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AANA J [journal]
- Reexamining traditional intraoperative fluid administration: evolving views in the age of goal-directed therapy. [Journal Article]
- AANA J 2014 Jun; 82(3):235-42.
Intraoperative volume administration has long been a topic of debate in the field of anesthesia. Only recently, however, has the conversation shifted to a discussion of appropriate intraoperative volume. A thorough review of the literature explores the history of today's widely accepted fluid administration equation and discusses possible explanations and consequences of iatrogenically induced hypervolemia. Current studies exploring various volume administration techniques are reviewed, as are emerging technologies available to help guide anesthesia providers with intraoperative fluid management.
- Cardiopulmonary collapse in the wake of robotic surgery. [Journal Article]
- AANA J 2014 Jun; 82(3):231-4.
Since the Food and Drug Administration approved the da Vinci Surgical System in 2000, robotic surgery is becoming increasingly popular in the operating room. Despite its popularity and proposed benefits, robotic surgeries encompass many complications that are often confounded by the patient's physiology and comorbidities. This article illustrates a case study of a patient who underwent a da Vinci ureterectomy. The case study will highlight the implications and complications that may arise with pneumoperitoneum and steep Trendelenburg positioning, and an overview of the current literature in robotic surgery will be presented.
- High fatigue scores among older Dutch nurse anesthetists. [Journal Article]
- AANA J 2014 Jun; 82(3):227-30.
In The Netherlands, hospital care production pressure recently increased substantially, while the number of nurse anesthetists available did not match this rise. The longtime existing norm of no night shifts for nurses beyond the age of 55 years was increased to age 57 to meet the demand for more nurse anesthetists. In this pilot study, we aimed to determine the level of fatigue and its correlation with demographic items among this category of employees. A validated questionnaire was distributed to all Dutch nurse anesthetists above 50 years of age working in Dutch hospitals, which asked for their level of fatigue. The Checklist Individual Strength Questionnaire was used to measure fatigue. Overall, 105 of 115 potential participants completed the questionnaire (response rate, 91%). The mean scores (+/- standard deviation) were as follows: total fatigue, 81.3 +/- 8.3; subjective fatigue, 31.4 +/- 3.2; physical activity, 13.1 +/- 2.2; motivation, 16.8 +/- 2.6; and concentration, 20.0 +/- 3.8. No correlation could be demonstrated between demographic characteristics and fatigue. Dutch nurse anesthetists above the age of 50 years show a high fatigue score and therefore need special attention to prevent them from harmful physical and psychological effects and to sustain maximal patient safety.
- Sevoflurane as a therapy for acute chlorine gas exposure in an austere healthcare environment: a case report. [Journal Article]
- AANA J 2014 Jun; 82(3):223-6.
Chlorine is a common agent found worldwide in industrial and household applications. This element is found everywhere and anywhere around the globe. Because of its ubiquitous nature in the world, chlorine-injured patients may be expected at all medical facilities, from large-urban to small-community to austere-tent facilities. Chlorine has been used as a chemical weapon since 1915 and has been accidentally released in transport, storage, and use, causing industrial accidents worldwide. A patient with a history of severe chlorine inhalational injury sustained 2 chlorine gas exposures within 48 hours. The patient was treated with intubation, mechanical ventilation, and directed therapies for severe injury by chlorine gas inhalation. Sevoflurane has a role in treating chlorine inhalation injury. Additional therapies are possible, some of which are not available in remote locations.
- Ultrasound-guided interscalene-supraclavicular block for an intramedullary nailing of a pathologic humeral fracture: practical application of ultrasound-guided regional anesthesia. [Journal Article]
- AANA J 2014 Jun; 82(3):219-22.
Fractures of the proximal upper extremity present a challenge to the anesthesia provider when administering a regional anesthetic because the dermatomal distribution of the upper extremity requires more local anesthetic coverage than any single brachial plexus nerve block can provide. A 60-year-old woman underwent intramedullary nailing of a pathologic humeral fracture using a combination of regional and general anesthesia. This case study shows how ultrasound guidance permitted the performance of both an interscalene and supraclavicular nerve block for a single procedure without the increased volume of local anesthetic that would normally be required, while still providing complete coverage of the entire upper extremity.
- Community of inquiry model: advancing distance learning in nurse anesthesia education. [Journal Article]
- AANA J 2014 Jun; 82(3):212-8.
The number of distance education courses offered by nurse anesthesia programs has increased substantially. Emerging distance learning trends must be researched to ensure high-quality education for student registered nurse anesthetists. However, research to examine distance learning has been hampered by a lack of theoretical models. This article introduces the Community of Inquiry model for use in nurse anesthesia education. This model has been used for more than a decade to guide and research distance learning in higher education. A major strength of this model learning. However, it lacks applicability to the development of higher order thinking for student registered nurse anesthetists. Thus, a new derived Community of Inquiry model was designed to improve these students' higher order thinking in distance learning. The derived model integrates Bloom's revised taxonomy into the original Community of Inquiry model and provides a means to design, evaluate, and research higher order thinking in nurse anesthesia distance education courses.
