Anesthesia Guidebook

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:

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!

Leadership Tactics

By Jocko Willink

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 favor and go meet these incredible people.  April, Danielle and Jill will be pumped to meet you.

So that’s it… just wanted to drop a quick shoutout to those of you headed to AANA Annual Congress this weekend and say I hope it’s an amazing conference.  Go get your learn on, meet some new friends and stop by the MaineHealth booth and tell my friends I said hello.

And with that… I’ll see ya next time!

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/10.1080/08923647.2020.1701301

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.org/10.1080/10401334.2018.1456928

Harwood, K. J., McDonald, P. L., Butler, J. T., Drago, D., & Schlumpf, K. S. (2018). Comparing student outcomes in traditional vs intensive, online graduate programs in health professional education. BMC medical education, 18(1), 240-240. https://doi.org/10.1186/s12909-018-1343-7

Hoffman, H. J., & Elmi, A. F. (2020). Comparing Student Performance in a Graduate-Level Introductory Biostatistics Course Using an Online versus a Traditional in-Person Learning Environment. Journal of statistics and data science education, ahead-of-print(ahead-of-print), 1-10. https://doi.org/10.1080/10691898.2020.1841592

Imus, F. S., & Burns, S. (2015). What to Consider Before Beginning Graduate Education: A Pilot Study. AANA J, 83(5), 345-350. https://www.ncbi.nlm.nih.gov/pubmed/26638456

Imus, F. S., Burns, S., & Weglarz, D. M. (2017). Self-efficacy and graduate education in a nurse Anesthesia program: A pilot study. AANA Journal, 85(3), 205-216. 

Institute for Healthcare Improvement. (2023). How to improve. https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx

Kondo, M. C., Jacoby, S. F., & South, E. C. (2018). Does spending time outdoors reduce stress? A review of real-time stress response to outdoor environments. Health & place, 51, 136-150. https://doi.org/10.1016/j.healthplace.2018.03.001

Lowrance, J. (2023). Anesthesia Guidebook. https://anesthesiaguidebook.com

Malek-Ismail, J. (2021). Thriving in the First Semester of Graduate School: A Process of Rebalancing and Self-Determination. The American journal of occupational therapy, 75(S2), 7512520410-7512520410p7512520411. https://doi.org/10.5014/ajot.2021.75S2-RP410

Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-396. 

Mesisca, J., & Mainwaring, J. (2021). Stress, Anxiety, and Well-being in Nurse Anesthesia Doctoral Students. AANA J,89(5), 396-402. https://www.ncbi.nlm.nih.gov/pubmed/34586993

Montag, C., Sindermann, C., Lester, D., & Davis, K. L. (2020). Linking individual differences in satisfaction with each of Maslow’s needs to the Big Five personality traits and Panksepp’s primary emotional systems. Heliyon, 6(7), e04325-e04325. https://doi.org/10.1016/j.heliyon.2020.e04325

National Center for Education Statistics. (2021). Table 9. Unduplicated headcount enrollment at Title IV institutions, by control of institution, student level, level of institution, and distance education status of student: United States, 2020–21. In: U.S. Department of Education.

Osaili, T. M., Ismail, L. C., ElMehdi, H. M., Al-Nabulsi, A. A., Taybeh, A. O., Saleh, S. T., Kassem, H., Alkhalidy, H., Ali, H. I., Al Dhaheri, A. S., & Stojanovska, L. (2023). Comparison of students’ perceptions of online and hybrid learning modalities during the covid-19 pandemic: The case of the University of Sharjah. PLoS One, 18(3), e0283513. https://doi.org/10.1371/journal.pone.0283513

Palmer, L., amp, J. M., Ren, D., & Henker, R. (2014). Comparison of Nurse Anesthesia Student 12 Lead EKG Knowledge, Interpretation Skill, Satisfaction and Attitude: Traditional Instruction vs. Asynchronous Online Video Lecture. Journal of Online Learning and Teaching, 10(3), 420-n/a. https://ezproxy.library.arizona.edu/login?url=https://www.proquest.com/scholarly-journals/comparison-nurse-anesthesia-student-12-lead-ekg/docview/1650489030/se-2?accountid=8360

Papaleontiou–Louca, E., Esmailnia, S., & Thoma, N. (2022). A Critical Review of Maslow’s Theory of Spirituality. Journal of Spirituality in Mental Health, 24(4), 327-343. https://doi.org/10.1080/19349637.2021.1932694

Pecka, S. L., Kotcherlakota, S., & Berger, A. M. (2014). Community of inquiry model: Advancing distance learning in nurse anesthesia education. AANA Journal, 82(3), 212-218. 

Polit, D., & Beck, C. (2020). Nursing Research. Philadelphia, UNITED STATES Wolters Kluwer Health. 

Pressman, S. D., Gallagher, M. W., & Lopez, S. J. (2013). Is the Emotion-Health Connection a “First-World Problem”? Psychological science, 24(4), 544-549. https://doi.org/10.1177/0956797612457382

Wilson, J. T., Gibbons, S. W., & Wofford, K. (2015). Process Improvement: Addressing Attrition from the Uniformed Services University of the Health Sciences Nurse Anesthesia Program. AANA J, 83(5), 351-356. https://www.ncbi.nlm.nih.gov/pubmed/26638457

Worthen, M., & Cash, E. (2022). Stress Management. StatPearls [Internet], Jan. 2022. https://www.ncbi.nlm.nih.gov/books/NBK513300/

Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. Excli j, 16, 1057-1072. https://doi.org/10.17179/excli2017-480

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. (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., Wang, X., Liu, H., Mo, H., Pan, D., Wen, S., & Zhou, A. (2021). Effects of Dexmedetomidine on Patients Undergoing Laparoscopic Surgery for Colorectal Cancer. The Journal of Surgical Research, 267, 687–694. https://doi.org/10.1016/j.jss.2021.06.043

Tang, Y., Liu, J., Huang, X., Ding, H., Tan, S., & Zhu, Y. (2021). Effect of Dexmedetomidine-Assisted Intravenous Inhalation Combined Anesthesia on Cerebral Oxygen Metabolism and Serum Th1/Th2 Level in Elderly Colorectal Cancer Patients. Frontiers in Surgery, 8, 832646–832646. https://doi.org/10.3389/fsurg.2021.832646

Xu, B., Li, Z., Zhou, D., Li, L., Li, P., & Huang, H. (2017). The influence of age on sensitivity to dexmedetomidine sedation during spinal anesthesia in lower limb orthopedic surgery. Anesthesia & Analgesia, 125(6), 1907-1910. https://doi.org/10.1213/ANE.0000000000002531

Zhang, J., Liu, G., Zhang, F., Fang, H., Zhang, D., Liu, S., Chen, B., & Xiao, H. (2019). Analysis of postoperative cognitive dysfunction and influencing factors of dexmedetomidine anesthesia in elderly patients with colorectal cancer. Experimental and Therapeutic Medicine, 18(3), 3058–3064. https://doi.org/10.3892/ol.2019.10611

If you want to dive deeper, recommended reading:

DNP Reference Tools

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, and Sarah, 18, and is also survived by mother Nancy Sommerfeld, father Donald Strube, sisters Shannon and Nicky (Troy) Cross, niece Josie Cross and nephew Chance Cross.

Services will be held Tuesday, January 16, 2024 at:
Evangelical Lutheran Church
315 E Main St
Mount Horeb, WI 53572

Visitation to begin at noon and service will begin at 3 p.m.

Obituary contributed by Matt Zinder, MS, CH, CRNA.