In this episode of the Atomic Anesthesia Podcast, nurse anesthesia residents are guided through the pivotal moments of emergence and extubation—recognized as one of the riskiest steps in the operating room. Listeners will gain practical strategies for timing and executing a safe, efficient wake-up following general anesthesia, including the choice between restoring spontaneous breathing early for extremity and head or neck surgeries, or precisely titrating off anesthetics and using nitrous oxide during abdominal and thoracic procedures. The episode breaks down emergence criteria, ventilatory and hemodynamic parameters, medication effects, and the consequences of mixing techniques, all illustrated with clear, experience-based teaching points drawn from years of practice. CRNAs at all levels are invited to reflect, share their own perspectives, and incorporate these actionable insights to optimize patient safety, comfort, and workflow in the perioperative environment.

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This is a joint episode recorded with Dr. Chloe Gomez of the My Favorite Learner podcast. This episode explores the foundational concepts of pharmacogenetics and its impact on drug responses during anesthesia, highlighting how genetic, genomic, and epigenetic variations shape individual reactions to commonly used medications in perioperative care. Designed for nurse anesthesia residents, the show walks through the scenarios of variable drug response, the roles of metabolizing enzymes, transport molecules, and molecular targets, as well as the influence of environmental factors and polymorphisms such as single-nucleotide variants and ethnic differences in metabolism. Key topics include disease-specific considerations like G6PD deficiency, acute intermittent porphyria, long QT syndrome, Brugada syndrome, atypical pseudocholinesterase, and malignant hyperthermia, with a focus on clinical implications for personalized medicine, precision dosing, and ethical issues surrounding genetic testing, privacy, and patient equity. Practical advice covers vigilant monitoring, individualized dosing, preoperative assessment for genetic risk, and strategies for documenting and communicating findings for safer anesthesia practice.

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This episode of the Atomic Anesthesia Podcast explores the emerging role of Suzetrigine, a novel non-opioid NaV1.8 channel inhibitor, in multimodal surgical pain management. Host Rhea and guest JR Phillips, a DNAP student, discuss the science, efficacy, and safety profile of Suzetrigine, its potential for opioid-sparing strategies, and its unique advantages over traditional opioids and sodium channel blockers. Listen in for an evidence-based look at how this new FDA-approved analgesic could reshape perioperative care, improve patient outcomes, and what its current limitations and future possibilities might be for anesthesia professionals and learners.

To take a quiz about this topic, check out this link: [HERE]

For references for this episode, click [HERE]

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In the final installment of the Trauma and Burn Anesthesia Series, we explore the unique physiology and management of burn patients, a population that differs significantly from blunt or penetrating trauma. This episode covers the classification and severity of burns, the pathophysiology of burn shock, and essential principles like calculating burn extent using the rule of nines, applying the Parkland formula for fluid resuscitation, and monitoring for fluid creep. We also examine systemic complications affecting the cardiovascular, pulmonary, and metabolic systems, challenges of smoke inhalation injury and carbon monoxide poisoning, and the altered pharmacology that impacts anesthesia care. Finally, we discuss perioperative considerations such as blood loss, temperature control, and multimodal pain management, emphasizing why burn patients require such specialized care and preparation from anesthesia providers.

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In part 9 of the Trauma Anesthesia Series, we dive into the critical topic of mass casualty events—what defines them, how hospitals respond when resources are overwhelmed, and the principles of patient triage that determine who gets treated first. Using real-world examples, we explore common triage algorithms, the color-coded tagging system, and the difficult but necessary decisions providers must make to save the greatest number of lives. The episode also addresses the emotional toll of these crises, highlighting second victim syndrome and the importance of resilience, mental health support, and teamwork for healthcare providers navigating these high-stakes situations.

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Welcome to part 8 of the Trauma & Burn Anesthesia Series. In this episode, we take a broad look at special populations in trauma anesthesia—pregnant, pediatric, and geriatric patients. Each of these groups presents unique physiologic challenges, risk factors, and perioperative considerations that require anesthesia providers to adapt their trauma management strategies. From managing airway swelling and aspiration risk in pregnant patients, to balancing fluid resuscitation and minimizing radiation exposure in children, to mitigating postoperative delirium and cognitive dysfunction in older adults, this episode offers a high-level overview of principles you can apply in clinical practice. Because each of these populations deserves a deeper dive, we’ve included links in the show notes to key articles and guidelines so you can explore further on your own. In future episodes, we’ll dedicate entire discussions to each special population for a more detailed breakdown. Join us as we highlight essential principles and considerations for trauma anesthesia providers caring for these vulnerable groups.

