Table of Contents
Methylene Blue to Treat Vasoplegia due to a Severe Protamine Reaction: A Case Report Dina L. Lutjen, CRNA, MS Karri L. Arndt, CRNA, DNP
Protamine sulfate is used during coronary artery bypass graft surgery to reverse the anticoagulating effects of heparin. This case report describes a woman who after cardiac bypass experienced a severe protamine reaction with profound hypotension, which was unresponsive to volume resuscitation and vasopressor therapy. The authors state a review of the pathophysiologic characteristics associated with vasoplegia and the pharmacodynamics of methylene blue will potentially enable anesthesia providers to use this lifesaving drug when needed.Print version:
Methylene blue, protamine reaction, vasoplegic syndrome.
Utilization of a Massive Transfusion Protocol During Liver Lobe Resection: A Case Report
Bryan Tune, CRNA, DNP
The implementation of a massive transfusion protocol (MTP) in acute care facilities that manage traumatically injured and hemorrhagic patients has shown strong evidence in improving patient outcomes. The author of this case report says the availability of an MTP in his institution allowed for rapid resuscitation of a patient with an acute vascular hemorrhage. In analyzing the current data on the benefits of an MTP, the author concludes that it behooves anesthesia providers to question whether such a protocol exists in their institution. Print version:
Fresh frozen plasma, massive transfusion protocol, platelets, red blood cells, resuscitation.
Implementation of an Evidence-Based Extubation Checklist to Reduce Extubation Failure in Patients With Trauma: A Pilot Study William O. Howie, CRNA, DNP, MS, CCRN Richard P. Dutton, MD, MBA
This prospective, case-controlled observational study assessed whether an evidence-based extubation checklist would increase anesthesia providers’ documentation of standardized extubation criteria and reduce the occurrence of preventable extubation failures in the early postoperative period. The authors report the results of this project indicate an extubation checklist may positively influence provider documentation of evidence-based criteria for extubation, as well as reduce the occurrence of preventable extubation failures. Print version:
Anesthesia, checklist, failed extubation, reintubation, trauma.
Skin Electrical Resistance Does Not Change Following Infraclavicular Block Amit Lehavi, MD Alexander Kiorescu, MD Philippe Abecasis, MD Arkady Baskevitch, MD Yeshayahu (Shai) Katz, MD, DSC
The infraclavicular approach to block nerve conduction in the brachial plexus is a common technique of regional anesthesia for surgery of the forearm and hand. The authors studied 20 patients undergoing hand surgery under infraclavicular brachial plexus block and found that no statistically significant change in the electrical resistance of the skin was observed during 20 minutes after placement of the block. These results strongly suggest that the electrical resistance of the skin cannot be used to predict a successful infraclavicular block.Print version:
Nerve block, regional anesthesia, skin electrical resistance.
High-Fidelity Simulation for Continuing Education in Nurse Anesthesia M. Roseann Cannon-Diehl, CRNA, DNP Susan M. Rugari, RN, PhD, CNS Terri S. Jones, CRNA, DNP
A revolution in continuing education is occurring, and simulation is a key component. In this research article, the authors explore the usefulness of high-fidelity simulation (HFS) as a valuable tool for continuing education and report the results of a needs assessment conducted among 22 practicing nurse anesthetists. Information from this needs assessment could be used as a foundation for further research and educational planning at the local, state, and national levels related to using HFS for continuing education. Print version:
Continuing education, high-fidelity simulation, nurse anesthetists, simulation.
Anesthesia for the Adult Patient With an Unrepaired Congenital Cyanotic Heart Defect: A Case Report Marianne S. Cosgrove, CRNA, DNAP, APRN
Adult congenital heart disease, previously considered a rare comorbidity, is increasingly becoming a reality for today’s anesthesia providers. Despite successful surgical repair or palliation, these individuals present the anesthesia provider with a multitude of challenges. Individualized care of these fragile patients should be approached with a keen understanding of the patient’s underlying cardiac anomaly. This case report chronicles the anesthetic care of a woman presenting for left-sided ureteroscopy with laser lithotripsy and stent placement.Print version:
Adult, congenital heart disease, cyanotic heart lesions, general anesthesia.
Shared Experiences of CRNAs Who Were on Duty in New Orleans During Hurricane Katrina
Marjorie A. Geisz-Everson, CRNA, PhD
Dianne Dodd-McCue, DBA
Marsha Bennett, RN, DNS, APRN, ACRN
The purpose of this focused ethnography was to describe the shared experiences of Certified Registered Nurse Anesthetists (CRNAs) who were on duty in New Orleans, Louisiana, during Hurricane Katrina, as well as to elucidate the psychosocial impact the storm had on them. The authors conclude that the results of this study should be used to guide policies regarding disaster activation of CRNAs, to educate CRNAs on preparing for disaster duty, and to provide a framework for future disaster studies regarding CRNAs.Print version:
CRNAs, focused ethnography, Hurricane Katrina, natural disaster.
A Preventive Intervention for Rising Intraocular Pressure: Development of the Molloy/Bridgeport Anesthesia Associates Observation Scale Bonnie Molloy, CRNA, PhD, APRN
There is increasing interest in monitoring intraocular pressure (IOP) during surgery in steep Trendelenburg position because of reported incidents of postoperative visual loss (POVL). The aim of this study was to develop an observation scale that correlated with statistically significant changes in intraoperative patients’ IOP. The scale is named the Molloy/Bridgeport Anesthesia Observation Scale (MBOS). It could be used with no cost and minimal training to assess the need for treatment interventions to prevent a rise in IOP levels and potentially prevent POVL.Print version:
Chemosis, intraocular pressure, ischemic optic neuropathy, ocular perfusion pressure, postoperative visual loss.
AANA Journal Course: Update for Nurse Anesthetists – Part 2 – Evidence-Based Anesthesia: The Use of Preprocedural Ultrasonography During Labor to Facilitate Placement of an Epidural Catheter CDR Dennis Spence, CRNA, PhD, NC, USN LCDR Ryan Nations, CRNA, MS, NC, USN LT Orlando Rivera, CRNA, MSN, NC, USN LT Shawn Bowdoin, RN, BSN, NC, USN LT Bradley Hazen, CRNA, MSN, NC, USN LT Robert Orgill, CRNA, MSN, NC, USN CDR John Maye, CRNA, PhD, NC, USN
Placement of an epidural catheter in parturients can be challenging because the anatomic changes of pregnancy may make it difficult to palpate an ideal insertion point or detect loss of resistance. Preprocedural ultrasonography (U/S-P) is reported to facilitate placement of epidural catheters in parturients. This course offers a state-of-the-science review and some practical tips on the use of U/S-P to facilitate epidural catheter placement during labor. The authors suggest this technique may improve the efficacy of epidural catheter placement during labor in certain populations; however, they also acknowledge areas where further research is needed.Print version:
Epidural, labor, parturients, preprocedural, ultrasonography.