-against-the-bair-hugger/502204321/  Carlson, J. (2019 August 1). Judge tosses lawsuits from 5,000-plus plaintiffs against 3M warming blanket. StarTribune.   Retrieved from https://www.startribune.com/judge-tosses-lawsuits-from-5-000-plus-plaintiffs-against-3m-warming-blanket/513491312/.  Kellam, M. D., Dieckmann, L. S., & Austin, P. N. (2013). Forced‐air warming devices and the risk of surgical site infections. AORN journal, 98(4), 353-369. Retrieved from https://aornjournal.onlinelibrary.wiley.com/doi/epdf/10.1016/j.aorn.2013.08.001  Madrid, E., Urrutia, G., i Figuls, M. R., Pardo‐Hernandez, H., Campos, J. M., Paniagua, P., … & Alonso‐Coello, P. (2016). Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database of Systematic Reviews, (4). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009016.pub2/epdf/full  Maisel, W., (2017 August 30).  Information about the Use of Forced Air Thermal Regulating Systems – Letter to Health Care Providers. U.S. Food & Drug Administration. https://www.fda.gov/medical-devices/letters-health-care-providers/information-about-use-forced-air-thermal-regulating-systems-letter-health-care-providers McGrory, B. (2018). Letter to the Editor on “Hypothermia in Total Joint Arthroplasty: A Wake-Up Call.” The Journal of Arthroplasty 33(4) 3056-3059.  Retrieved from: https://www.arthroplastyjournal.org/action/showPdf?pii=S0883-5403%2818%2930506-0  Meier, B. (2010 December

Dr. Jason Bolt, DNP, CRNA is a YouTuber and social media influencer in the anesthesia community. He graduated from Union University with his doctorate in anesthesia in 2019 and now practices in a collaborative group in the Bay Area. He offers mentorship through his YouTube channel memberships and enjoys helping others reach their goals in nursing and in anesthesia. He volunteers as a member of the AANA Communications Committee and is active in advocating for CRNAs on a legislative level. He is better known online as Bolt CRNA and you can find him @bolt_CRNA on YouTube, Instagram, Tiktok and Facebook.  We talk about the pitfalls and leverage points of social media for anesthesia learners and other healthcare learners including nursing & medical students. 10 tips for surviving anesthesia training and your social media life: Make your posts anonymous relative to your school & clinical sites. (Avoid posting your school or clinical site names… like HIPAA, but for your school & clinical sites.)Avoid posting protected patient health information. This is obvious… and all about HIPAA. Keep your posts POSITIVE about healthcare. Rep your career path and the path of others in healthcare in the best light possible. Your posts reflect you as a provider and the profession in general.Avoid posting anything that may offend someone else. This is a tough one… especially when folks like Joe Rogan score multi-million dollar contracts to speak their mind. But you’re not Joe Rogan. (#yourenotjoerogan) You’re a student/learner… the more you piss people off by your posts & opinions, the harder (not easier) your path may be.Post & surf on your own time. Social media & any electronic communication is time stamped and discoverable. Practice vigilance at work and your profile pic at home. Avoid the usual pitfalls of social media… politics, religion, racism, sexism, demeaning posts/tags/likes/shares, etc. For content producers: be authentic, be honest, be truthful and cite peer-reviewed, professional sources in your posts if you’re talking about medical information. Be legit. What you & others post is not “peer reviewed” or edited by experts, so be extremely careful if you’re producing medical education for the world. Understand that your preceptors, faculty, professors, attendings, employers, program directors and legal teams at institutions (if necessary) will check you out on social media… post only what you want your employer and your mother to see.Rep your style. Do you. Tell people who you are & the path you’re on… real life stories gain traction more than fabricated realities. Have fun, find the others, connect with people, network and believe in the open, beautiful, hopeful world that social media is great at promoting. Be well. Shun the unbelievers, haters, trolls & hateful people. Block ’em. Don’t even engage. Watch the Social Dilemma. And then limit your time on social media with alerts on your phone. Go live your real life and be well. Jason Bolt, DNP, CRNA making it look easy. Follow him @bolt_CRNA. #boltCRNA

Today my guests are Trent and Katie Bishop, a CRNA couple who practice independently and live in Durango, Colorado. We’re going to talk about serotonin syndrome and cases that both Trent and Katie have recently experienced as providers in their practice. Trent & Katie Bishop are CRNAs practicing independently in Durango, Colorado. Trent has a background in biology and EMS prior to pursuing a career as a critical care Registered Nurse and now as a CRNA.  He has prior work experience at level 1 & level 2 trauma centers working in open heart and vascular surgery.  He currently enjoys working as a independent CRNA in a small surgical hospital in Durango, Colorado.  One of the things he has truly come to love about anesthesia in a rural environment is seeing his patients out in the community and knowing he did a small thing to make their lives better. Katie has been a Registered Nurse since 2004 when she started out working on a high acuity inpatient floor before transitioning to the medical ICU in 2006. She considers it the best experience anyone could have asked for prior to anesthesia as she ran the code team for meany years and floated & worked in other ICUs, as well. She has worked as a CRNA at level 1 & 2 trauma centers for several years. She absolutely loves independent practice and regional anesthesia and is actively engaged in expanding her regional anesthesia practice. She writes, “Aside from loving medicine and anesthesia, I absolutely adore my family and my time with our toddler, Jackson, Trent, and our furbabies (2 dogs and 1 cat). Durango is the best place for us to be with all of the snowboarding, camping, hiking, rafting, and travel. It’s even better when friends and family come to visit.” References Altman, C. S., & Jahangiri, M. F. (2010). Serotonin syndrome in the perioperative period. Anesthesia & Analgesia, 110(2), 526-528.  doi: 10.1213/ANE.0b013e3181c76be9 Berger, M., Gray, J. A., & Roth, B. L. (2009). The expanded biology of serotonin. Annual review of medicine, 60, 355-366. https://doi.org/10.1146/annurev.med.60.042307.110802 Frazer A, Hensler JG. Serotonin Involvement in Physiological Function and Behavior. In: Siegel GJ, Agranoff BW, Albers RW, et al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects. 6th edition. Philadelphia: Lippincott-Raven; 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK27940/ Harper Juanillo, E., Chambliss, LR. (2018). Amniotic Fluid Embolism: Clinical Challenges and Diagnostic Dilemmas. J Pediatric Women’s Healthcare. 1(2): 1012. Wang, R. Z., Vashistha, V., Kaur, S., & Houchens, N. W. (2016). Serotonin syndrome: preventing, recognizing, and treating it. Cleve Clin J Med, 83(11), 810-7. doi:10.3949/ccjm.83a.15129

