Susan Murrell, CRNA, MSN, uses the GlideScopeVideo Laryngoscope (GVL) to intubate the trachea in a patient undergoing general endotracheal anesthesia at the VA San Diego Medical Center, San Diego, California. The GVL consists of an integrated camera mounted at the end of a curved laryngeal blade that displays the captured image on an attached color monitor. When compared to traditional laryngoscopy, the GVL often allows for an improved view of the glottis. (Photo taken by Jeff Johnson, CRNA, MSN, VA San Diego Medical Center.)
Nerve Agents: Implications for Anesthesia ProvidersIn this review article, the author points out that the possibility of encountering a person who has been exposed to a nerve agent is a reality today. Different types of nerve agents that are currently being manufactured as well as the symptomatic and definitive treatment of the patient who presents with acute nerve agent toxicity are discussed. The physiology of the neuromuscular junction and the autonomic nervous system receptors that nerve agent toxicity affects also are reviewed.
Keywords: Chemical weapons, cholinesterase inhibitors, nerve agents, nerve gas.
Version: 2008; 76(2)95-97.Authors: Paula Kay Hrobak, CRNA, MSN
A Review of Recent Studies Relating Ligand Diffusion, General Anesthesia, and SleepIn this review article, the author discusses chreode theory of molecule diffusion, nonspecific volatile anesthetic activity, the relationship between general anesthesia and sleep, and a theory of sleep. Three specific theories are described. The first theory describes the diffusion of molecules across a protein surface to a receptor. A second theory involving the role of chreodes presents a mechanism of action of nonspecific anesthetic agents. And, the third theory proposes that an external agent influences sleep in a way similar to that of the nonspecific anesthetic molecules.
Keywords: Nonspecific anesthetic mechanism, protein surface water, sleep from nitrogen effect, sleep theory.
Version: 2008;76(2):109-112.Authors: Lemont B. Kier, PhD, BS
The Effects of Chrysin, a Passiflora incarnata Extract, on Natural Killer Cell Activity in Male Sprague-Dawley Rats Undergoing Abdominal SurgeryCOL(ret) Normalynn Garrett, CRNA, PhD, AN, USA
Surgery is associated with suppression of natural killer (NK) cell activity and may contribute to cell metastasis. Chrysin, a passion flower extract, may be beneficial because of its potential to attenuate surgical suppression of NK cell activity. The authors divided 37 male Sprague-Dawley rats into 3 treatment groups; analysis of covariance, with preoperative NK cell activity as the covariate, was used to compare differences in NK cell activity among the groups. The findings suggest that chrysin may attenuate surgical suppression of NK cell activity, thereby minimizing metastatic spread of cancer.
Current Antifibrinolytic Therapy for Coronary Artery RevascularizationThe purpose of this review article is to describe the clinical significance of antifibrinolytic therapy and the current implications associated with its use. The authors discuss 2 main classes of antifibrinolytics that are used in coronary artery bypass graft procedures: synthetic lysine analogues and serine protease inhibitors. Both classes of antifibrinolytics have been shown to decrease the incidence of blood transfusion; however, new data have emerged regarding an increase in adverse outcomes associated with serine protease inhibitors.
Mitral Valve Replacement: A Case ReportIn this article, the authors state that mitral regurgitation is the most commonly encountered valvular lesion in anesthesia clinical practice. Knowledge of the pathophysiology and proper anesthetic management is crucial to achieving optimal outcomes. A case is reported, followed by a detailed discussion on mitral regurgitation. The goals for the anesthetist include preservation of forward flow with minimal regurgitation and decreased pulmonary congestion. Invasive monitoring and transesophageal echocardiography have improved diagnostics and anesthetic management.
AANA Journal Course: Update for Nurse Anesthetists—Part 1—Toward Reducing Peri-operative TransfusionsDespite the ever-increasing safety of the supply of blood products, disease transmission is listed as the primary patient concern regarding transfusions. The author of this course states the primary concerns for anesthetists center on risks associated with blood transfusions, such as transfusion-related acute lung injury, anaphylactic transfusion reaction, clerical errors resulting in ABO incompatibility, and blood products contaminated with infectious organisms. These concerns have contributed to renewed efforts to minimize blood transfusion without negative patient consequences.