Clinical Potpourri for Your Life and Your Practice.
Authors: PMID: 31612837 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Tags: AANA J Source Type: research

Intravenous Lidocaine for Relief of Chronic Neuropathic Pain.
Abstract The purpose of this study was to describe the therapeutic effectiveness/pain relief of moderate-dose lidocaine infusions in patients with chronic neuropathic pain. Retrospective reviews of medical records were conducted for 40 patients referred to a midwestern pain clinic for management of intractable neuropathic pain despite use of multiple medications and treatment modalities. Descriptive statistics were used to summarize patients' demographic data, lidocaine dosing and infusion rate, daily opioid intake, adjuvant medication use, and medication allergies and intolerances. Paired samples t test was used ...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Wren K, Lancaster RJ, Walesh M, Margelosky K, Leavitt K, Hudson A, Albala MZ Tags: AANA J Source Type: research

Evaluating a Quality Improvement Initiative to Increase Anesthesia Providers' Use of and Understanding of Quantitative Neuromuscular Monitors.
Abstract Improved understanding of the monitoring and dosing practices of anesthesia providers regarding neuromuscular blockade is necessary. The use of subjective methods such as peripheral nerve stimulation and clinical assessment tests can increase the risk of residual neuromuscular blockade and adverse postoperative outcomes. Quantitative monitoring of neuromuscular blockade is an alternative tool to peripheral nerve stimulation to guide neuromuscular blockade; however, it is rarely used by providers. We developed an initiative to improve anesthesia providers' knowledge of neuromuscular blockade pharmacology, ...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Bedsworth MB, Harris EM, Vacchiano CA, Thompson JA, Grant SA, Goode VM Tags: AANA J Source Type: research

It's Never Just a Block: An Analysis of Regional Anesthesia Closed Claims.
Abstract Anesthesia care increasingly includes use of regional anesthesia techniques, either as a primary anesthetic or to reduce the patient's postoperative pain. Both neuraxial anesthesia and peripheral nerve blockade have several noteworthy functions. These functions include diminishing sensory sensation to pain and potentially producing a motor blockade, both of which may facilitate the surgical procedure. The desire to reduce reliance on opioid medications, protocols to enhance and accelerate patient recovery from surgery, and patient expectations all contribute to the likelihood that use of regional anesthes...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Hirsch M, Geisz-Everson M, Clayton BA, Wilbanks B, Golinski M, Kremer M, Nicely KW Tags: AANA J Source Type: research

Combined Interscalene Brachial Plexus and Superficial Cervical Plexus Nerve Block for Midshaft Clavicle Surgery: A Case Series.
The objective of this study was to evaluate the efficacy of a combined interscalene brachial plexus block and superficial cervical plexus peripheral nerve block as anesthesia for clavicle surgical procedures. Ten midshaft clavicle fractures were surgically repaired using a combination of an ultrasound-guided interscalene brachial plexus block and a superficial cervical plexus block as the primary anesthetic. All patients underwent surgery successfully using regional anesthesia with light sedation, without the need for rescue opioids or rescue local anesthesia. No adverse events were recorded. This case series describes a s...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Fugelli CG, Westlye ET, Ersdal H, Strand K, Bjørshol C Tags: AANA J Source Type: research

Inclusive Recruitment and Admissions Strategies Increase Diversity in CRNA Educational Programs.
This study examines the impact of a 2-tiered outreach, education, and intervention approach on candidates of color applying to and gaining acceptance in a graduate nurse anesthesia program. The authors implemented individual- and social-level recruitment strategies over three 12-month periods targeting candidates of color nearing eligibility for applying to nurse anesthesia programs at 2 points: colleges and workplace. Strategies included developing information sessions and workshops, partnering with diversity organizations, and strategic recruiting. Because institutionalized admissions criteria play a role in patterns tha...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Kilburn F, Hill L, Porter MD, Pell C Tags: AANA J Source Type: research