“Tell me and I will forget. Show me and I will remember. Let me do and I will understand.” – Confucius Demo-do teaching is all about “show me and I will remember.” Demo-do is a simple process where educators outline what will be demonstrated, then demonstrate the process as it should be performed, then coach the learner through immediately practicing the technique. Demonstration may seem like a silly thing for clinical preceptors to do with anesthesia learners. Too often, CRNAs & physician anesthesiologists expect learners to just know what to do – having completed the reading & studying ahead of time – and get to work practicing whatever skill is to be taught without getting the chance to see a demonstration. The demo-do process changes all that. By demonstrating skills, learners get to see what they’ve studied performed by an expert just prior to them being expected to perform the skill. Check out the podcast to get the full run down on this technique that will enhance your clinical teaching and accelerate the time it takes for learners to master what you’re teaching them.

Please follow the link below to complete the survey associated with this podcast for Obi’s research with the University of Saint Francis: Effectiveness of a Nurse Anesthetist Preceptor Training Survey https://www.surveymonkey.com/r/9M7VG92 Obinna Odumodu, BSN, SRNA is currently completing his doctorate in anesthesia at the University of Saint Francis in Fort Wayne, Indiana as of February 2021, when this podcast was published. This podcast will review best practices in precepting and is being utilized as a teaching tool as part of Obi’s doctoral research. Obi was motivated to create this podcast as a tool for helping SRNAs and CRNAs hone their skills as clinical educators. To that end, we review the benefits of preceptor training, the qualities of effective preceptors and how to tailor approaches to teaching novices verses experienced anesthesia trainees. We also touch on adult learning theory, how to create positive learning environments and give effective feedback. Our hope is that this podcast will overcome the barriers of time consuming and costly preceptor training programs and give SRNAs & CRNAs some practical tools to improve their skills as clinical educators. Like any clinical skill – whether it’s placing central lines & arterial lines or mastering an array of airway techniques, clinical education is not something you show up knowing how to do. Being an effective preceptor is something you can get better at and if you’re working with any kind of learner, you owe it to those learners to think about and actually train on how to become a better educator. Being an expert clinical provider does not mean you are an expert clinical educator. It’s two skill sets. Hopefully this podcast will help you develop as a clinical educator. Obinna Odumodu was born in Texas but at the age of 3, his parents moved back to Nigeria after completing their degrees at Texas A&M University College Station. Obi grew up in Nigeria and when he was 19 years old, he returned to the United States where he completed a Bachelor’s degree in nursing at West Texas A&M University. He worked as a critical care Registered Nurse for over a decade before returning to complete his DNP degree at the University of Saint Francis. Obi is married to Josephine Odumodu and they have four boys. Interestingly, Obi started training in Jujitsu with his boys when they were young and just prior to entering anesthesia school, Obi won a world jujitsu championship in 2017. He plans to continue to train alongside his sons after completing anesthesia school later this year. References Anthony, D., Anthony, D., Jerpbak, C., Margo, K., Power, D., Slatt, L., & Tarn, D. (2014). Do we pay our community preceptors? results from a cera clerkship directors’ survey. Family Medicine. https://pubmed.ncbi.nlm.nih.gov/24652633/ Ashurst, A. (2008). Career development: The preceptorship process. Nursing and Residential Care, 10(6), 307-309. https://doi.org/10.12968/nrec.2008.10.6.29440 Bain, L. (1996). Preceptorship: A review of the literature. Journal of Advanced Nursing, 24(1), 104-107. https://doi.org/10.1046/j.1365-2648.1996.15714.x Bengtsson, M. &. (2015). Knowledge and skills needed to improve as preceptor: Development of a continuous professional development course – a qualitative study part I. BMC Nursing, 14, 51. https://doi.org/10.1186/s12912-015-0103-9. Bonner, J. M., Greenbaum, R. L., & Mayer, D. M. (2016). My boss is morally disengaged: The role of ethical leadership in explaining the interactive effect of supervisor and employee moral disengagement on employee behaviors. Journal of Business Ethics, 137(4), 731-742. https://doi.org/10.1007/s10551-014-2366-6 Bowers, A. J. (2016). Quantitative research methods training in education leadership and administration preparation programs as disciplined inquiry for building school improvement capacity. Journal of Research on Leadership Education, 12(1), 72-96. https://doi.org/10.1177/1942775116659462 Cashin, A. J., & Newman, C. (2010). The evaluation of a 12-Month health service manager mentoring program in a corrections environment. Journal for Nurses in Staff Development (JNSD), 26(2), 56-63. https://doi.org/10.1097/nnd.0b013e3181d4789e Easton, A. O. (2017). Development of an online, evidence-based CRNA Preceptor Training Tutorial (CPiTT): A quality improvement project. AANA Journal, 85(5). https://pubmed.ncbi.nlm.nih.gov/31566532/ Elisha, S., & Rutledge, D. (2011). Clinical education experiences: Perceptions of student registered nurse anesthetists. AANA Journal, 79(4 Supplement), S35. https://pubmed.ncbi.nlm.nih.gov/22403965/ Goldsmith, J. (2008). The code: standards of conduct, performance and ethics for nurses and midwives. https://www.nmc.org.uk/globalassets/sitedocuments/standards/nmc-old-code-2008.pdf. Hautala, K. T., Say

Today my guest is Chuck Frisch, DNP, CRNA, FAAPM, CH, a CRNA with over 35 years of experience in anesthesia who serves as the director of anesthesia at Box Butte General Hospital in Alliance, Nebraska. He’s here to talk about rural, independent CRNA practice. Chuck initially studied molecular, cellular & developmental biology in college before switching gears to nursing school in effort to get out of the solitude of research labs. He completed his associates degree in biology in 1978 and a second associates degree in nursing in 1979 at Mesa College, which is now Colorado Mesa University, in Grand Junction, Colorado. In 1985, Chuck completed his bachelor’s in anesthesia at Mount Marty College, which is now Mount Marty University, in order to becoming a CRNA. He then completed a Master’s degree in Health Administration in 1989 with the goal of one day being a chief CRNA. After 15 years of working in an anesthesia care team alongside physician anesthesiologists, chuck moved to Alliance, Nebraska to work in an independent anesthesia practice in 2000. While first a co-director of anesthesia, following the retirement of his partner, he became the director of anesthesia at Box Butte General Hospital in 2002. Chuck returned to school to complete his doctorate of nursing practice degree in 2014 at Rocky Mountain University of Health Professions in Provo, Utah. He has served on numerous state association committees in Nebraska and served as the director of the state association for 1 term. Chuck is a Fellow of the American Academy of Pain Medicine and served on the AANA’s practice committee and help write and verify the first NBCRNA pain management certification exam. He’s been married for 43 years, has 4 children, two of whom were adopted internationally and his first grandchild is due to be born in June of 2021. We talk about the unique challenges in working in a small, rural setting including patient screening for elective cases, how CRNAs are utilized throughout the hospital as airway and critical care experts, who your resources are and what kind of mindset you need to succeed in a rural independent practice. Dr Frisch’s bio at Box Butte General Hospital is here.

