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AANA J [journal]
- Council on Accreditation of Nurse Anesthesia Educational Programs adopts standards for the Practice Doctorate and Post-graduate CRNA Fellowships. [News]
- AANA J 2014 Jun; 82(3):177-83.
The Council on Accreditation of Nurse Anesthesia Educational Programs appointed a Standards Revision Task Force to develop new accreditation standards. After 3 years of research and development (2011-2013) by the task force, the Council approved the first entry-level Practice Doctorate Standards and the first voluntary Post-graduate CRNA Fellowship Standards in January 2014. This defining moment in accreditation history marks a transition in the educational preparation of entry-level nurse anesthetists and provides opportunities for learning in a variety of post-graduate fellowships for Certified Registered Nurse Anesthetists.
- Response. [Comment, Letter]
- AANA J 2014 Jun; 82(3):175-6.
- Use of the Iowa Satisfaction with Anesthesia Scale. [Comment, Letter]
- AANA J 2014 Jun; 82(3):175.
- Anesthesia case management for endovascular aortic aneurysm repair. [Journal Article]
- AANA J 2014 Apr; 82(2):145-52.
The incidence of angiopathology involving the aorta and microvasculature is expected to become more prevalent because of increased life expectancy and incidence of obesity. With the advent of endovascular aortic repair (EVAR), patients who were not considered surgical candidates for abdominal aortic aneurysmectomy because of their tenuous physical status can undergo corrective treatment and return to their activities of daily living. Because of the limited invasiveness of the procedure, it is unnecessary to cross-clamp the aorta, which minimizes hemodynamic variability and release of inflammatory mediators. As a result, the rate of myocardial ischemia, acute kidney injury, mesenteric ischemia, and blood loss is decreased. However, there are serious complications that can occur with EVAR, which include cerebral and myocardial ischemia, rapid massive hemorrhage, damage to access vessels, and endoleak. Presently, the most common anesthetic technique provided to patients undergoing EVAR is local anesthesia and monitored anesthetic care. A thorough understanding of the surgical procedure, perioperative process, and anesthetic considerations is vital to provide comprehensive care.
- Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: a case report. [Case Reports, Journal Article]
- AANA J 2014 Apr; 82(2):140-3.
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure used for the treatment of various types of cancer. Specifically, HIPEC has shown success where treatment failure sites (metastases) thrive. A classic example of one such area is the peritoneal surface, which remains a prominent failure site for patients with gynecologic and gastrointestinal cancer. Traditionally, most patients with advanced stages of cancer have undergone palliative procedures as part of their treatment modality or had no surgery at all. With the advent of cytoreductive surgery with HIPEC, patients with peritoneal cancer have shown increased survival rates. Anesthetic complications are common during this procedure with disturbances in hemodynamics, coagulation, and respiratory gas exchange. A knowledge of what to anticipate anesthetically will guide the practitioner to achieve successful management during and after the case. In this case report, a 71-year-old woman was treated for stage Ill peritoneal and ovarian cancer by cytoreductive surgery with HIPEC.
- Evaluation of postprocedure cognitive function using 3 distinct standard sedation regimens for endoscopic procedures. [Journal Article, Randomized Controlled Trial]
- AANA J 2014 Apr; 82(2):133-9.
The primary purpose of this investigation was to evaluate postprocedure cognitive function associated with 3 distinct standard sedation regimens used for endoscopic procedures. A secondary aim was to identify complications requiring provider interventions. Subjects scheduled for colonoscopies were approached for enrollment the day of their procedure. A convenience sample of 96 subjects was randomly assigned. Cognitive function was recorded on the day of surgery using the Mini-Mental State Examination (MMSE) and 24 and 48 hours postoperatively using the Telephone Interview of Cognitive Status (TICS). The propofol plus fentanyl group had a mean TICS score of 34.53 at 24 hours compared with 34.96 at 48 hours (P = .017). The midazolam plus fentanyl group had a mean TICS score of 34.76 at 24 hours compared with 36.26 at 48 hours (P = .004). The propofol-alone group had a mean TICS score of 35.09 at 24 hours compared with 35.98 at 48 hours (P = .924). The results of this investigation indicate that the sedation regimen of propofol alone has the least impact on postprocedure cognitive function. Additionally, the number of jaw lift interventions was significantly higher in both groups who received fentanyl.
- Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia. [Journal Article]
- AANA J 2014 Apr; 82(2):127-30.
No consensus exists on when it is safe to administer neuraxial blockade in a patient with a low platelet count. It has been suggested that thromboelastography (TEG) may be useful in assessing platelet function in parturients with thrombocytopenia. The purpose of the study was to analyze the incidence of neurologic complications, if any, related to regional anesthesia in parturients with a platelet count less than 100,000 mm-3 and especially those with less than 80,000 mm3 and normal TEG values. The data were prospectively collected during a 3-year period. All parturients whose platelet count was less than 100,000 mm(-3) were required to have TEG before a neuraxial technique was administered. This case series suggests that neuraxial techniques in parturients can be performed with a platelet count greater than 56,000 mm3 and a normal TEG result.
- Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients. [Journal Article]
- AANA J 2014 Apr; 82(2):121-6.
We wanted to determine whether 1 of 3 brachial plexus blocks was best for one of our most common surgeries, the cubital tunnel release with or without transposition of the ulnar nerve. Brachial plexus blocks can provide excellent results for upper extremity surgery, but we noticed inexplicable block failure for cubital tunnel releases with an incision in the proximal arm. In this case series, we initially reviewed 90 patients receiving axillary, infraclavicular, or supraclavicular blocks to determine if one block performed better for a surgical procedure that proceeds up the inner aspect of the arm. The theory that infraclavicular and supraclavicular blocks were superior for this surgery was not demonstrated in these patients. Success was not determined by the block chosen; however, the intercostobrachial nerve may be inconsistently blocked because it is difficult to visualize on ultrasound. We subsequently reviewed 30 more patients, but this time the volume of the intercostobrachial block was doubled. By increasing the volume, there appeared to be less need for surgeons to "touch up" blocks in the operating room. We suggest that increasing the volume of the intercostobrachial nerve block may improve success. Further studies to identify the intercostobrachial nerve by ultrasound are needed.
- Ventilation with increased apparatus dead space vs positive end-expiratory pressure: effects on gas exchange and circulation during anesthesia in a randomized clinical study. [Journal Article, Research Support, Non-U.S. Gov't]
- AANA J 2014 Apr; 82(2):114-20.
Atelectasis formation can be reduced by positive end-expiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. Thirty patients, with ASA physical status 1 or 2, scheduled for elective open colon surgery were randomly assigned to be ventilated with either PEEP at 10 cm H20 (PEEP, 15 patients) or increased tidal volumes achieved with larger apparatus dead space but with zero end-expiratory pressure (DS group, 15 patients). Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP.
- Anesthetic management of Costello syndrome: a case report. [Journal Article]
- AANA J 2014 Apr; 82(2):108-13.
Costello syndrome is a rare genetic disorder with an estimated 300 medical cases worldwide. Typical features that characterize this syndrome include short stature, macrocephaly, developmental delay, loose skin folds, distinctive coarse facial features, and multiorgan system anomalies. The following case report discusses the anesthetic management for a 3-year-old boy undergoing general anesthesia for a scheduled dental restoration, hydrocelectomy, inguinal hernia repair, and bilateral myringotomy with placement of pressure equalization tubes. A scarcity of literature for the anesthetic management of Costello syndrome (also known as faciocutaneoskeletal syndrome) exists. Utilizing an overview of the pertinent literature, clinical practice recommendations are suggested for the anesthetic implications of managing a pediatric patient with this rare syndrome.