On The Cover

Kellee Holt, CRNA, MNA, is teaching the Mayo Nurse Anesthesia program students use of the ultrasound machine for peripheral nerve blocks. “I am demonstrating landmarks/techniques for an ultrasound guided supraclavicular block. Our practice in Carroll, Iowa is an all CRNA practice. We currently have 6 anesthetists. We are an off campus site for the Mayo Nurse Anesthesia Program. The students spend 8 weeks at our facility learning how to do regional anesthesia. In this photo are Mayo clinic SRNAs Kayla Runkle [lying down on bed], then from left to right is Mandy Hilgeman, Jana McNeil, and Annie Aguilar.” (Photo taken by Christopher Dietz, CRNA.)

Articles

  • Emerging Evidence in Infection Control: Effecting Change Regarding Use of Disposable Laryngoscope Blades The purpose of this evidence-based project was to deter­mine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Frequency of use, ease of use, and complications encountered when using the disposable blade were evaluated before and after an in-service program designed to increase the use of disposable blades. This article shows that a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades, which should translate to improved patient outcomes.
    Keywords: Disposable laryngoscope blade, infection control, reusable laryngoscope blade, single-use laryngoscope blade.
    Version: 2013;81(2):103-112. Authors: Melissa D. Machan, CRNA, DNP, ARNP, W. Patrick Monaghan, CLS, SBB, PhD, John McDonough, CRNA, EdD, Gerard Hogan, CRNA, DNSc, ARNP
  • Palliative Sedation in Nursing Anesthesia Palliative sedation is a technique of providing a sedative for end-of-life care to patients with intractable pain. The litera­ture discusses the techniques and use of palliative sedation. Numerous articles have been written regarding the issues surrounding its use, but no literature has discussed the pre­scription or administration of palliative sedation by a nurse anesthetist. This article illustrates how palliative sedation should be understood, embraced, and utilized as an area of expertise suited for nursing anesthesia.
    Keywords: End-of-life care, palliative sedation in nursing anesthesia, sedation in nursing anesthesia.
    Version: 2013;81(2):113-117. Authors: Michael T. Wolf, CRNA, MHS, APNP
  • Effects of Ketamine on Major Depressive Disorder in a Patient With Posttraumatic Stress Disorder Ketamine has been used in anesthesia for many years and in various environments with an acceptable safety margin. The side effects of hallucinations and paranoid thoughts need to be overcome for acceptance of ketamine infusion in mainstream psychiatry. In this case report, it is pro­posed that ketamine has potential for treatment of major depression associated with posttraumatic stress disorder in combat veterans.
    Keywords: Combat veterans, depression, ketamine, N-methyl-d-aspartate, posttraumatic stress disorder (PTSD).
    Version: 2013;81(2):118-120. Authors: Arthur L. Womble, CRNA, PhD
  • Anesthesia Care Team Risk: Considerations to Standardize Anesthesia Technician Training It is questionable whether the skills of anesthesia support personnel who are trained on the job have kept up with an increasingly complex healthcare environment. Medical technology and demand for high-quality care will continue to escalate; patient safety will remain a top priority. This article examines how a definitive strategy to mitigate risk and ensure patient safety begins with strengthening the infrastructure of the anesthesia team.
    Keywords: Anesthesia support personnel, certified anesthesia technician, patient safety, standardization.
    Version: 2013;81(2):121-126. Authors: Lisa Haas, CRNA, DNP, NE-BC
  • Thromboelastography-Guided Transfusion Therapy in the Trauma Patient This article presents thromboelastography (TEG) as an important assay to incorporate into anesthesia practice for development of evidence-based therapy of trauma patients receiving blood transfusions. Analysis with TEG provides a complete picture of hemostasis, which is far superior to isolated, static conventional tests. The result is a fast, well-designed, and precise diagnosis enabling more cost-effective treatment, improved clinical outcome, accurate use of blood products, and pharmaceutical therapies at the point of care.
    Keywords: Coagulopathy, thromboelastography, transfusion therapy, trauma.
    Version: 2013;81(2):127-1132. Authors: Charice Brazzel, CRNA, DNP
  • AANA Journal Course: Update for Nurse Anesthetists – Part 1 – Pathophysiology and Management of Angiotensin-Converting Enzyme Inhibitor–Associated Refractory Hypotension During the Perioperative Period Hypertension is a common chronic condition in many patients requiring anesthesia. Pharmacologic therapy is a mainstay of treatment for hypertension, with angiotensinconverting enzyme (ACE) inhibitors being a frequently prescribed class of drugs. The American College of Cardiology and American Heart Association 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery provide information on many drug classes used in the treatment of hypertension; noticeably absent is a guideline for ACE inhibitors. With the prevalence of hypertension and use of ACE inhibitors, anesthesia providers are likely to encounter refractory hypotension of this nature. The absence of guidelines regarding ACE inhibitors in the perioperative period contributes to a lackof consistency in practice.
    Keywords: Angiotensin-converting enzyme (ACE) inhibitor, methylene blue, refractory hypotension, vasoplegic syndrome, vasopressin.
    Version: 2013;81(2):133-140. Authors: Andrea Thoma, CRNA, MS