The Top Drawer Run Down is a 3-part series covering the 39 most commonly administered intravenous medications in anesthesia. These medications are often found in the top drawer of anesthesia carts in the United States. The Top Drawer Run Down was originally posted on From the Head of the Bed… a podcast for the anesthesia community in September of 2019. Michael Mielniczek, MSN, CRNA joins me to deliver the run down on these medications. Michael has a deep interest in pharmacology and completed his anesthesia training with a Master’s in Nursing from the University of Scranton in 2018. He joined me on Episode 3 of Anesthesia Guidebook for a deep dive into succinylcholine, a medication that was the focus of his graduate degree research. He has spoken at state CRNA conferences on succinylcholine, as well as at the national AANA Annual Congress. We cover the following medications in this series: Part 1: PropofolEtomidateKetamineLidocaineFentanylMorphineHydromorphoneRemifentanilSufentanilAlfentanilSuccinylcholineRocuroniumVecuroniumCisatracurium Part 2: AtropineGlycopyrrolateNeostigmineSugammadexMetoprololLabetalolEsmololHydralazinePhenylephrineEphedrineEpinephrineCalcium Chloride Part 3: HeparinNaloxoneAlbuterolDexamethasoneFamotidineOndansetronHaloperidolFurosemideMetoclopramideKetorolacOxytocinMethylergonovineCarboprost Here is the Anesthesia Guidebook Top Drawer Run Down Study Guide: Anesthesia-Guidebooks-Top-Drawer-Run-Down-Study-GuideDownload The information provided in this series is as accurate as possible but mistakes can happen. It is your responsibility to consult experienced healthcare providers, up-to-date published text books and peer reviewed literature before making decisions to implement information you hear in podcasts, blogs and social media posts, including Anesthesia Guidebook. Dig deep, do your homework and own your practice. Your practice is your responsibility. Resources: 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). Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education. Miller, R. D., et. al. (2014). Miller’s Anesthesia. Elsevier Health Sciences. Nagelhout, J. J., Elisha, S., & Plaus, K. (2013). Nurse anesthesia. Elsevier Health Sciences. Ouellette, R., & Joyce, J. (Eds.). (2010). Pharmacology for nurse anesthesiology. Jones & Bartlett Publishers. Rezai, S., Hughes, A. C., Larsen, T. B., Fuller, P. N., & Henderson, C. E. (2017). Atypical amniotic fluid embolism managed with a novel therapeutic regimen. Case reports in obstetrics and gynecology, 2017. Tubog, T. D., Kane, T. D., & Pugh, M. A. (2017). Effects of ondansetron on attenuating spinal anesthesia-induced hypotension and bradycardia in obstetric and nonobstetric subjects: a systematic review and meta-analysis. AANA Journal, 85(2), 113-122.

The Top Drawer Run Down is a 3-part series covering the 39 most commonly administered intravenous medications in anesthesia. These medications are often found in the top drawer of anesthesia carts in the United States. The Top Drawer Run Down was originally posted on From the Head of the Bed… a podcast for the anesthesia community in September of 2019. Michael Mielniczek, MSN, CRNA joins me to deliver the run down on these medications. Michael has a deep interest in pharmacology and completed his anesthesia training with a Master’s in Nursing from the University of Scranton in 2018. He joined me on Episode 3 of Anesthesia Guidebook for a deep dive into succinylcholine, a medication that was the focus of his graduate degree research. He has spoken at state CRNA conferences on succinylcholine, as well as at the national AANA Annual Congress. We cover the following medications in this series: Part 1: PropofolEtomidateKetamineLidocaineFentanylMorphineHydromorphoneRemifentanilSufentanilAlfentanilSuccinylcholineRocuroniumVecuroniumCisatracurium Part 2: AtropineGlycopyrrolateNeostigmineSugammadexMetoprololLabetalolEsmololHydralazinePhenylephrineEphedrineEpinephrineCalcium Chloride Part 3: HeparinNaloxoneAlbuterolDexamethasoneFamotidineOndansetronHaloperidolFurosemideMetoclopramideKetorolacOxytocinMethylergonovineCarboprost Here is the Anesthesia Guidebook Top Drawer Run Down Study Guide: Anesthesia-Guidebook’s-Top-Drawer-Run-Down-Study-GuideDownload The information provided in this series is as accurate as possible but mistakes can happen. It is your responsibility to consult experienced healthcare providers, up-to-date published text books and peer reviewed literature before making decisions to implement information you hear in podcasts, blogs and social media posts, including Anesthesia Guidebook. Dig deep, do your homework and own your practice. Your practice is your responsibility. Resources: Brull, S. J., & Kopman, A. F. (2017). Current Status of Neuromuscular Reversal and Monitoring Challenges and Opportunities. Anesthesiology: The Journal of the American Society of Anesthesiologists, 126(1), 173-190. Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education. Lauria, M.  (2018)  Emergency reflex action drills.  EmCrit RACC. Retrieved from https://emcrit.org/emcrit/emergency-reflex-action-drills/ Miller, R. D., et. al. (2014). Miller’s Anesthesia. Elsevier Health Sciences. Nagelhout, J. J., Elisha, S., & Plaus, K. (2013). Nurse anesthesia. Elsevier Health Sciences. Ouellette, R., & Joyce, J. (Eds.). (2010). Pharmacology for nurse anesthesiology. Jones & Bartlett Publishers.

