In Episode 15 of the Nurse Anesthesia Podcast, Jeremy and Sass dive into the pharmacological world of ketamine. They talk about all the anesthesia situations where it can be useful. They discuss the pharmacology of ketamine, appropriate dosing, what the current evidence really shows about its use with increased intracranial pressure, and how it is frequently used for analgesia. It really is the Swiss army knife of anesthetic meds!
References

1. Aleksandrova LR, et al. Antidepressant effects of ketamine and the roles of AMPA glutamate receptors and other mechanisms beyond NMDA receptor antagonism. J Psychiatry Neurosci. 2017 Jul; 42(4): 222–229.
2. Bar-JosephG, et al. Effectiveness of Ketamine in Decreasing Intracranial Pressure in Children With Intracranial Hypertension. J Neurosurg Pediatr. 2009 Jul;4(1):40-6.
3. Farrell A, Bendo D. Perioperative Management of Severe Traumatic Brain Injury: What Is New? Curr Anesthesiol Rep. 2018; 8(3): 279–289.
4. Ghojazadeh M, et al. Using Ketamine and Propofol for Procedural Sedation of Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Adv Pharm Bull. 2019 Feb;9(1):5-11.
5. Hashimoto K. Rapid‐acting antidepressant ketamine, its metabolites and other candidates: A historical overview and future perspective. Psychiatry Clin Neurosci. 2019 Oct; 73(10): 613–627.
6. Jankauskas V, et al. A review of ketamine’s role in ECT and non-ECT settings
7. Neuropsychiatr Dis Treat. 2018; 14: 1437–1450.
8. Liriano F, et al. Ketamine as treatment for post-traumatic stress disorder: a review. Drugs Context. 2019; 8: 212305.
9. Merelman AH, et al. Alternatives to Rapid Sequence Intubation: Contemporary Airway Management with Ketamine. West J Emerg Med. 2019 May; 20(3): 466–471.
10. Porter S. Perioperative ketamine for acute analgesia and beyond. Rom J Anaesth Intensive Care. 2019 Apr; 26(1): 67–73.

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Music by Alex Grohl

Mixed & Edited by Next Day Podcast
info@nextdaypodcast.com

In this episode Jeremy and Mark focus on the cricothyroid membrane. They discuss the anatomy, sizing, vasculature and orientation of this important airway landmark. They then highlight techniques for palpating the cricothyroid membrane, and finish up with a discussion that explains how to use Point of Care Ultrasound (POCUS) to mark where exact position of this membrane is on the neck. This is an episode you won’t want to miss!

References

1. Lin J, Bellinger R, Shedd A, et al. Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review. Diagnostics (Basel). 2023;13(9):1541. Published 2023 Apr 25. doi:10.3390/diagnostics13091541
2. Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: best evidence, techniques, and clinical impact. Br J Anaesth. 2016 Sep;117 Suppl 1:i39-i48. doi: 10.1093/bja/aew176. Epub 2016 Jul 17. PMID: 27432055.
3. Rai Y, You-Ten E, Zasso F, De Castro C, Ye XY, Siddiqui N. The role of ultrasound in front-of-neck access for cricothyroid membrane identification: A systematic review. J Crit Care. 2020 Dec;60:161-168. doi: 10.1016/j.jcrc.2020.07.030. Epub 2020 Aug 13. PMID: 32836091. Journal of Anaesthesia, Volume 117, Issue suppl_1, September 2016, Pages i39–i48, https://doi.org/10.1093/bja/aew176
4. Hung KC, Chen IW, Lin CM, Sun CK. Comparison between ultrasound-guided and digital palpation techniques for identification of the cricothyroid membrane: a meta-analysis. Br J Anaesth. 2021 Jan;126(1):e9-e11. doi: 10.1016/j.bja.2020.08.012. Epub 2020 Sep 28. PMID: 32896429.
5. Kristensen MS, Teoh WH. Ultrasound identification of the cricothyroid membrane: the new standard in preparing for front-of-neck airway access. Br J Anaesth. 2021 Jan;126(1):22-27. doi: 10.1016/j.bja.2020.10.004. Epub 2020 Oct 31. PMID: 33131758.
6. Siddiqui N, Arzola C, Friedman Z, Guerina L, You-Ten KE. Ultrasound Improves Cricothyrotomy Success in Cadavers with Poorly Defined Neck Anatomy: A Randomized Control Trial. Anesthesiology. 2015 Nov;123(5):1033-41. doi: 10.1097/ALN.0000000000000848. PMID: 26352376.