Most Hemodynamically Stable Method for Change From High to Low Anesthesia Flow: A Randomized Controlled Trial Comparing State Entropy, High Fresh Gas Flow for 10 Minutes, and 0.8 Ratio of End-Expired Agent Concentration to Inspired Agent Concentration.
This study was undertaken to determine the most hemodynamically stable method to low-flow anesthesia (LFA) between 10-minute administration of high fresh gas flow, 0.8 equilibration ratio (Fe/Fi), and state entropy (SE) between 40 and 60, a marker for adequate depth of anesthesia. Change from high fresh gas flow to LFA was done in 3 groups of 30 patients each: group T (time): 10 minutes; group R (ratio): Fe/Fi = 0.8, and group SE: SE = 40 to 50. A decrease in mean blood pressure or heart rate was treated with ephedrine or atropine, with study termination at more than 2 boluses of either. In group SE, no patient required ep...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Punj J, Pandey R, Darlong V Tags: AANA J Source Type: research

Nasal Ventilation Mask for Prevention of Upper Airway Obstruction in Patients With Obesity or Obstructive Sleep Apnea.
Abstract This project aimed to develop and implement a nasal ventilation mask (NVM) guideline to reduce the incidence of airway obstruction in outpatients undergoing endoscopy procedures. An observational design was used to evaluate implementation of an NVM guideline as the oxygen delivery method for this patient population. An evidence-based guideline for NVM use was developed for patients with obstructive sleep apnea (OSA) and/or an elevated body mass index (BMI) above 35 kg/m² undergoing esophagogastroduodenoscopy and/or colonoscopy procedures at an outpatient endoscopy clinic. Patients receiving moderate ...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Willard CE, Rice AN, Broome ME, Silva SG, Muckler VC Tags: AANA J Source Type: research

Characterizing Anesthetic Management and Perioperative Outcomes Associated with a Novel, Fusionless Scoliosis Surgery in Adolescents.
This study aims to characterize the anesthetic management and perioperative outcomes of AVT and traditional posterior spinal fusion (PSF) after establishing the technique at our institution. Scoliosis correction procedures performed in patients aged 10 to 21 years between January 2014 and August 2017 were identified in the electronic medical record. Patient characteristics and perioperative data about anesthetic use and pain management were extracted. Descriptive statistics were generated. Thirty-five patients undergoing AVT and 40 patients undergoing PSF met inclusion criteria. Preoperative fluoroscopy-guided epidural pla...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Chen E, Sites BD, Rubenberg LA, Meador GD, Braun JT, Schroeck H Tags: AANA J Source Type: research

Ketamine and Treatment-Resistant Depression.
Abstract Major depressive disorder affects tens of millions of people each year. One-third of those affected have depression that is resistant to conventional pharmacologic, psychologic, or somatic treatments. Patients with treatment-resistant depression have few remedies other than electroconvulsive therapy or transcranial magnetic stimulation. Recent research has highlighted the promising antidepressant effects of subanesthetic ketamine infusions. This journal course examines the efficacy of ketamine for treatment-resistant depression. Evidence from 10 systematic reviews and randomized controlled trials suggest ...
Source: AANA Journal - October 1, 2019 Category: Anesthesiology Authors: Lent JK, Arredondo A, Pugh MA, Austin PN Tags: AANA J Source Type: research

Education News.
This article focuses on the use of its education standards as the foundation for the International Federation of Nurse Anesthetists' Anesthesia Program Approval Process. The approval process strongly encourages educational institutions throughout the world to improve the education of nurse anesthetists and other nonphysician anesthetists, with the ultimate goal being patient safety. The approval process also promotes the use of nurses to administer anesthesia whenever adequate resources are available. PMID: 31587709 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Horton BJ, Anang SP, Björkelund KB, Riesen M, Yang HJ Tags: AANA J Source Type: research

Ultrasound-guided Intravenous Line Placement Course for Certified Registered Nurse Anesthetists: A Necessary Next Step.
Abstract Ultrasonography (US) proficiency has become a desirable skill for anesthesia providers. It is commonly used in the perioperative arena for establishing peripheral and central vascular access. Establishing intravenous access is one of the most common procedures performed by Certified Registered Nurse Anesthetists (CRNAs) as frontline anesthesia providers. However, there is no structured US training program for CRNAs for vascular access at our institution. We designed and implemented a multimodality US training program specifically for the use of surface US for central and peripheral vascular access for CRN...
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Bortman J, Mahmood F, Mitchell J, Feng R, Baribeau Y, Wong V, Coolidge B, Bose R, Gao Z, Jones S, Matyal R Tags: AANA J Source Type: research

