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AANA J [journal]
- Author's reply. [Comment, Letter]
- AANA J 2013 Aug; 81(4):257-8.
- Pathophysiology and management of angiotensin-converting enzyme inhibitor-associated refractory hypotension during the perioperative period. [Journal Article]
- AANA J 2013 Apr; 81(2):133-40.
Hypertension is a common chronic condition in many patients requiring anesthesia. Pharmacologic therapy is a mainstay of treatment for hypertension, with angiotensin-converting enzyme (ACE) inhibitors being a frequently prescribed class of drugs. The American College of Cardiology and American Heart Association 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery provide information on many drug classes used in the treatment of hypertension; noticeably absent is a guideline for ACE inhibitors. Literature demonstrates that practice standards vary on whether ACE inhibitor regimens are continued or withheld during the preoperative period. When ACE inhibitor therapy is continued in patients undergoing general anesthesia, varying degrees of hypotension can be seen depending on confounding patient variables and the type of surgical procedure. In some instances, this hypotension can be refractory to traditional interventions such as administration of a fluid bolus, ephedrine, or phenylephrine. Vasopressin and methylene blue have been found to be effective treatments for ACE inhibitor-associated refractory hypotension. With the prevalence of hypertension and use of ACE inhibitors, anesthesia providers are likely to encounter refractory hypotension of this nature. The absence of guidelines regarding ACE inhibitors in the perioperative period contributes to a lack of consistency in practice.
- Thromboelastography-guided transfusion Therapy in the trauma patient. [Journal Article, Review]
- AANA J 2013 Apr; 81(2):127-32.
This article presents thromboelastography (TEG) as an important assay to incorporate into anesthesia practice for development of evidence-based therapy of trauma patients receiving blood transfusions. The leading cause of death worldwide results from trauma. Hemorrhage is responsible for 30% to 40% of trauma mortality and accounts for almost 50% of the deaths occurring in the initial 24 hours following the traumatic incident. On admission, 25% to 35% of trauma patients present with coagulopathy, which is associated with a sevenfold increase in morbidity and mortality. The literature supports that routine plasma-based routine coagulation tests, such as prothrombin time, activated partial thromboplastin time, and international normalized ratio, are inadequate for monitoring coagulopathy and guided transfusion therapy in trauma patients. A potential solution is incorporating the use of the TEG assay into the care of trauma patients to render evidence-based therapy for patients requiring massive blood transfusions. Analysis with TEG provides a complete picture of hemostasis, which is far superior to isolated, static conventional tests. The result is a fast, well-designed, and precise diagnosis enabling more cost-effective treatment, improved clinical outcome, accurate use of blood products, and pharmaceutical therapies at the point of care.
- Anesthesia care team risk: considerations to standardize anesthesia technician training. [Journal Article]
- AANA J 2013 Apr; 81(2):121-6.
The anesthesia profession has produced voluminous research data on equipment and techniques leading to safer practices, but the lack of attention given to the inconspicuous role of anesthesia support personnel on the anesthesia care team may pose a risk to patient safety. It is questionable whether the skills of anesthesia support personnel who are trained on the job have kept up with an increasingly complex healthcare environment. Medical technology and demand for high-quality care will continue to escalate; patient safety will remain a top priority. Therefore, a definitive strategy to mitigate risk and ensure patient safety begins with strengthening the infrastructure of the anesthesia team. Formal education and certification may ensure that skill sets of anesthesia support personnel will uniformly advance with technology and standards of patient care.
- Effects of ketamine on major depressive disorder in a patient with posttraumatic stress disorder. [Case Reports, Journal Article]
- AANA J 2013 Apr; 81(2):118-9.
Ketamine has been used in anesthesia for many years and in various environments with an acceptable safety margin. The side effects of hallucinations and paranoid thoughts need to be overcome for acceptance of ketamine infusion in mainstream psychiatry. In this case report, the anesthesia department was consulted because of familiarity with the medication and the ability to modulate unacceptable side effects with its use as is done in monitored anesthesia care. It is proposed that ketamine has potential for treatment of major depression associated with posttraumatic stress disorder (PTSD) in combat veterans. This patient, who had debilitating and treatment-resistant major depression and PTSD, was treated by intravenous infusion of ketamine and experienced substantial short-term resolution of symptoms.
