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

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

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

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

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/

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

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