Accuracy of Visually Estimated Blood Loss in Surgical Sponges by Members of the Surgical Team.
This study highlights that assessments of patients' conditions can be partially based on methods often demonstrated to be inaccurate. Inaccurate visual estimation of blood loss might endanger patient safety. PMID: 31587711 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Kollberg SE, Häggström AE, Lingehall HC, Olofsson B Tags: AANA J Source Type: research

Implications of Inspired Carbon Dioxide During Ophthalmic Surgery Performed Using Monitored Anesthesia Care.
Abstract Inspired concentration of carbon dioxide (FICO₂) in ophthalmic surgery performed under monitored anesthesia care (MAC) has been largely ignored in the recommended monitoring standards of professional anesthesia societies. Most ophthalmic procedures are performed using MAC with facial draping that has been shown to retain carbon dioxide in the ambient air surrounding the patient. The administration of supplemental oxygen has been shown to prevent hypoxia but not hypercapnia. Hypercapnia can lead to physiologic changes, including tachypnea, tachycardia, and increased intraocular pressure. Several closed-c...
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: McHugh TA Tags: AANA J Source Type: research

Preparing for Total Power Failure in the Operating Room.
Abstract Total electrical power failure in the operating room is an uncommon event, but when it occurs, it poses a major threat to patient safety. Perhaps the most curable threat to patient safety is the lack of provider knowledge regarding what equipment capabilities will be lost and how long devices will function on battery power. The purpose of this project was to determine the internal battery-related capabilities and duration of function of site-specific anesthesia equipment during a total power failure and to develop a power failure protocol. Equipment capabilities and duration of function on internal batter...
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Vetter AG, Harman RJ, Stamper MJ, Titch JF, Vacchiano CA Tags: AANA J Source Type: research

Refusal of Epidural Anesthesia for Labor Pain Management by African American Parturients: An Examination of Factors.
Abstract Most parturients use epidural anesthesia for labor pain management, with excellent pain relief possible within minutes of administration. An examination of the literature revealed a disparity of use that existed along ethnic and racial lines, with African Americans less likely to accept epidural anesthesia. No known studies to date had explored the reasons for this disparity. The purpose of this qualitative study was to identify those factors that influence African American parturients to decline epidural anesthesia for labor pain management. Andersen's Behavioral Model of Health Services Use served as th...
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Roberson MC Tags: AANA J Source Type: research

Use of a Double Gloving Technique to Decrease Cross-Contamination by Anesthesia Providers.
Abstract The purpose of this project was to determine the impact of double gloving during the induction of general anesthesia on the incidence of cross-contamination by the anesthesia provider. In a representative sample of anesthesia providers, induction sequences were initially evaluated using the providers' standard technique (group 0). The same providers were reevaluated after being educated on the double gloving technique (group 1). One month later the providers were reevaluated to identify which ones continued the double gloving technique (group 2). For each sequence, all providers were asked to complete a g...
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Jaffe G, Moriber N Tags: AANA J Source Type: research

Delayed Onset and Prolonged Horner Syndrome in Two Children After Single-Shot UltrasoundGuided Infraclavicular and Subclavian Perivascular Brachial Plexus Blocks for Upper Extremity Surgery: Case Reports.
We report delayed manifestations of Horner syndrome in 2 children following ultrasound-guided infraclavicular and subclavian perivascular blocks. PMID: 31587716 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Gupta A, Talwar V, Kamal G, Gupta N Tags: AANA J Source Type: research

Anesthetic Management of a Patient with Severe Diastolic Dysfunction for Umbilical Hernia Repair: A Case Report.
Abstract Research has shown that 1 out of 3 people aged 55 or older will develop heart failure, which is often a fatal prognosis. Investigations have demonstrated that 35% of heart failure patients will succumb to their condition within 5 years of onset. Worldwide, it is estimated that 23 million people are living with and suffering from symptoms associated with heart failure. Heart failure can result from various sequences of events, and ultimately effect either the systolic or diastolic function of the cardiovascular system. Depending upon which condition is present, anesthesia providers must take into considera...
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Smith KS Tags: AANA J Source Type: research

