To Press or Not to Press, and If So, With What? A Single Question–Focused Meta-analysis of Vasopressor Choice During Regional Anesthesia in ObstetricsChuck Biddle, CRNA, PhD
Given the underlying assumption that reasonable maternal hemodynamics can be achieved with either ephedrine or phenylephrine, this focused meta-analysis addresses the impact of vasopressor choice on resultant neonatal Apgar scores during regional anesthesia. The literature was systematically searched for randomized trials of obstetric vasopressor use employing standard search tools. The current meta-analysis provides an updated, evidence-based validation of vasopressor use from the American Society of Anesthesiologists’ 2007 “Practice Guidelines for Obstetric Anesthesia.”
Keywords: Apgar score, meta-analysis, neuraxial hypotension, obstetric hypotension, obstetric vasopressor, vasopressor.
Print version: 2013;81(4):261-264.
Detection of Pneumothorax with UltrasoundJonathan P. Kline, CRNA, MSNADavid Dionisio, CRNAKevin Sullivan, CRNATrey Early, CRNAJoshua Wolf, CRNADeanna Kline, CRNA, DNP
Diagnosis of a pneumothorax in the perioperative area can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. Ultrasound guidance allows the anesthesia provider a method of quickly ruling out this potentially life-threatening complication. This article details the use of sonography for fast and accurate diagnosis of pneumothorax.
Keywords: Bat sign, lung sliding, pleural line, pneumothorax, seashore sign, ultrasound.
Print version: 2013;81(4):265-271.
Forced-Air Warming Design: Evaluation of Intake Filtration, Internal Microbial Buildup, and Airborne-Contamination EmissionsMike Reed, MBBS, MD, FRCSOliver Kimberger, MDPaul D. McGovern, BSc, MBBS, MRCS, PGCME, FHEAMark C. Albrecht, MStat, MBA, BSME
Forced-air warming devices are effective for the prevention of surgical hypothermia. However, these devices intake nonsterile floor-level air, and it is unknown whether they have adequate filtration measures to prevent the internal buildup or emission of microbial contaminants. This article highlights the need for upgraded intake filtration, preferably high-efficiency particulate air filtration, on current generation forced-air warming devices.
Keywords: Airborne contamination, filtration, forced-air warming, operating room ventilation, patient warming.
Print version: 2013;81(4):275-280.
Dewi De Jarnett, CRNA
Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.
Keywords: Airway stenting, endoscopic mask, fiberoptic intubation, morbid obesity, positive pressure ventilation.
Print version: 2013;81(4):282-284.
Keywords: Immunosuppression, pediatric transplant anesthesia, sedation tolerance.
Print version: 2013;81(4):286-290.
Perioperative Changes in Oxygen Saturation After Ambulatory Laparoscopic Cholecystectomy: A Retrospective Analysis
Michael Seneca, CRNA, MSN
Mark Zapp, MD
Martha Seneca, FNP-BC, MSN
In the ambulatory surgical setting, patients may present with grossly abnormal oxygen saturation (Spo2) readings that, along with other disease pathology, make referral to an inpatient facility a straightforward decision. Patients presenting with unexplained slightly abnormal Spo2 readings might make evaluation as an appropriate candidate for the ambulatory setting more problematic. Little guidance is provided for these scenarios in current consensus documents. A retrospective analysis was performed.
Keywords: Ambulatory surgery, oxygen saturation, perioperative, postoperative changes, Spo2.
Print version: 2013;81(4):292-296.
Severe Pulmonary Hypertension: A Noncardiac, Nonobstetric Surgical Case StudyJennifer E. Andrews, CRNA, MSN, BSN, BSEd
This report describes the noncardiac, nonobstetric surgical case of a 29-year old woman with idiopathic pulmonary arterial hypertension. This case study briefly summarizes the surgical case and then discusses history, current classifications, epidemiology, pathophysiology, contemporary treatments, and basic anesthetic management related to pulmonary hypertension.
Keywords: Anesthesia management, noncardiac surgery, nonobstetric surgery, pulmonary hypertension.
Print version: 2013;81(4):297-302.