- Palliative sedation in nursing anesthesia. [Case Reports, Journal Article]
- AANA J 2013 Apr; 81(2):113-7.
Palliative sedation is a technique of providing a sedative for end-of-life care to patients with intractable pain. The literature discusses the techniques and use of palliative sedation. Numerous articles have been written regarding the issues surrounding its use, but no literature has discussed the prescription or administration of palliative sedation by a nurse anesthetist. By understanding the concept and ethics involved in its use and providing nursing care that is theory based, the author argues that the involvement of nursing anesthesia is appropriate and within the scope of practice. Few other healthcare disciplines can provide the patient care and empirical knowledge that is imperative in the care of the dying patient. This article discusses the concept and ethics of palliative sedation and presents a case of providing palliative sedation to a terminally ill patient by an experienced nurse anesthetist. Palliative sedation should be understood, embraced, and utilized as an area of expertise suited for nursing anesthesia.
- Emerging evidence in infection control: effecting change regarding use of disposable laryngoscope blades. [Journal Article]
- AANA J 2013 Apr; 81(2):103-8.
The purpose of this evidence-based project was to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Frequency of use, ease of use, and complications encountered when using the disposable blade were evaluated before and after an in-service program designed to increase the use of disposable blades. Participants completed an anonymous questionnaire about their knowledge and practice regarding disposable laryngoscope blades. Then they received an investigator-developed article to read about the best and most recent practices regarding disposable laryngoscope blades. The same anonymous questionnaire was completed 3 months later. Inventory of the disposable laryngoscope blades was collected before the project and 1 and 3 months later. After the intervention, 25% of anesthesia providers described performance as their reason for not using the disposable laryngoscope blade, which was down from 60% at the project's start. Inventory showed a 23% increase in use of disposable laryngoscope blades after the intervention, which a single-proportion Z test showed was statistically significant (Z = 2.046, P = .041). This evidence-based project shows that a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades, which should translate to improved patient outcomes.
- The National Practitioner Data Bank: what CRNAs need to know. [News]
- AANA J 2013 Apr; 81(2):97-102.
As a nationwide flagging system, the National Practitioner Data Bank (NPDB) allows state licensing boards, hospitals, and other registered healthcare entities the ability to monitor practitioners through reporting and inquiry about the qualifications and competency of healthcare practitioners seeking clinical privileges where incompetence or unprofessional conduct could adversely affect a patient's welfare. Certified Registered Nurse Anesthetists are not exempt from being reported on or queried by registered reporting and querying entities. The NPDB warehouses data pertaining to adverse actions or medical malpractice payments taken against a practitioner. Based on the updated federal ruling published in the Federal Register regarding the NPDB and Section 1921 of the Social Security Act, the NPDB has expanded the definition of healthcare practitioners to include all healthcare practitioners as a means of protecting beneficiaries of the Social Security Act's healthcare programs. As such, nurse anesthetists should be aware of the additional reportable information that may be collected or disseminated based on the updated ruling pertaining to the NPDB.
- A closer look at the standards for nurse anesthesia practice. [News]
- AANA J 2013 Apr; 81(2):92-6.
As part of its ongoing work, the AANA's Practice Committee reviewed the Scope and Standards for Nurse Anesthesia Practice, particularly focusing on the Standards for Nurse Anesthesia Practice. Revisions and updates were made to the standards to ensure clarity and reflect current anesthesia practice. This article highlights several of the important revisions made to the Standards for Nurse Anesthesia Practice, specifically focusing on the importance of documentation, updates to Standard V-Patient Monitoring, and changes to other documents affected by the updates. This is not an exhaustive discussion of all changes made to the document. The updated Standards for Nurse Anesthesia Practice are presented in their entirety.