Perioperative Management of the Direct-Acting Oral Anticoagulants.
Abstract Since the 1950s, warfarin has been the most commonly prescribed anticoagulant in the prevention of stroke-related thromboembolism. Beginning in 2008, direct-acting oral anticoagulants (DOACs) began to replace warfarin. Although the DOACs had a greater safety profile, approved reversal agentsfor use in emergent/excessive hemorrhage did not exist. This course reviews the perioperative management of the DOACs. PMID: 31587718 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - August 1, 2019 Category: Anesthesiology Authors: Kane TD, Tubog TD Tags: AANA J Source Type: research

Clinical Potpourri for Your Life and Your Practice.
PMID: 31584392 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Biddle C Tags: AANA J Source Type: research

Author's Correction.
Authors: Abstract This corrects the article DOI. PMID: 31584393 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Tags: AANA J Source Type: research

Effects of Midazolam on Postoperative Nausea and Vomiting and Discharge Times in Outpatients Undergoing Cancer-Related Surgery.
Abstract Midazolam, a short-acting benzodiazepine used for preoperative anxiolysis, may also have pharmacologic properties that could further reduce the incidence of postoperative nausea and vomiting (PONV) in high-risk patients when included in a multimodal antiemetic protocol. However, concerns remain that the sedating properties of midazolam will delay discharge after short outpatient procedures. A retrospective data analysis (N = 4,057) investigated effects of midazolam on postoperative antiemetic administration and length of stay following cancer-related outpatient procedures over 15 months. Following initial...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Majumdar JR, Vertosick E, Long M, Cansino C, Assel M, Twersky R Tags: AANA J Source Type: research

Beach Chair Position in a Patient With Subclavian Steal Syndrome and Axillary Lymph Node Dissection: A Case Report.
This report describes the management of this particular case, then reviews the relevant literature regarding cardiovascular and cerebral perfusion monitoring. PMID: 31584395 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Krasucki DJ Tags: AANA J Source Type: research

Use of Near-Infrared Spectroscopy to Measure Tissue Oxygen Saturation During Total Knee Arthroplasty With Use of a Tourniquet.
Abstract The primary purpose of this proof-of-concept quality improvement effort was to evaluate the practicality of using near-infrared spectroscopy (NIRS) to measure tissue oxygen saturation (Sto2) during total knee arthroplasty (TKA) with use of a tourniquet. NIRS sensors were applied to the biceps femoris (BF) and gastrocnemius (GS) muscles of both lower extremities of patients undergoing TKA procedures. For a convenience sample of 15 patients, measurement of Sto2 was attempted at baseline, following subarachnoid block administration, and after tourniquet inflation and deflation. Mean baseline Sto2 (SD) was 71...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Gaines RR, Rice AN, Gadsden JC, Morgan BT, Vacchiano CA Tags: AANA J Source Type: research

Single Dose of Ketamine During Kyphoplasty Procedures Does Not Reduce Postoperative Narcotic Consumption.
Abstract This retrospective cohort study aimed to explore the study institution’s intraoperative ketamine use during kyphoplasty and compare narcotic requirements in patients who received intraoperative ketamine with those who did not. The authors hypothesized that a single dose of ketamine during kyphoplasty would reduce postoperative narcotic consumption. Included patients underwent kyphoplasty under monitored anesthesia care between 2012 and 2013. Excluded patients were younger than 18 years or had general anesthesia, endotracheal intubation, or major intraoperative complications. Narcotics were converted...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Sharp SM, Chance EA, Karsonovich T, Cubbison S, Ugokwe KT Tags: AANA J Source Type: research

Burnout and the Nurse Anesthetist: An Integrative Review.
Abstract The rapid changes in the US healthcare system have resulted in collateral damage to many healthcare providers. Many of these changes have increased demands placed on providers, resulting in high prevalence rates of burnout throughout various healthcare specialties. One healthcare specialty that has reported a recent surge in burnout in the United States is the Certified Registered Nurse Anesthetist (CRNA). Despite these concerns, most of the burnout research on anesthesia providers has focused on anesthesiologists and CRNA-equivalent anesthesia providers from other countries. This is particularly concerni...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Del Grosso B, Boyd AS Tags: AANA J Source Type: research