The Top Drawer Run Down is a 3-part series covering the 39 most commonly administered intravenous medications in anesthesia. These medications are often found in the top drawer of anesthesia carts in the United States. The Top Drawer Run Down was originally posted on From the Head of the Bed… a podcast for the anesthesia community in September of 2019. Michael Mielniczek, MSN, CRNA joins me to deliver the run down on these medications. Michael has a deep interest in pharmacology and completed his anesthesia training with a Master’s in Nursing from the University of Scranton in 2018. He joined me on Episode 3 of Anesthesia Guidebook for a deep dive into succinylcholine, a medication that was the focus of his graduate degree research. He has spoken at state CRNA conferences on succinylcholine, as well as at the national AANA Annual Congress. We cover the following medications in this series: Part 1: PropofolEtomidateKetamineLidocaineFentanylMorphineHydromorphoneRemifentanilSufentanilAlfentanilSuccinylcholineRocuroniumVecuroniumCisatracurium Part 2 AtropineGlycopyrrolateNeostigmineSugammadexMetoprololLabetalolEsmololHydralazinePhenylephrineEphedrineEpinephrineCalcium Chloride Part 3 HeparinNaloxoneAlbuterolDexamethasoneFamotidineOndansetronHaloperidolFurosemideMetoclopramideKetorolacOxytocinMethylergonovineCarboprost Here is the Anesthesia Guidebook Top Drawer Run Down Study Guide: Anesthesia-Guidebook’s-Top-Drawer-Run-Down-Study-GuideDownload The information provided in this series is as accurate as possible but mistakes can happen. It is your responsibility to consult experienced healthcare providers, up-to-date published text books and peer reviewed literature before making decisions to implement information you hear in podcasts, blogs and social media posts, including Anesthesia Guidebook. Dig deep, do your homework and own your practice. Your practice is your responsibility. Resources: Çoruh, B., Tonelli, M. R., & Park, D. R. (2013). Fentanyl-induced chest wall rigidity. Chest, 143(4), 1145-1146. Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education. Miller, R. D., et. al. (2014). Miller’s Anesthesia. Elsevier Health Sciences. Nagelhout, J. J., Elisha, S., & Plaus, K. (2013). Nurse anesthesia. Elsevier Health Sciences. Ouellette, R., & Joyce, J. (Eds.). (2010). Pharmacology for nurse anesthesiology. Jones & Bartlett Publishers. Panchal, A. R., et. al. (2018).  2018 American Heart Association focused update on advanced cardiovascular life support use of antiarrhythmic drugs during and immediately after cardiac arrest.  Circulation, 138(23), e740-e749.    Retrieved from https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000613. 

In this episode, I talk with Jenny Li, BSN, SRNA about using pre-procedural ondansetron to prevent spinal-induced hypotension in elective cesarean-sections. Ms Li is completing her Doctorate of Nursing Practice (DNP) at the University at Buffalo and structured her doctoral work around this topic. She received a Bachelor of Science in Psychology from University of California, Davis in 2013 and went back to school for a second Bachelor’s in Nursing at the University of Rochester. She worked in the Cardiovascular ICU at Strong Memorial Hospital in Rochester, NY for 2 years before returning to school to complete her Doctor of Nursing Practice degree. She is expected to graduate in May 2021. Resources: Gao, L., Zheng, G., Han, J., Wang, Y., & Zheng, J. (2015). Effects of prophylactic ondansetron on spinal anesthesia-induced hypotension: a meta-analysis. International journal of obstetric anesthesia, 24(4), 335-343. . https://doi.org/10.1016/j.ijoa.2015.08.012 Heesen, M., Klimek, M., Hoeks, S. E., & Rossaint, R. (2016). Prevention of spinal anesthesia-induced hypotension during cesarean delivery by 5-hydroxytryptamine-3 receptor antagonists: a systematic review and meta-analysis and meta-regression. Anesthesia & Analgesia, 123(4), 977-988. Karacaer, F., Biricik, E., Ünal, İ., Büyükkurt, S., & Ünlügenç, H. (2018). Does prophylactic ondansetron reduce norepinephrine consumption in patients undergoing cesarean section with spinal anesthesia?. Journal of anesthesia, 32(1), 90-97. Kinsella, S. M., Carvalho, B., Dyer, R. A., Fernando, R., McDonnell, N., Mercier, F. J., … & Consensus Statement Collaborators. (2018). International consensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Obstetric Anesthesia Digest, 38(4), 171-172. Ortiz-Gómez, J. R., Palacio-Abizanda, F. J., Morillas-Ramirez, F., Fornet-Ruiz, I., Lorenzo-Jiménez, A., & Bermejo-Albares, M. L. (2017). Reducing by 50% the incidence of maternal hypotension during elective caesarean delivery under spinal anesthesia: Effect of prophylactic ondansetron and/or continuous infusion of phenylephrine-a double-blind, randomized, placebo controlled trial. Saudi journal of anaesthesia, 11(4), 408. Šklebar, I., Bujas, T., & Habek, D. (2019). Spinal Anaesthesia-induced Hypotension in Obstetrics: Prevention and Therapy. Acta Clinica Croatica, 58(Suppl 1), 90. Tatikonda, C. M., Rajappa, G. C., Rath, P., Abbas, M., Madhapura, V. S., & Gopal, N. V. (2019). Effect of intravenous ondansetron on spinal anesthesia-induced hypotension and bradycardia: A randomized controlled double-blinded study. Anesthesia, Essays and Researches, 13(2), 340. Trabelsi, W., Romdhani, C., Elaskri, H., Sammoud, W., Bensalah, M., Labbene, I., & Ferjani, M. (2015). Effect of ondansetron on the occurrence of hypotension and on neonatal parameters during spinal anesthesia for elective caesarean section: a prospective, randomized, controlled, double-blind study. Anesthesiology research and practice, 2015. Tubog, T. D., Kane, T. D., & Pugh, M. A. (2017). Effects of ondansetron on attenuating spinal anesthesia-induced hypotension and bradycardia in obstetric and nonobstetric subjects: a systematic review and meta-analysis. AANA J, 85(2), 113-122. Zhou, C., Zhu, Y., Bao, Z., Wang, X., & Liu, Q. (2018). Efficacy of ondansetron for spinal anesthesia during cesarean section: a meta-analysis of randomized trials. Journal of International Medical Research, 46(2), 654-662.

