Ep 48: Evidence Update on ACE Inhibitors and ARBs

Ep 48: Evidence Update on ACE Inhibitors and ARBs

Hypotension can occur during surgery and anesthesia in patients with a history of hypertension who take angiotensin converting enzyme inhibiting (ACEI) or angiotensin receptor blocking (ARB) medications. In this episode Jeremy and Mark talk about what the current evidence says about holding or allowing patients to take their ACEI or ARB on the day of surgery. This has been a hot topic in the anesthesia community with no clear guidelines…until now. Tune in to find out!    References •     Giannas E, et al. Perioperative management of renin-angiotensin system inhibitors in patients undergoing elective major noncardiac surgery: a mixed model investigation using systematic review, meta-analysis, multicentre service evaluation, and national survey. Br J Anaesth. 2025;135:861–869. •     2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery. Circulation. 2024. DOI: 10.1161/CIR.0000000000001285. [Supersedes 2014 ACC/AHA Guideline] •     Kidney Disease: Improving Global Outcomes (KDIGO) 2024 CKD Guideline — perioperative RAS inhibitor management recommendations. https://kdigo.org/guidelines/ckd-evaluation-and-management/ •     Keshock M, et al. Hold ACE inhibitors and ARBs before noncardiac surgery? Emerging evidence suggests a patient-specific approach. Cleve Clin J Med. 2025;92(10):619–626.   About The Nurse Anesthesia: We provide continuing education for CRNAs and RNs.  Our goal is provide the very best in anesthesia education and to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and practicing CRNAs who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. We are here for you. For anyone who wants to learn or if you just want to 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 want to be. Let's do this together. It's Go Time! Visit us at: www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Sign up for The Nurse Anesthesia Courses: Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase & complete this series. Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com [info@thenurseanesthesia.com] to get your discount code. Learn more about our courses at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl

Ep 47: NPO Shake Up – New Guidelines from an International Multidisciplinary Panel

We spend a lot of time and effort attempting to prevent aspiration during anesthesia, and advising patients to avoid eating or drinking before surgery is an established practice. In this episode, Jeremy and Mark discuss new guidelines from an international multidisciplinary panel that challenges some long established NPO practices. Some of the big shake-ups include allowing clear liquids up to the time of surgery, permitting a small amount of milk in coffee and still calling it a clear liquid, and promoting salivation stimulants such as gum or a lollipop both before and after surgery. Tune in to check out these new guidelines and decide for yourself if it’s time to shake things up!   References 1.    Rüggeberg A, El-Boghdadly K, Bilotta F, et al. Peri-operative fasting in adults: an international, multidisciplinary consensus statement. Anaesthesia. Published online February 9, 2026. doi:10.1111/anae.70130 2.     MENDELSON CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191-205. doi:10.1016/s0002-9378(16)39829-5 3.    Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology. 1999;90(3):896-905. doi:10.1097/00000542-199903000-00034 4.    Joshi GP, Abdelmalak BB, Weigel WA, et al. 2023 American Society of Anesthesiologists Practice Guidelines for Preoperative Fasting: Carbohydrate-containing Clear Liquids with or without Protein, Chewing Gum, and Pediatric Fasting Duration. Anesthesiology. 2023;138(2):132-151. doi:10.1097/ALN.0000000000004381 About The Nurse Anesthesia We provide continuing education for CRNAs and RNs.  Our goal is provide the very best in anesthesia education and to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and practicing CRNAs who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. We are here for you. For anyone who wants to learn or if you just want to 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 want to be. Let's do this together. It's Go Time! Visit us at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase & complete this series. Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com [info@thenurseanesthesia.com] to get your discount code. Learn more about our courses at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl

Ep 46: Advanced Oxygenation Using High Flow Nasal Oxygenation with Simon McDonald and Amanda Virginia

In this episode of The Nurse Anesthesia Podcast, Jeremy explores the supporting evidence, mechanisms, and clinical applications of high flow nasal oxygenation (HFNO) in anesthesia practice with Simon McDonald and Amanda Virginia. These experts share their insights on how HFNO technology enhances patient safety during airway management, procedural sedation, and extubation.  During their conversation, Jeremy, Simon, and Amanda discuss the development of HFNO, the mechanisms that provide significant physiological benefits for oxygenation, and most importantly…the clinical applications of this therapy in anesthesia practice.  For anesthesia providers who want to take their practice to the next level of advanced oxygenation for patients, this is a must listen!    References 1.    Patel A, Nouraei SA. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE): a physiological method of increasing apnoea time in patients with difficult airways. Anaesthesia. 2015;70(3):323-329. doi:10.1111/anae.12923  2.    Thiruvenkatarajan V, Sekhar V, Wong DT, Currie J, Van Wijk R, Ludbrook GL. Effect of high-flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta-analysis. Anaesthesia. 2023;78(1):81-92. doi:10.1111/anae.15845    Fisher & Paykel Healthcare: https://www.fphcare.com/us/hospital/optiflow-thrive/anesthesia/ [https://www.fphcare.com/us/hospital/optiflow-thrive/anesthesia/] About The Nurse Anesthesia We’re seasoned educators and practicing CRNAs who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. We're here for you. Let's do this together. It's Go Time! Visit us at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase & complete this series. Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com [info@thenurseanesthesia.com] to get your discount code. Learn more about our courses at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl

Ep 45: Anesthesia Q&A – Pharyngeal & Laryngeal Anatomy

It's Q&A time with Sass and Jeremy...where they willingly subject themselves—and you—to the intellectual equivalent of laryngoscopy without topicalization! In this episode they dive headfirst (cephalad to caudad of course) into the pharyngeal and laryngeal anatomy that every anesthesia provider thinks they remember… until they don’t. From the classic “wait… is that CN IX or CN X?” moment, to realizing the posterior cricoarytenoid is the only muscle keeping that airway open—this episode rocks the upper airway questions in all the right ways. But here’s the deal—this isn’t just an academic exercise. There’s a method to the madness. Question-based learning is one of the most powerful, evidence-based learning strategies out there. Retrieval practice (aka forcing your brain to recall information under pressure) strengthens memory pathways and improves long-term retention far better than passive review. And let’s be honest… if you’re a CRNA, you’re already living this life thanks to the NBCRNA's MAC program. Quarterly questions aren’t optional—they’re part of the deal. So, let’s get to it and train like we play!   About The Nurse Anesthesia We provide continuing education for CRNAs and RNs.  Our goal is provide the very best in anesthesia education and to build a commUNITY of learning in anesthesia and critical care! We’re seasoned educators and practicing CRNAs who know anesthesia. We literally write the textbook! We have the clinical expertise, educational experience, and practical know how to give you the most current and relevant anesthesia content available. We are here for you. For anyone who wants to learn or if you just want to 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 want to be. Let's do this together. It's Go Time! Visit us at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase & complete this series. Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com [info@thenurseanesthesia.com] to get your discount code. Learn more about our courses at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl

Ep 44: The McMurray Enhanced Airway with Roxanne McMurray

In this episode of The Nurse Anesthesia Podcast, Jeremy talks with Roxane McMurray, DNP, CRNA, APRN who is the creator of the McMurray Enhanced Airway (MEA). The MEA is in a new airway device classification known as “Distal Pharyngeal Airways” or DPAs. Her innovative device is placed orally to help maintain a patent airway in patients who are at risk for upper airway obstruction while under anesthesia or even during airway emergencies.  The MEA facilitates ventilation in several airway management situations and solves many of the problems we encounter with basic airway devices such as oral pharyngeal airways (OPAs) and nasal pharyngeal airways (NPAs), by being better positioned at the junction of the oro- and hypo-pharyngeal space or distal pharyngeal space…thus bypassing the areas that cause upper airway obstruction.  Roxanne has reimagined basic airway management. Her device is being used in critical care areas, EMS, and in anesthesia for monitored anesthesia care cases and difficult airway management situations. If you have not heard of the McMurray Enhanced Airway, and even for those who have…this is a must listen! References 1.    For more information about the McMurray Airway: https://www.mcmurraymed.com/  3.    Daniel C, Feeney M, Gordon L. A New Distal Pharyngeal Airway Device Associated with a Reduced Need for Chin-Lift and Jaw-Thrust Maneuvers in Sedated Patients. AANA J. 2024 Apr;92(2):115-120. PMID: 38564207. 4.    DuCanto J. Sudden Hypoxemia in GI Procedure Relieved by a New Distal Pharyngeal Airway (DPA): Case Report. Anesthesia Patient Safety Foundation (APSF). 2023 Jul16. https://www.apsf.org/article/sudden-hypoxemia-in-gi-procedure-relieved-by-a-new-distal-pharyngeal-airway-dpa-case-report/ 5.    McMurray R, Becker L, Olsen KF, McMurray M. Airway Management for Deep Sedation: Current Practice, Limitations, and Needs as Identified by Clinical Observation and Survey Results. AANA J. 2020 Apr;88(2):123-129. PMID: 32234203. 6.    McMurray RR, McMurray MR. Introducing the First Distal Pharyngeal Airway. A A Pract. 2023;17(6):e01691. Published 2023 Jun 19. doi:10.1213/XAA.0000000000001691   About The Nurse Anesthesia We’re seasoned educators and practicing CRNAs who know anesthesia and our goal is provide the very best in anesthesia education and to build a commUNITY of learning in anesthesia and critical care! Visit us at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]     Sign up for The Nurse Anesthesia Courses Our CRISIS MANAGEMENT SERIES is currently available!  CRNAs & RN’s get CE credits when they purchase & complete this series. Resident Registered Nurse Anesthesiologists get a steep discount! Email us at info@thenurseanesthesia.com [info@thenurseanesthesia.com] to get your discount code. Learn more about our courses at www.thenurseanesthesia.com [http://www.thenurseanesthesia.com]   Follow us on Instagram @thenurseanesthesia   Legal Disclaimer The Nurse Anesthesia Podcastis for educational and informational purposes only. It does not constitute medical. We continuously strive for accuracy, however, medicine is constantly evolving, and clinical decisions should always be made based on current guidelines, institutional policies, and individual patient considerations. The views expressed are those of the hosts and guests, and Do NOT necessarily reflect the opinions of any affiliated institutions. Listeners should consult their own healthcare providers before making any medical decisions.    Music by Alex Grohl