Role of Alveolar-Arterial Gradient in Partial Pressure of Oxygen and PaO2/Fraction of Inspired Oxygen Ratio Measurements in Assessment of Pulmonary Dysfunction.
Abstract Assessment of pulmonary dysfunction is vital to anesthetists. Measurements including the gradient between the alveolar partial pressure of oxygen (PAo2) and the arterial partial pressure of oxygen (Pao2), called the PAo2 - Pao2 , and the ratio of the Pao2 to the fraction of inspired oxygen (FIo2) (Pao2/FIo2 ratio) are useful in determining the extent of acute lung injury. A literature review via MEDLINE using the terms PAo2 - Pao2 , Pao2/FIo2 ratio, and pulmonary dysfunction was performed to identify articles on the use of these measures in the perioperative period. Both measures have been found to predic...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Harris DE, Massie M Tags: AANA J Source Type: research

Use of Nalbuphine for Treatment of Neuraxial Opioid-Induced Pruritus: A Systematic Review and Meta-Analysis.
Abstract Opioid-induced pruritus is prevalent after neuraxial administration of opioid. A number of preventive measures have been reported; however, only a few studies evaluated treatment strategies for established pruritus. The pharmacokinetics and pharmacodynamic profiles of nalbuphine make this drug ideal for the treatment of established pruritus. The primary outcome of this systematic review and meta-analysis was the incidence of pruritus after neuraxial opioid administration. Secondary outcomes were the incidence of sedation and postoperative nausea and vomiting. Pooled estimates were reported by calculating ...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Tubog TD, Harenberg JL, Buszta K, Hestand JD Tags: AANA J Source Type: research

Anesthesia Exposure in the Young Child and Long-term Cognition: An Integrated Review.
The objective of this review is to evaluate the human research on anesthesia neurotoxicity in the young child. Three databases were searched for studies on anesthesia exposure in infants and children. Positive clinical outcomes in several studies showed no difference in cognitive function between children exposed and unexposed to anesthesia. Research findings also demonstrated negative clinical outcomes following anesthesia exposure, including physical changes on magenetic resonance imaging such as lower gray matter density in the occipital cortex and cerebellum; lower scores on performance IQ, listening comprehension, and...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Rosenblatt A, Kremer M, Swanson B, Shah R Tags: AANA J Source Type: research

AANA Journal Course Clarifying the Confusion of Adult Emergence Delirium.
Abstract To date, researchers studying emergence delirium in adults have not adopted a consensus on the terminology for the phenomenon, a formalized definition, a measurement tool or standardized differential diagnosis to distinguish emergence delirium from postoperative delirium, anticholinergic or serotonergic toxicities, and other physiologic issues that may present on emergence from anesthesia. This lack of a consensus in emergence delirium research and differential diagnostic tools is confounding findings and preventing improved patient outcomes. Information from an integrative review of the literature in con...
Source: AANA Journal - June 1, 2019 Category: Anesthesiology Authors: Greiner S, Kremer MJ Tags: AANA J Source Type: research

Pain Management Efficacy Study Between Continuous and Single-Administration Bupivacaine Following Lumbar Spinal Fusion.
This study compared patients undergoing lumbar fusion who received plain bupivacaine from May 2011 until August 2012 with those who received liposomal bupivacaine from September 2012 until May 2013. The aim was to determine which preparation reduced postoperative opioid use the most. All lumbar spinal fusion surgeries in the periods indicated were included in the study. Ninety-three patient charts were reviewed: 47 for the plain bupivacaine group and 46 for the liposomal bupivacaine group. The study found no statistical difference between liposomal and plain bupivacaine in providing postoperative pain control from lumbar f...
Source: AANA Journal - April 1, 2019 Category: Anesthesiology Authors: Tumulak J, Johnston S, Adams P Tags: AANA J Source Type: research

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.
Abstract Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effot to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by ...
Source: AANA Journal - February 6, 2017 Category: Anesthesiology Authors: Pellegrini JE, Toledo P, Soper DE, Bradford WC, Cruz DA, Levy BS, Lemieux LA Tags: AANA J Source Type: research

On Combat Anesthesia.
PMID: 27501647 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Kammer K Tags: AANA J Source Type: research

Response.
PMID: 27501648 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Strube PD, Perkins AD Tags: AANA J Source Type: research