Today I’m joined by Jennifer & Robert Montague to talk about the experience of significant others in anesthesia school. Rob is currently a second-year SRNA at the University of New England and Jen, his wife, is a Master’s-prepared Registered Dietitian who has taken on the lioness’ share of providing child care and homeschooling responsibilities for their two children while Rob attends anesthesia school. Jen and Rob moved across the country from Montana to Maine for Rob to pursue a mid-life career change from working as an international mountaineering guide to becoming a CRNA. This podcast is like something from Death, Sex & Money or Joe Rogan – it’s narrative, it’s a story and unfolds over the hour & half we talk. You’ll love hearing Rob & Jen’s humor and love for one another and their kids… how resilient their children are and how they’ve made the move work financially & emotionally as individuals and a couple. If you’re getting ready for anesthesia school, wondering if you can do it with your family and children and how it all works, we talk through all of that. Who better to learn from than a couple, with kids, who are going through not only anesthesia school but doing it all in the middle of a worldwide pandemic? I’ve been looking forward to doing a show on this topic for a long time and I’m so grateful to bring you Jen & Rob’s story! So settle in to the conversation, break it up over a couple of commutes or an evening on the couch with your significant other and enjoy the story.

Lieutenant Colonel Peter D. Strube is a CRNA who graduated from St. Mary’s University school of anesthesia in 2006 with a master’s degree. His undergraduate degree is from Luther College in Decorah, Iowa. He was awarded the Doctor of Nurse Anesthesia (DNAP) in June of 2017 and is currently enrolled in his MBA. Lieutenant Colonel Strube is soon to be retired from the United States Army Nurse Corps.  Dr Strube has mobilized and deployed four times during current military operations which includes service in both Iraq and Afghanistan.  Dr Strube is the Assistant Program Director at the University of Wisconsin-Oshkosh CRNA Program.  He owns and operates Trollway Anesthesia that covers several critical access hospitals.  Dr Strube has authored several professional articles and training programs, speaks professionally both nationally and internationally, and tutors at risk students on their anesthesia boards.  He has been elected to serve on the Wisconsin state association board and is currently the AANA Region 3 Director.  He has served his community as a member of the Mount Horeb Board of Education and is a Commissioner on the Dane County Ethics Board and is a court appointed mentor for veterans in crisis.   You connect with LTC Peter Strube, DNP, CRNA, APNP through Prodigy Anesthesia’s website at the following link. Matt Zinder, MS, CRNA, CH may be reached through his anesthesia business, Zinder Anesthesia, LLC and his Going Viral podcast here.

Aurora Quaye, MD is an anesthesiologist who specializes in regional anesthesia and pain medicine at Maine Medical Center in Portland, Maine. She completed her residency at Massachusetts General Hospital and a fellowship in Regional Anesthesia at Brigham and Women’s Hospital. Dr. Quaye’s clinical interests include decreasing the use of opioids for pain management, in improving provider education on non-opioid analgesic strategies, and in identifying analgesic techniques that decrease the potential for opioid misuse, dependence and addiction. Dr Quaye has led committees to establish institutional guidelines for perioperative continuation of buprenorphine at analgesic dosing for patients with history of Opioid Use Disorder. These guidelines have been incorporated in acute pain management protocols at Massachusetts General Hospital and Maine Medical Center. This change from the prior practice of discontinuing buprenorphine has shown early promise in facilitating postoperative pain relief while limiting opioid prescribing. Resources: Quaye, A. N. A., et. al. (2020) Perioperative Continuation of Buprenorphine at Low–Moderate Doses Was Associated with Lower Postoperative Pain Scores and Decreased Outpatient Opioid Dispensing Compared with Buprenorphine Discontinuation, Pain Medicine, Volume 21, Issue 9, Pages 1955–1960, https://doi.org/10.1093/pm/pnaa020 Quaye, A. N. A., & Zhang, Y. (2019). Perioperative management of buprenorphine: solving the conundrum. Pain Medicine, 20(7), 1395-1408. Ward, E. N., Quaye, A. N. A., & Wilens, T. E. (2018). Opioid use disorders: perioperative management of a special population. Anesthesia and analgesia, 127(2), 539. Anderson, T. A., Quaye, A. N., Ward, E. N., Wilens, T. E., Hilliard, P. E., & Brummett, C. M. (2017). To Stop or Not, That Is the QuestionAcute Pain Management for the Patient on Chronic Buprenorphine. Anesthesiology: The Journal of the American Society of Anesthesiologists, 126(6), 1180-1186.

The following ten ideas have the power to change your attitude towards and even the trajectory of your professional career and life.  There’s three core domains to developing as an anesthesia provider:  your knowledge base, skill set and attitude.  Each are unique and require different kinds of effort or deliberate practice to grow & improve.  This guide is predominately about tweaking & improving the attitude you approach your career with.  If you’re gonna show up in your life, why not show up with a level of stoke that pulls you through the doldrums & pushes you towards where you want to be?  These ten ideas may help you do just that. 1.  What you do matters because you hold the lives of your patients in your hands. 2.  You’re only as good as the decisions you make today (sort of). 3.  You provide a service and you are replaceable.  4.  You have an incredible capacity to develop your skills, knowledge, attitude and even intelligence.   5.  We work in systems that are designed by people, and people work in relationships.   6.  No one cares about your money, career, scope of practice, time off, goals, wellbeing and success more than you do. 7.  Embracing delayed gratification and understanding the power of compounding interest are critical to creating a brighter financial future for yourself. 8.  You have more power, influence and capacity than you think, and so does everyone else.   9.  Location – Compensation – Autonomy.  You can pick 2.   10. Joy is more valuable than your income or job. Ten-Things-Every-Anesthesia-Provider-Should-KnowDownload Resources Duckworth, A. (2016). Grit: The power of passion and perseverance (Vol. 124). New York, NY: Scribner. Retrieved from http://www.simonandschuster.com/books/Grit/Angela-Duckworth/9781501111105. Dweck, C. S. (2008). Mindset: The new psychology of success. Random House Digital, Inc..  Retreived from https://www.penguinrandomhouse.com/books/44330/mindset-by-carol-s-dweck-phd/9780345472328/. Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt.  Retrieved from https://www.hmhbooks.com/shop/books/Peak/9780544947221. Jebb, A. T., Tay, L., Diener, E., & Oishi, S. (2018). Happiness, income satiation and turning points around the world. Nature Human Behaviour, 2(1), 33-38. Oliver, M. (2020). Devotions: The Selected Poems of Mary Oliver. Penguin Books. The Notorious B.I.G. (1997). Mo money mo problems [Song]. On Life after death. Bad Boy Records; Arista.

