Nurse anesthesiology resident turns training into action

James Breceda, BSN, RN, CCRN, PCCN, CMC, a third-year nurse anesthesiology resident at Virginia Commonwealth University (VCU), was months from graduation when a crisis in the cardiac catheterization lab tested his training. 

“I was the only anesthesia provider in the room,” Breceda said. “The first thing I did was call for help from the CRNA supervising me. Then my instincts kicked in, and I knew what I had to do to get the patient breathing again.” 

He immediately began following the steps he had practiced countless times. First, he deepened the patient’s anesthesia to relax the airway muscles. When that didn’t work, he performed a Larson maneuver, applying pressure on both sides at the base of the skull to help the vocal cords reopen. 

“I realized the patient had a transesophageal echocardiogram [an ultrasound of the heart] earlier, and the lubricant used on the probe might be causing irritation,” he said. “I suctioned the airway to remove the secretions. But even then, the patient still wasn’t getting enough oxygen.” 

Breceda knew he needed a more secure airway. He inserted a laryngeal mask airway (LMA), a device used to maintain an open airway during anesthesia. Once he placed the LMA, the patient started breathing again. 

He said the brief episode demonstrated the importance of being prepared, observant, and alert in any situation as an anesthesia provider. Thanks to his training at VCU, he said the steps he took to save the patient were “second nature.” 

“Those steps have been ingrained in my head for the past two and a half years in school,” he said. “Knowing what to do and how to react made what could have been a very chaotic situation less stressful.”

The experience reminded Breceda why he chose to study nurse anesthesiology and become a CRNA/nurse anesthesiologist. CRNAs are advanced practice registered nurses who specialize in administering anesthesia and providing care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures. 

“When I was working as a registered nurse, I sometimes felt there was a gray area about what I could or couldn’t do,” he said. “In anesthesia, you own the responsibility of keeping the patient safe from start to finish. That’s what I wanted for my career, to be the provider who patients can trust when they’re most vulnerable.” 

Breceda hopes to bring that same confidence and compassion to his future practice. “When I walk into a room, I want the patient to know they’re safe, and that I’ll treat them like family. And if something goes wrong, I’ll be there to make it right.” 

Reflecting on that day in the cath lab, he sees it as a defining moment in his development as a future CRNA/nurse anesthesiologist. 

“It was a culmination of everything I’ve learned over the past three years,” he said. “It showed me I know how to manage a crisis and make decisions that can help save a patient’s life.”