Hazardous Intraoperative Behaviors: What's at Risk?.
PMID: 27501649 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Philippon J Tags: AANA J Source Type: research

Effects of a 30-mL Epidural Normal Saline Bolus on Time to Full Motor Recovery in Parturients Who Received Patient-Controlled Epidural Analgesia With 0.125% Bupivacaine With 2 µg/mL of Fentanyl.
Effects of a 30-mL Epidural Normal Saline Bolus on Time to Full Motor Recovery in Parturients Who Received Patient-Controlled Epidural Analgesia With 0.125% Bupivacaine With 2 µg/mL of Fentanyl. AANA J. 2016 Jun;84(3):159-65 Authors: Couture D, Osborne L, Peterson JA, Clements SM, Sanders A, Spring JA, Spence DL Abstract Previous research suggests that an epidural bolus of 30 mL of normal saline after vaginal delivery may decrease the time for recovery from motor block. A double-blind, randomized controlled study was conducted in 46 parturients to determine if a 30-mL normal saline bolus or sham...
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Couture D, Osborne L, Peterson JA, Clements SM, Sanders A, Spring JA, Spence DL Tags: AANA J Source Type: research

Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review.
Abstract Venous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fea...
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Hernandez S, Valdes J, Salama M Tags: AANA J Source Type: research

The Jehovah's Witness Population: Considerations for Preoperative Optimization of Hemoglobin.
Abstract Most members of the Jehovah's Witness community refuse blood transfusions, and there are variations in what alternatives they will accept depending on their personal decisions. To provide culturally competent care, healthcare providers need to be knowledgeable about substitutions for blood administration as well as the risks and benefits of available alternatives so that they can inform their patients. It has been recognized in the literature that preoperative optimization of hemoglobin levels with alternative treatment modalities through a multidisciplinary approach can improve clinical outcomes in patie...
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Campbell YN, Machan MD, Fisher MD Tags: AANA J Source Type: research

Anesthetic Considerations of Stiff-Person Syndrome: A Case Report.
Abstract Stiff-person syndrome (SPS) is a neurologic disorder characterized by painful involuntary episodes of severe muscle rigidity affecting the axial muscles and extremities. Although the etiology of SPS is unknown, it is suspected to involve the synthesis of γ-aminobutyric acid (GABA). Symptoms of SPS are precipitated by sudden unexpected movements, noises, and stress. Additionally, SPS has been linked with various autoimmune disorders, including diabetes mellitus, thyroid disease, pernicious anemia, and certain cancers. Because of the effect of SPS and SPS medications, inhalational agents and neuromusc...
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Hylan K, Vu AD, Stammen K Tags: AANA J Source Type: research

Preventive Dorzolamide-Timolol for Rising Intraocular Pressure During Steep Trendelenburg Position Surgery.
Abstract The study purpose was to evaluate preventive use of dorzolamide-timolol ophthalmic solution (Cosopt) during laparoscopic surgery with the patient in steep Trendelenburg (ST) position. Periorbital swelling, venous congestion, and elevated intraocular pressure (IOP) may produce low ocular perfusion. Prompt IOP reduction is important because 30- to 40-minute episodes of acute IOP elevations can result in retinal ganglion cell dysfunction. Dorzolamide-timolol ophthalmic drops reduce IOP and may ameliorate this effect. A double-blind randomized experimental study was conducted to test the effect of dorzolamide...
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Molloy BL, Cong X, Watson C Tags: AANA J Source Type: research

Unknown Pseudocholinesterase Deficiency in a Patient Undergoing TIVA with Planned Motor Evoked Potential Monitoring: A Case Report.
This article examines a case where succinylcholine was chosen to facilitate intubation due to its ultra short duration and the request of the surgeon to monitor motor evoked potentials. Following succinylcholine administration the neurophysiologist was unable to obtain motor evoked potentials. This case study highlights the intraoperative and postoperative management of an elderly patient with an unknown pseudocholinesterase deficiency. PMID: 27501655 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Binkley C Tags: AANA J Source Type: research

Tranexamic Acid in Anesthetic Management of Surgical Procedures.
Abstract Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements. In addition, this...
Source: AANA Journal - June 1, 2016 Category: Anesthesiology Authors: Mayeux J, Alwon K, Collins S, Hewer I Tags: AANA J Source Type: research