This episode is a continuation of the series on Leadership in Emergencies… the art & science of resuscitation. Be sure to go check out episode 7 of the podcast where I give a quick run down of leadership in emergencies and how we can work towards improving our individual & team performance in anesthesia crises. Ryan Mountjoy, MD is a board-certified physician anesthesiologist with Spectrum Healthcare Partners in Portland, Maine.  He is the Co-Director of Orthopedic Trauma and Total Joint Anesthesia and the Co-Director of Regional Anesthesia and Acute Pain Medicine at Maine Medical Center and the Site Chief of Anesthesia at MaineHealth’s Scarborough Surgery Center.  He completed his anesthesia residency at Stanford University and then pursued a Regional and Ambulatory Anesthesia fellowship at Duke University, where he worked prior to moving to Maine.  He has been practicing in the Portland area for 4 years and enjoys time with his family, anything outdoors and sampling Maine’s prolific food and beverage scene.  

This is a distillation of 10 key tips to help folks who are learning airway management improve their skills. This show gets straight to the point: 10 tips for airway management in 10 minutes. 10 Tips for Airway Management 1. Develop a growth mindset and practice deliberately 2. Do a good airway assessment 3. Develop and follow a plan 4. Control your environment 5. Position the patient and yourself for success 6. Preoxygenate adequately 7. Communicate effectively 8. Choose meds appropriately and let them work 9. Take your time with laryngoscopy 10. Recognize when you need to change your plan and do so deliberately Chong, J. (2016).  Airway management in obese patients.  EMNote.  Retrieved from http://www.emnote.org/emnotes/airway-management-in-obese-patients  This is my personal ramp preference – a stack of blankets wrapped with one blanket (which helps when removing the ramp after intubation) and either a pillow or foam shay on top. Resources: Achar, S. K., Pai, A. J., & Shenoy, U. K. (2014). Apneic oxygenation during simulated prolonged difficult laryngoscopy: comparison of nasal prongs versus nasopharyngeal catheter: a prospective randomized controlled study. Anesthesia, essays and researches, 8(1), 63. Booth, A. W. G., Vidhani, K., Lee, P. K., & Thomsett, C. M. (2017). SponTaneous Respiration using IntraVEnous anaesthesia and Hi-flow nasal oxygen (STRIVE Hi) maintains oxygenation and airway patency during management of the obstructed airway: an observational study. BJA: British Journal of Anaesthesia, 118(3), 444-451 Caputo, N., Azan, B., Domingues, R., Donner, L., Fenig, M., Fields, D., … & McCarty, M. (2017). Emergency Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). Academic Emergency Medicine, 24(11), 1387-1394. Chong, J. (2016).  Airway management in obese patients.  EMNote.  Retrieved from http://www.emnote.org/emnotes/airway-management-in-obese-patients  Dearani, J. A., Gold, M., Leibovich, B. C., Ericsson, K. A., Khabbaz, K. R., Foley, T. A., … & Daly, R. C. (2017). The role of imaging, deliberate practice, structure, and improvisation in approaching surgical perfection. The Journal of thoracic and cardiovascular surgery, 154(4), 1329-1336. Ericsson, K. A. (2015). Acquisition and Maintenance of Medical Expertise: A Perspective From the Expert – Performance Approach With Deliberate Practice. Academic Medicine, 90(11), 1471. doi:10.1097/ACM.0000000000000939 Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt. Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81. e Silva, L. O. J., Cabrera, D., Barrionuevo, P., Johnson, R. L., Erwin, P. J., Murad, M. H., & Bellolio, M. F. (2017). Effectiveness of apneic oxygenation during intubation: a systematic review and meta-analysis. Annals of emergency medicine, 70(4), 483-494.  Heard, A., Toner, A. J., Evans, J. R., Palacios, A. M. A., & Lauer, S. (2017). Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of buccal RAE tube oxygen administration. Anesthesia & Analgesia, 124(4), 1162-1167. Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux. Lee, P. K., Booth, A. W. G., Vidhani, K., & Bath, J. M. (2017). Spontaneous Breathing For the Difficult Airway: STRIVE Hi Demonstrates Its Versatility. Anesthesiology News. Moulton, C. E., Regehr, G., Mylopoulos, M., & MacRae, H. M. (2007). Slowing down when you should: a new model of expert judgment. Academic Medicine: Journal Of The Association Of American Medical Colleges, 82(10 Suppl), S109-S116. Myatra, S. N., Kalkundre, R. S., & Divatia, J. V. (2017). Optimizing education in difficult airway management: meeting the challenge. Current Opinion in Anesthesiology, 30(6), 748-754. Nørskov, A. K., Rosenstock, C. V., Wetterslev, J., Astrup, G., Afshari, A., & Lundstrøm, L. H. (2015). Diagnostic accuracy of anaesthesiologists’ prediction of difficult airway management in daily clinical practice: a cohort study of 188 064 patients registered in the Danish Anaesthesia Database. Anaesthesia, 70(3), 272-281. [THIS IS THE STUDY SHOWING 93% OF DIFFICULT INTUBATIONS AND 94% OF DIFFICULT MASK VENTILATION CASES WERE NOT ANTICIPATED.]  Patel, A., & Nouraei, S. A. R. (2015). Transnasal Humidified Rapid‐Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia, 70(3), 323-329. Patel, A., & Nouraei, S. A. R. (2016) Nasal ventilation: oxygenation, no desat, and thrive.  Anesthesiology News.  Retri

The NBCRNA CPC Program allows for CRNAs to earn Class B Credits by listening to podcasts; this episode tells you how. The National Board of Certification & Recertification for Nurse Anesthetists (NBCRNA) recognizes anesthesia-related podcasts, like Anesthesia Guidebook, as valid sources of Class B credit in their Continued Professional Certification (CPC) Program that all CRNAs participate in. Class B credits are designed to encourage professional development and CRNAs must obtain 40 hours of Class B credit every 4-year cycle of the CPC Program. If you follow Anesthesia Guidebook, you’ll easily get 10 hours of content each year and all you have to do is claim your credit – FOR FREE – with NBCRNA! The podcast tells you how and the PDFs below show you how. Earning Class B credit has never been easier! How to Report Class B Credits from Podcasts.PDFDownload NBCRNA Class B Reporting FORMDownload NBCRNA Class B Credits Website: https://www.nbcrna.com/continued-certification/class-b-credits