About The Nurse Anesthesia

We are building a commUNITY of learning in anesthesia and critical care. For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!

Sign up for The Nurse Anesthesia Courses

We are currently developing anesthesia content! Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com

Follow us on Instagram

We post about all things anesthesia. Follow us on Instagram @thenurseanesthesia

Comments or Suggestions?

We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Please contact us on Instagram with suggestions.

Legal Disclaimer

The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.

Music by Alex Grohl

Mixed & Edited by Next Day Podcast
info@nextdaypodcast.com

In today’s podcast Jeremy and Mark review several anesthesia concepts that were covered in previous episodes…specifically Malignant Hyperthermia, Pulse Oximetry, and Adrenal Crisis.

As educators we know it’s important to revisit and review anesthesia concepts in order to help with long term memory retention. There’s actually a learning technique called

spaced learning (or spaced repetition) where information is reviewed at increasing intervals over time, instead of being crammed in a single session.

This method leverages the psychological spacing effect, where learning and retention are more effective when study sessions are spread out. And in the context of learning anesthesia concepts, spaced learning helps learners more efficiently memorize and deeply understand complex topics by reinforcing the material at various intervals, allowing for better long-term retention.

Also, since all CRNAs will need to recertify their credential in the future with the NBCRNAs new MAC questions…these episodes will help with that too!

References

1. Bruder EA, Ball IM, Pickett W. 2015. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. doi 10.1002/14651858.
2. Chabre O, et al. 2017. Epidemiology of primary and secondary adrenal insufficiency. Ann Endocrinol. 78(6):490-494.
3. Chan ED, et al. Pulse oximetry: understanding its basic principles
   facilitates appreciation of its limitations. Respir Med. 2013 Jun;107(6):789-99.
4. Elisha, S., Heiner, J. S., & Nagelhout J. J. (2023). Nurse Anesthesia (7th ed.) Elsevier Saunders.
5. Elshal MM, et al. Perfusion Index: Could It Be a New Vital Sign? Front Med (Lausanne). 2021 Oct 1;8:651909.
6. Liu M., 2017. Perioperative steroid management. Anesthesiology, 127(1), 166-172.
7. www.mhaus.org
8. Yamamoto LG, et al. Nail polish does not significantly affect pulse oximetry measurements in mildly hypoxic subjects. Respir Care. 2008 Nov;53(11):1470-4.

Resources/information discussed in podcast

About The Nurse Anesthesia

For anyone who wants to learn or review anesthesia concepts…we will set you up for a successful educational jOURney by providing short, meaningful courses to accelerate your nurse anesthesia learning, tackle your training, and become the successful CRNA you have always dreamed of. Let's do this together. It's Go Time!

Sign up for The Nurse Anesthesia Courses

Learn more about The Nurse Anesthesia at www.thenurseanesthesia.com

Comments or Suggestions?

We’re here to help you improve your anesthesia learning and practice, and we want to make sure our content is relevant for you. Click here to share your comments and suggestions.

Legal Disclaimer

The Nurse Anesthesia INC. expressly disclaims any liability in connection with the use of any content in its podcasts, social media posts, and all other published content by any third party.

Music by Alex Grohl

Mixed & Edited by Next Day Podcast
info@nextdaypodcast.com