Caution: Predatory Journals Want Your Business!
PMID: 27311147 [PubMed - in process] (Source: AANA Journal)
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Aker J Tags: AANA J Source Type: research

Intrathecal Spread of Injectate Following an Ultrasound-Guided Selective C5 Nerve Root Injection in a Human Cadaver Model.
In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected. One injection revealed dye extended proximally into the epidural space, which penetrated the dura mater and was present on the spinal cord and brainstem. Dye was noted distally to the divisions in 3 injections. The anterior scalene muscle and phrenic nerve were stained in all 4 injections. It ap...
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Falyar CR, Abercrombie C, Becker R, Biddle C Tags: AANA J Source Type: research

Effect of Ultrasound-Guided Placement of Difficult-to-Place Peripheral Venous Catheters: A Prospective Study of a Training Program for Nurse Anesthetists.
Abstract Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals. The rate of success, procedure time, number of skin punctures, discomfort,...
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Partovi-Deilami K, Nielsen JK, Moller AM, Nesheim SS, Jorgensen VL Tags: AANA J Source Type: research

Local Anesthetic Adjuvants Providing the Longest Duration of Analgesia for Single- Injection Peripheral Nerve Blocks in Orthopedic Surgery: A Literature Review.
Abstract Inadequate pain relief after surgery may delay surgical recovery, decrease patient satisfaction, increase length of stay, raise the risk of hospital readmissions, and increase overall healthcare costs. One way to decrease postoperative pain for patients undergoing orthopedic surgery is through the use of peripheral nerve blocks. Anesthesia providers can add many adjuvants to local anesthetics to improve quality and prolong duration of analgesia. The purpose of this literature review is to evaluate local anesthetic adjuvants to peripheral nerve blocks. A review of published studies using PubMed, MEDLINE, a...
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Patacsil JA, McAuliffe MS, Feyh LS, Sigmon LL Tags: AANA J Source Type: research

Design of an Evidence-Based "Second Victim" Curriculum for Nurse Anesthetists.
Design of an Evidence-Based "Second Victim" Curriculum for Nurse Anesthetists. AANA J. 2016 Apr;84(2):107-13 Authors: Daniels RG, McCorkle R Abstract The "second victim" phenomenon--when a healthcare provider experiences adverse events because of the adverse events of a patient--is not well known or understood among healthcare professionals, including Certified Registered Nurse Anesthetists (CRNAs). No published research is currently available on the impact of second victim specifically in CRNAs, but it is known that second victim poses major challenges for healthcare professionals...
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Daniels RG, McCorkle R Tags: AANA J Source Type: research

Use of Personal Electronic Devices by Nurse Anesthetists and the Effects on Patient Safety.
Abstract Certified Registered Nurse Anesthetists (CRNAs) provide high-quality patient care to ensure patient safety. Strict vigilance and prompt response is required of the CRNA to make critical decisions. Distractions during anesthesia delivery may threaten patient safety. Personal electronic devices (PEDs) have become an integral tool used by 90% of adults. Adaptation of PEDs has permitted their integration into current anesthesia practice. Although technologic advancements have improved accessibility to resources and communication, they also serve as a source of distraction. Inappropriate PED use while administ...
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Snoots LR, Wands BA Tags: AANA J Source Type: research

Using a Structured Assessment Tool to Evaluate Nontechnical Skills of Nurse Anesthetists.
ard D Abstract Nontechnical skills are critical for good anesthetic practice but are seldom addressed explicitly in clinical training. The purposes of this study were (1) to evaluate the reliability and validity of the observation-based assessment tool Nurse Anaesthetists' Non-Technical Skills system (N-ANTS) and (2) to evaluate the effect of training nurse anesthetist supervisors in the use of N-ANTS. This system comprises a global rating score, 4 categories, and 15 elements to rate nurse anesthetists' nontechnical skills. A 1-day workshop was conducted for 22 nurse anesthetist supervisors to rate nurse anestheti...
Source: AANA Journal - April 1, 2016 Category: Anesthesiology Authors: Lyk-Jensen HT, Dieckmann P, Konge L, Jepsen RM, Spanager L, Østergaard D Tags: AANA J Source Type: research