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

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 to get your discount code.

Learn more about our courses at 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

Episode Summary

Jeremy and Sass discuss the anesthetic management for a thyroidectomy in this 43rd episode of The Nurse Anesthesia Podcast.

They first review the physiology and signs and symptoms of both hyperthyroidism and hypothyroidism, and then review the essential case management strategies for this front of neck procedure. A key part of the anesthesia management is the pharmacology that’s involved, and knowing what type of medication to give and when is crucial when caring for these patients. This is an episode packed full of anesthesia pearls that you won’t want to miss!

References

1. Bajwa SJ, Sehgal V. Anesthesia and thyroid surgery: The never ending challenges. Indian J Endocrinol Metab. 2013;17(2):228-234. doi:10.4103/2230-8210.109671

2. Biello A, Kinberg EC, Menon G, et al. Thyroidectomy. [Updated 2024 Nov 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563279/

3. Guzzetti L, Inversini D, Bacuzzi A. Anaesthesia for thyroid and parathyroid surgery. BJA Educ. 2024;24(8):270-276. doi:10.1016/j.bjae.2024.04.004

4. Elisha S, Boytim M, Bordi S, Heiner J, Nagelhout J, Waters E. Anesthesia case management for thyroidectomy. AANA J. 2010 Apr;78(2):151-60. PMID: 20583462.

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

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 to get your discount code.

Learn more about our courses at 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

Episode Summary

In this episode of The Nurse Anesthesia Podcast Jeremy discusses the medications used to block/inhibit/blunt the sympathetic response to laryngoscopy and intubation. He discusses the mechanisms of how lidocaine, fentanyl, esmolol, or dexmedetomidine can be used to limit or even prevent the tachycardia and hypertension that can occur from placing a laryngoscope blade into the hypopharynx.

Gear up…because we’re about to explain how to do laryngoscopy without the hyperdynamic drama!

References

1. Chung KS, et al. “A comparison of fentanyl, esmolol, and their combination for blunting the haemodynamic responses during rapid-sequence induction.” doi:10.1007/BF03008287

2. Gurulingappa, et al. “Attenuation of Cardiovascular Responses to Direct Laryngoscopy and Intubation-A Comparative Study Between iv Bolus Fentanyl, Lignocaine and Placebo(NS).” doi:10.7860/JCDR/2012/4070.2619

3. Hassani V, et al. “Comparison of fentanyl and fentanyl plus lidocaine on attenuation of hemodynamic responses to tracheal intubation in controlled hypertensive patients undergoing general anesthesia. doi:10.5812/aapm.6442

4. Mendonça FT, et al. “Effects of lidocaine and esmolol on hemodynamic response to tracheal intubation: a randomized clinical trial.” doi:10.1016/j.bjane.2021.01.014

5. Mulimani SM, et al. “Efficacy of a Bolus Dose of Esmolol and Bolus Dose of Lignocaine for Attenuating the Pressor Response to Laryngoscopy and Endotracheal Intubation in General Anesthesia: A Comparative Study.” . doi:10.4103/aer.AER_31_19

6. Qi DY, et al. “Efficacy of intravenous lidocaine versus placebo on attenuating cardiovascular response to laryngoscopy and tracheal intubation: a systematic review of randomized controlled trials.”

7. Qin J, et al. “Effects of intravenous lignocaine on haemodynamic responses to laryngoscopy and tracheal intubation in adults under general anaesthesia: A systematic review and meta-analysis.” doi:10.4103/ija.ija_201_25

8. Saleh A, et al. “Effects of Dexmedetomidine vs Esmolol on Postintubation Hemodynamics: A Meta-Analysis.” doi:10.2344/23-0059

9. Sharma S, et al. “Comparison of Esmolol and Dexmedetomidine for Suppression of Hemodynamic Response to Laryngoscopy and Endotracheal Intubation in Adult Patients Undergoing Elective General Surgery: A Prospective, Randomized Controlled Double-blinded Study.” . doi:10.4103/aer.AER_226_17

10. Teong, Cheng Yeon et al. “The Haemodynamic Response to Endotracheal Intubation at Different Time of Fentanyl Given During Induction: A Randomised Controlled Trial.” doi:10.1038/s41598-020-65711-9

Resources/information discussed in podcast

About The Nurse Anesthesia

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

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 to get your discount code.

Learn more about our courses at www.thenurseanesthesia.com

Follow us on Instagram