ADDITIONAL RESOURCES:

Pregnant Patients:

• Guidelines for the Management of Pregnant Trauma Patients (Jain, 2015)
• Trauma in the Obstetric Patient: A Bedside Tool (ACEP)

Pediatrics:

• Initial assessment and management of pediatric trauma patients (McFadyen, 2012)

Geriatrics:

• Perioperative Management of the Geriatric Trauma Patient (Muldowney, 2025)
• Trauma in the elderly patient (Atinga, 2018)

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This episode of the Trauma and Burn Anesthesia Series explores the acute management of spinal cord injury, from mechanisms like motor vehicle accidents and falls to the growing impact on older adults. Key topics include early recognition, imaging strategies, spinal precautions, maintaining supranormal mean arterial pressure for cord perfusion, and the use of methylprednisolone to reduce inflammation. We break down injury types—including Brown-Séquard, anterior, posterior, and central cord syndromes—along with crucial anesthesia pearls for airway management and safe patient transfer. The episode also highlights complications like neurogenic shock and autonomic dysreflexia, detailing when succinylcholine can be used safely and practical steps for treating hypertensive crises in chronic cord injuries.

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In this episode of the Trauma and Burn Anesthesia Series, we examine traumatic brain injury, the leading cause of trauma-related death in the U.S., affecting over a million people annually and leaving millions with long-term disability. We discuss the importance of the Glasgow Coma Scale, the types of primary injuries such as subdural, epidural, and intraparenchymal hematomas as well as diffuse axonal injury, and how these lead to increased intracranial pressure, herniation, and neurological decline. We explore secondary brain injury from hypotension, hypoxemia, hypercapnia, and hyperthermia, emphasizing the need to maintain adequate perfusion and oxygenation while balancing damage control resuscitation. Key management strategies include hyperosmolar therapy, ICP monitoring, CSF drainage, hyperventilation, mannitol use, steroids, seizure and infection prophylaxis, and cautious fluid therapy. We also cover practical intraoperative considerations, avoiding excessive anesthetics, carefully managing CSF drains, and adjusting ventilation, while highlighting the added complexity when TBI patients also present with massive hemorrhage.

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In this episode of the Trauma and Burn Anesthesia Series, we take a deep dive into one of the most critical moments in trauma care: the induction and maintenance of anesthesia in hemodynamically unstable patients. We break down the principles behind choosing the right agents, why dose reductions and careful titration are essential, and how rapid sequence induction sets the standard in trauma. You’ll hear about the role of etomidate and ketamine, why propofol is dangerous in unstable patients, and when vasopressors may actually be appropriate to support induction. We also cover strategies for managing volatile anesthetics, why nitrous oxide should be avoided, and how to prevent intraoperative recall in patients at extremely high risk. From heating strategies to avoid coagulopathy, to lung-protective ventilation in the face of pulmonary injury, and even emergency interventions like thoracotomy and REBOA, this episode takes you through the challenges and nuanced decision-making of trauma anesthesia. If you’ve ever wondered how to balance unconsciousness, perfusion, and safety in critically injured patients, this is the episode for you.

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In part 4 of the Trauma and Burn Anesthesia series, we turn to the critical steps of securing the airway, establishing reliable vascular access, and safely transitioning the patient from the trauma bay to the operating room. This episode highlights the challenges of airway management in unstable and severely injured patients, including techniques for rapid sequence induction, surgical airways, and strategies to minimize the risks of hypoxemia and aspiration. Intravenous and arterial line placement are discussed in the context of urgent access for fluid resuscitation, vasoactive support, blood sampling, and continuous hemodynamic monitoring. The episode also examines the logistical and physiologic considerations of patient transfer, emphasizing teamwork, communication, and vigilance to maintain stability during this vulnerable phase of trauma care.

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