- Perioperative dorzolamide-timolol intervention for rising intraocular pressure during steep Trendelenburg positioned surgery. [Journal Article, Research Support, Non-U.S. Gov't]
- AANA J 2014 Jun; 82(3):203-11.
Elevated intraocular pressure (IOP) and venous congestion may produce a low ocular perfusion state that can lead to postoperative visual loss (POVL). The literature cites the importance of early IOP reduction to prevent optic nerve damage and visual loss. This study examined dorzolamide hydrochloride and timolol maleate (Cosopt) eyedrops on reducing elevated IOP during laparoscopic surgery with the patient in steep Trendelenburg position. A quasi-experimental study design was used. Subjects involving robotic urologic and gynecologic procedures at 3 separate medical centers were included. The medication was administered topically to both eyes at time points when IOP approached 40 mm Hg. The IOP was measured at 30-minute intervals compared with a supine, anesthetized baseline and final postprocedure supine measurements. A total of 194 patients were recruited, and 63 patients received dorzolamide-timolol treatment when IOP levels reached 38 to 40 mm Hg. Repeated-measures analysis of variance showed that IOP values dropped significantly after drug intervention at 60, 90, and 120 minutes (P < .001). Effect sizes of pharmacologic intervention on IOP reduction were strong (partial eta2 of 0.60 to 0.66). Treatment with dorzolamide-timolol eyedrops significantly reduces elevated IOP of patients who undergo lengthy laparoscopic surgery in the steep Trendelenburg position.
- Effects of intraosseous transfusion of whole blood on hemolysis and transfusion time in a swine model of hemorrhagic shock: a pilot study. [Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.]
- AANA J 2014 Jun; 82(3):198-202.
This prospective, experimental, mixed study determined whether there were differences in intraosseous (IO) and intravenous (IV) whole blood transfusion relative to hemolysis and transfusion time. Swine were assigned to the IV group (n = 6) with an 18-gauge catheter in the auricular vein or the IO group (n = 7) with a 15-gauge 10 needle in the proximal humerus. Following baseline specimen collection, 900 mL of blood was collected from each animal. The collected blood was autologously transfused by the IV or IO route using a pressure infusion bag inflated to 300 mm Hg, with immediate posttransfusion specimen collection. Hemolysis was defined by the amount of plasma free hemoglobin. Multivariate analysis of variance revealed no significant differences between groups relative to posttransfusion free hemoglobin or transfusion time (P = .065). The IV group's mean free hemoglobin level was 10.23 +/- 10.52 micromol/L; the IO group, 7.2 +/- 5.82 micromol/L. The IV group's mean transfusion time was 13.48 +/- 4.1 minutes; the IO group, 28.70 +/- 19.51 minutes. Intraosseous transfusion does not significantly increase hemolysis or transfusion time compared with IV transfusion. Clinically, it can take up to twice as long to transfuse 900 mL of blood IO compared with IV.
- Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation. [Journal Article]
- AANA J 2014 Jun; 82(3):188-97.
Postoperative sore throat (POST) is usually self-limiting but was rated by patients as one of the top 10 most undesirable anesthetic outcomes. Pharmacologic interventions that have been suggested to decrease the incidence of POST include application of local anesthetics and corticosteroids to the cuff of the endotracheal tube. These interventions often require extra steps during induction of general anesthesia. We sought evidence for using nonsteroidal, nonlocal anesthetic, topical pharmacologic interventions conveniently implemented preoperatively to decrease the incidence of POST. One hundred seventeen potential evidence sources were located, with 11 randomized controlled trials meeting inclusion criteria. The evidence examined ketamine, aspirin, and azulene gargle; benzydamine gargle or oral spray; dexpanthenol pastilles; and lozenges containing amyl-m-cresol or magnesium. Although there were methodologic concerns with the studies, the evidence suggested that all the treatment medications decreased the incidence of POST at early and late intervals. The severity of POST was also typically reduced. Preoperative ketamine and aspirin gargle are probably the most promising for providers practicing in the United States. However, before these agents are recommended for general use, large multicenter trials should be done exploring not only efficacy but also dose-response relationships and side effects.
- Ouality and performance measurement: national efforts to improve quality of care through measurement development. [News]
- AANA J 2014 Jun; 82(3):184-7.
The US Department of Health and Human Services created the National Quality Strategy to provide a framework to focus providers and organizations in achieving greater impact around better care, healthy people and communites, and affordable care. Providing incentive programs around quality measurement is one mechanism used to achieve these aims. Certified Registered Nurse Anesthetists (CRNAs) should begin to familiarize themselves with the consensus development process used in measurement development and the importance of measurement endorsement through the National Quality Forum. Additionally, CRNAs should become familiar with what Physician Quality Reporting System (PORS) measures CRNAs are currently using in anesthesia and the 2015 payment adjustments one may face if not currently reporting to the PORS.