Today I’m joined by Will Cohen to talk about clinical precepting. We discuss ways to create effective learning environments, how to expect excellence while being supportive and other tips for mastering the art of precepting. Will created the Facebook page CRNA Preceptors and has become well known in the CRNA world for creating masterfully crafted deep dives on physiology & pharmacology to help CRNA preceptors train their resident SRNAs William Cohen is a CRNA who currently practices at two hospitals in the Kansas City metro area.  The first is the University of Kansas Health System which serves as the regional level 1 trauma & burn center.  The other is the Minimally Invasive Surgical Hospital, which focuses on bariatric and orthopedic surgeries and is staffed by a CRNA-only team proficient in multimodal, opioid sparing and ultrasound guided regional anesthesia techniques.  Mr. Cohen graduated from the Our Lady of Lourdes Nurse Anesthesia Program with a Master’s degree, and had been in various clinical roles prior to entering the anesthesia environment. He has provided patient care in the pre-hospital setting as an EMT and Paramedic in Ohio and New Jersey, as well as working as a trauma critical care nurse in Atlantic City. Throughout each phase of his career, William has always taken on preceptor roles and enjoys having learners in the clinical environment. William has a wide array of interests in healthcare, including precepting learners, human behavior during crisis and emergencies, airway management, opioid sparing anesthesia, and process improvement. Saving the best for last, William thrives on being a husband and father. His family loves to travel, as well as go mountain biking, skiing and experiencing whatever local foods and beers happen to be found along the way. Chipas, A., Cordrey, D., Floyd, D., Grubbs, L., Miller, S., & Tyre, B. (2012). Stress: perceptions, manifestations, and coping mechanisms of student registered nurse anesthetists. AANA Journal, 80(4).

Leadership in emergencies is about leadership outside of emergencies. The art and science of resuscitation involves understanding and mastering both the systems design and human factors at play in emergencies. In this episode, I unpack research by Weinger, et. al. (2017) to help us see the potential for improvement in our response to emergencies as anesthesia providers. This is the tip of the iceberg and in future shows, we’ll explore concepts related to cognitive biases, leadership & followership, communication, flow, stress inoculation training and more. Resources: Weinger, M. B., Banerjee, A., Burden, A. R., McIvor, W. R., Boulet, J., Cooper, J. B., … & Torsher, L. (2017). Simulation-based assessment of the management of critical events by board-certified anesthesiologists. Anesthesiology: The Journal of the American Society of Anesthesiologists, 127(3), 475-489.

Today I talk with Marcus House, BSN, SRNA about his decision to live in an ambulance during remote clinical rotations in anesthesia school. Marcus is currently working towards completing his Doctor of Nurse Anesthesia Practice at Missouri State University. He holds Bachelor of Science degrees in Education and Nursing, both from Southeast Missouri State University. Marcus worked for 7 years as a high school science teacher alongside his wife, Casey, also a high school teacher, before returning to nursing school. He spent 3 years working in a CVICU prior to pursuing his doctorate degree in anesthesia. He would like you to know that he “knows when to hold ’em, AND when to fold ’em, [he] once owned a Nintendo Power Glove and [he’s] comfortable being either ‘big spoon’ or ‘little spoon’.” In all seriousness, choosing to go mobile for your housing arrangements during graduate school or residency, depending on your clinical rotations, may make a lot of sense. As Marcus points out in the podcast, he’s saving money compared to the cost of rent while enjoying a personalized home on wheels that will be his to keep after anesthesia school. With many graduate anesthesia programs sending their SRNAs wide and far for clinical rotations, it can be extremely challenging to find affordable housing on the fly in grad school while still maintaining rent or a mortgage at a home base. You don’t have to look far on the internet webs to find a virtual plethora of blog sites, Instagram & Pinterest feeds and YouTube channels dedicated to #vanlife for ideas & guides on build outs. I put a few photos of Marcus’ ambulance, Bernice, below and you’ll find several more at Anesthesia Guidebook’s Instagram page. I’ll also include some photos on Instagram from a Sprinter van build that my wife and I completed after we finished anesthesia school. While we were able to get through our program in traditional housing, we’ve thoroughly enjoyed having a van for weekend to multi-week road trip adventures after grad school. Don’t hesitate to reach out to Marcus via Facebook or email ([email protected]) (that’s Marcus-dot-house, the number one, at gmail.com) or drop a question/comment below, on Instagram or directly to me via email ([email protected]) if you want to talk about van life in anesthesia school in more detail.

Kiki Mattress, MSNA, CRNA runs the blog The CRNA Chase which seeks to “empower, inspire, and educate” people who are interested in becoming CRNAs. In this episode, I talk with Kiki about her journey to become a CRNA and her passion for helping others understand and be successful on that same path. “Don’t just talk about it, be about it!” Kiki Mattress, MSNA, CRNA on what it takes to become a CRNA. Kiki’s professional career started after an Associate’s Degree in Engineering from Tri-County Technical College.  After working in engineering and deciding it wasn’t the path she wanted to continue on, Kiki returned to Tri-County for a diploma as a surgical technologist.  While she was working in the OR as a surgical tech she first met a CRNA who became a mentor to her and encouraged her to return to nursing and then anesthesia school.  Kiki took up that path with another Associate’s Degree in Nursing from Tri-County followed by her Bachelor of Science in Nursing from the University of South Carolina Upstate and then her Master of Science in Nurse Anesthesia from the University of New England.  Upon graduating from UNE, Kiki moved back to South Carolina where she works as an independently contracting CRNA.  You don’t want to miss this episode and if you’re already a SRNA or CRNA, forward this show on to the people you know who are thinking about becoming CRNAs! Resources: The CRNA Chase Blog Follow The CRNA Chase on Twitter Connect with Kiki Mattress on LinkedIn Itzkoff, D. (2020, September 16). Chris Rock Tried to Warn Us. The New York Times. Retrieved from https://www.nytimes.com

MJ Hiblen is an illustrator from Norwich, United Kingdom who’s first book of art titled, Front Line Heroes is available now from Eyewear Publishing.  This book is incredibly powerful.  I’ve followed MJ’s work on Instagram since the early days of the COVID19 pandemic when he began drawing images depicting the coronavirus as a classic comic-book style menacing villain with healthcare workers squaring off as the front line heroes the world has come to know them as.  When I saw that this collection of art was coming together in a limited edition hardcover, I immediately put my order in.  The book went to print in August 2020 and over the last few weeks I’ve shared it with colleagues in my anesthesia department.  Their first glance at the artwork – during busy shifts at our level 1 trauma center – was often much like mine:  at first intrigued and then within pages, fighting back tears as we realize the beauty and power of what M.J. Hiblen has captured in his images.  His work is evocative & heart wrenching, at once it powerfully represents the human toll and suffering this virus has brought around the world while also casting healthcare workers as the defiant, battle-worn and ultimately triumphant care providers they are. You owe it to yourself, after the year we’ve all experienced, to look M.J. Hiblen up on Instagram and get a copy of this book for yourself.  You can find it on Amazon or directly from the publisher at Eyewear Publishing.  Links to the book are in the show notes and if you hurry, you might still be able to get one only 1000 first edition hardcovers, signed by M.J. Hiblen. Click here: M.J. Hiblen on Instagram Order your copy of Front Line Heroes, art by M.J. Hiblen here.

