Check out the timestamps below to help you navigate through the many topics we discussed.
On This Episode:
Thoracic anesthesia is one of the most complex and high-stakes specialties in medicine, where the airway may literally be open on the table, and every breath depends on seamless teamwork.
In this episode of Anesthesia Alchemy, Lynn and Garry welcome Dr. Melissa Puskac, a CRNA and thoracic anesthesia expert, to unpack the challenges and breakthroughs that define this field. From carinal resections and sleeve lobectomies to esophagectomies and mediastinal mass surgeries, Dr. Puskac explains how modern techniques like cross-field ventilation, high-frequency jet ventilation (HFJV), and ECMO are transforming survival and recovery.
You’ll also hear about the risks of airway strictures, recurrent laryngeal nerve injuries, and “spit fistulas,” along with the extraordinary surgical creativity—like neocarinal reconstruction—that makes these procedures possible. It’s a fascinating look into the art and science of anesthesia in some of the most demanding surgeries performed today.
Here’s some of what you’ll hear in this episode:
🌬️ Airway mastery
🫁 Carinal & sleeve resections
🥼 Esophagectomy techniques
⚠️ Complications matter
🧠 Collaboration is key
Catch Sharon Live at the 53rd Annual Refresher Course for Nurse Anesthetists!
Join Sharon this November 14–16, 2025, at the Hilton Hotel in Walt Disney World Village, Florida, for the Frank Moya Continuing Education Program’s annual conference. She’ll be delivering four insightful talks as part of the guest faculty lineup.
Don’t miss this chance to learn, connect, and recharge—with some Disney magic on the side!
Click here for more details and to register
Important Links:
"Balancing its powerful benefits with these potential complexities requires continuous learning by our anesthesia providers."
- Lynn & Garry
References
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Casiraghi M, et al. Surgical Technique on Tracheal Surgery Carinal resection: technical tips. Received: 30 April 2018; Accepted: 30 May 2018; Published: 12 June 2018. doi: 10.21037/jovs.2018.05.23
Costantino, Christina L. et al. Carinal surgery: A single-institution experience spanning 2 decades. The Journal of Thoracic and Cardiovascular Surgery, Volume 157, Issue 5, 2073 - 2083.e1
Friedel, Godehard & Kyriss, Thomas & Leitenberger, Andrea & Toomes, Heikki. (2003). Long-term results after 110 tracheal resections. German medical science : GMS e-journal. 1. Doc10
Ginsberg, Robert J . Carinal Resection and Sleeve Pneumonectomy Using a Transsternal Approach. Operative Techniques in Thoracic and Cardiovascular Surgery, Volume 3, Issue 3, 203 - 21
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Veeramachaneni, Nirmal K. et al. Surgical Repair of Iatrogenic Cervical Tracheal Stenosis. Operative Techniques in Thoracic and Cardiovascular Surgery, Volume 13, Issue 1, 40 - 52.
Puskac, M.M., Hetz, R.A. (2019). Thoracic Surgery and Esophagectomy. In: Nates, J., Price, K. (eds) Oncologic Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-74698-2_166-2
Mehran R, Deslauriers J. Carinal Pneumonectomy. ThoracSurg Clin. 2018 Aug;28(3):315-322. doi: 10.1016/j.thorsurg.2018.04.004. PMID: 30054069.
Rice D, Elsheikh M, Ferguson M, Puskac M, PotylchanskyE. A simplified approach to robotic tracheal resection, JTCVS Techniques, Volume 27, 2024, Pages 176-178, ISSN 2666-2507. https://doi.org/10.1016/j.xjtc.2024.06.022.
(https://www.sciencedirect.com/science/article/pii/S2666250724002724)
Blackmon SH, Correa AM, Skoracki R, et al. Supercharged pedicled jejunal interposition for esophageal replacement: a 10-year experience. Ann Thorac Surg. 2012;94(4);1104-1113. https://doi:10.1016/j.athorasur.2012.05.123