This episode on succinylcholine will unravel the mysteries and controversies around the medication – from it’s molecular shape and how that influences which receptors subtypes and locations it exerts its effects on to practical information on dosing and how to optimize airway management while mitigating the side effects of succinylcholine.  At the time of this recording in March of 2018, Michael was a second-year Student Registered Nurse Anesthetist at the University of Scranton and a student representative for the AANA Foundation.  He has since passed his boards as a CRNA and began his anesthesia practice in the greater Boston area. His background includes experience as a cardiac critical care Registered Nurse in Austin, Texas.   As part of his graduate studies, Michael completed an in-depth project regarding the history, latest research and controversies surrounding succinylcholine. Michael has presented on succinylcholine at state association conferences and went on to give a podium presentation at the 2018 AANA Annual Congress in Boston titled “Succinylcholine:  From Discovery to Current Evidence for Everyday Practice.”  Resources: Alvarellos, M. L., McDonagh, E. M., Patel, S., McLeod, H. L., Altman, R. B., & Klein, T. E. (2015). PharmGKB summary: succinylcholine pathway, pharmacokinetics/pharmacodynamics. Pharmacogenetics and genomics, 25(12), 622. Barash, P. G. (Ed.). (2009). Clinical anesthesia. Lippincott Williams & Wilkins. Fukano, N., Suzuki, T., Ishikawa, K., Mizutani, H., Saeki, S., & Ogawa, S. (2011). A randomized trial to identify optimal precurarizing dose of rocuronium to avoid precurarization-induced neuromuscular block. Journal of anesthesia, 25(2), 200-204. Lee, C. (2003). Conformation, action, and mechanism of action of neuromuscular blocking muscle relaxants. Pharmacology & therapeutics, 98(2), 143-169. Nagelhout, J. J., & Plaus, K. L. (2014). Nurse anesthesia. Elsevier Health Sciences. Miller, R. D. (2015). Miller’s anesthesia (8th ed.). Philadelphia, PA: Churchill Livingstone/Elsevier. Schreiber, J. U., Lysakowski, C., Fuchs-Buder, T., & Tramer, M. R. (2005). Prevention of Succinylcholine-induced Fasciculation and MyalgiaA Meta-analysis of Randomized Trials. Anesthesiology: The Journal of the American Society of Anesthesiologists, 103(4), 877-884. Tran, D. T., Newton, E. K., Mount, V. A., Lee, J. S., Wells, G. A., & Perry, J. J. (2015). Rocuronium versus succinylcholine for rapid sequence induction intubation. The Cochrane Library.

Matt Poirier, MSNA, CRNA joins Anesthesia Guidebook to give a run down on dexmedetomidine. We cover the pharmacology & dosing right off the bat in this episode and then we take some time to discuss the art of using dexmedetomidine peri-operatively. Matt Poirier is a Certified Registered Nurse Anesthetist at Maine Medical Center, a level 1 trauma center in Portland, Maine.  He obtained his Bachelor of Science in nursing from the University of Southern Maine and his Master of Science in nurse anesthesia from the University of New England.  Prior to Matt’s nursing career, he attended Assumption College in Worcester Massachusetts and obtained a Bachelor of Arts in biology and chemistry and subsequently worked as both an analytic and synthetic chemist. References Kaur, M., & Singh, P. M. (2011). Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesthesia, essays and researches, 5(2), 128. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173414/. Liu, Y., Liang, F., Liu, X., Shao, X., Jiang, N., & Gan, X. (2018). Dexmedetomidine reduces perioperative opioid consumption and postoperative pain intensity in neurosurgery: a meta-analysis. Journal of neurosurgical anesthesiology, 30(2), 146-155. McEvoy, M. D., Scott, M. J., Gordon, D. B., Grant, S. A., Thacker, J. M., Wu, C. L., & … Miller, T. E. (2017). American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on optimal analgesia within an enhanced recovery pathway for colorectal surgery: part 1–from the preoperative period to PACU. Perioperative Medicine, 61. doi:10.1186/s13741-017-0064-5

Welcome! You made it! This is episode 1: the origin story, the backdrop, the context to who we are, where we’re from and where we are headed. Check out the podcast in your favorite player or right here on the website to hear our story, which is all about YOUR STORY! You’re on a path to becoming an expert anesthesia provider… we’re here to help guide you. Everything we do is designed to help you master your craft.  Anesthesia providers hold their patients’ lives in their hands during every case. You never know when you will face crashing hemodynamics, a lost airway or a life-threatening surgical problem… and each of these emergencies can be complicated by your patients’ pathophysiology, suboptimal systems of care that surround you and/or your individual preparedness for the moment. Anesthesia Guidebook will help you deepen your practice so that you can come through for your patients when it counts. If you’re just starting to explore the absolutely fascinating world of anesthesia, maybe as a critical care Registered Nurse, medical student, anesthesia resident or SRNA, we have stories, guides and resources specifically designed with you in mind. Anesthesia Guidebook is also for those seasoned providers who are looking to level up, dig deeper, stay fresh and develop new skills. We’ll bring you the latest on evidence-based medicine and emerging trends & techniques in the anesthesia community, so you can stay sharp and give your patients and students your best. Renowned psychologist and best selling author on human performance & expertise, Anders Ericsson, has said: “Most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers.” (Ericsson, 2004) Ericsson’s words throw down the gauntlet for anesthesia providers. And the stakes couldn’t be higher. The most vulnerable times in our patients lives often begin when we say “hello.” We have an esteemed responsibility to meet the demand for clinical expertise & assure high functioning systems of care that our patients expect, deserve and entrust their lives to. Anesthesia Guidebook will bring you compelling stories, e-books and other resources built around pathophysiology, pharmacology, airway management, human performance and team dynamics, all tailored to the high stakes environment you work in.  Your path to becoming an expert anesthesia provider – to mastering your craft – will be the focus of everything we do. Sources: Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.