On The Cover

A nurse anesthesia program faculty member performs a simulated ultrasound guided peripheral nerve block at the Center for Advanced Medical Learning and Simulation (CAMLS) in Tampa, Florida. The photo was taken in the Surgical and Interventional Training Center within CAMLS. Pictured in the photo is Alan Todd, DNP, CRNA, simulation director, University of South Florida, Nurse Anesthesia Program. Photo by Ryan Noone.

Articles

  • Pain Management Efficacy Study Between Continuous and Single-Administration Bupivacaine Following Lumbar Spinal Fusion Poorly managed postoperative pain decreases patient satisfaction, impedes early patient mobilization, lengthens inpatient hospital stay, and increases healthcare costs. Multimodal analgesia with local anesthetics is considered most effective for postoperative pain management. This study compared patients undergoing lumbar fusion who received plain bupivacaine from May 2011 until August 2012 with those who received liposomal bupivacaine from September 2012 until May 2013. The aim was to determine which preparation reduced postoperative opioid use the most.
    Keywords: Bupivacaine, liposomal bupivacaine, pain management, postoperative pain, single-administration bupivacaine.
    Version: 2017;85(2):91-97. Authors: Jay Tumulak, DNP, CRNA, APN, Steve Johnston, CRNA, APN, Patty Adams, RN, BSN, CNOR
  • Effectiveness of Interventions to Increase Provider Monitoring of Endotracheal Tube and Laryngeal Mask Airway Cuff Pressures Previous research demonstrates that monitoring and adjusting pressures in endotracheal (ET) tubes 30 cm H2O or less and laryngeal mask airways (LMAs) 60 cm H2O or less decrease rates of postoperative pharyngolaryngeal complications. In this evidence-based practice project we examined whether a multistep intervention (departmental education plus reference cards in operating rooms plus addition of cuff pressure documentation variable in electronic anesthesia record) would increase the frequency of providers monitoring intracuff pressures and decrease the rate of high intracuff pressures.
    Keywords: Anesthesia provider, cuff pressure monitoring with manometer, endotracheal tube, laryngeal mask airway, pharyngolaryngeal complications.
    Version: 2017;85(2):98-103. Authors: CDR Randy E. Ashman, MSN, DNP, CRNA, NC, USN, Susan J. Appel, PhD, APRN-BC, CCRN, FAHA, CDR Arnel J. Barba, MS, DNP, CRNA, NC, USN
  • Propofol: Review of Potential Risks During Administration Propofol is one of the most commonly used agents by anesthesia providers. Despite its excellent safety profile, numerous drawbacks and patient safety issues remain. This article is a focused review of the common issues surrounding propofol administration as they relate to infection, pediatric sedation, and the propofol infusion syndrome.
    Keywords: Contamination, pediatric sedation, propofol infection, propofol infusion syndrome.
    Version: 2017;85(2):104-107. Authors: Adam C. Adler, MD, MS
  • An Initiative to Optimize Waste Streams in the Operating Room: RECycling in the Operating Room (RECOR) Project The goal of this project was to optimally sort waste material in the operating room (OR) environment and divert waste such that streams of low-cost disposal, including recyclable material, could be maximized. Using the Lean Six Sigma method, we followed 5 steps to define, measure, analyze, improve, and control. Descriptive statistics were used to describe OR characteristics during the study period.
    Keywords: Operating room, RECOR, recycled material, waste streams.
    Version: 2017;85(2):108-112. Authors: Deanna M. Martin, CRNA, N. David Yanez, PhD, Miriam M. Treggiari, MD, PhD, MPH
  • Effects of Ondansetron on Attenuating Spinal Anesthesia–Induced Hypotension and Bradycardia in Obstetric and Nonobstetric Subjects: A Systematic Review and Meta-Analysis Hypotension and bradycardia are common adverse effects following spinal anesthesia. Ondansetron has been studied in the attenuation of spinal anesthesia– induced hypotension (SIH) and bradycardia because of its antagonistic effect on the Bezold-Jarisch reflex. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to determine the efficacy of intravenous (IV) ondansetron in reducing the incidence of SIH and bradycardia.
    Keywords: Bradycardia, ondansetron, spinal anesthesia-induced hypotension.
    Version: 2017;85(2):113-122. Authors: Tito D. Tubog, DNAP, CRNA, Terri D. Kane, DNAP, CRNA, Marilyn A. Pugh, PhD
  • Development, Implementation, and Evaluation of a Nurse Anesthesia Program in Belize Because of a critical shortage of anesthesia providers in Belize, the Belize Ministry of Health initiated support for the creation of a nurse anesthesia education program. Developed in collaboration with Health Volunteers Overseas and the University of Belize, the nurse anesthesia education program graduated 10 nurse anesthetists. This article describes the 24-month nurse anesthesia education program’s design, implementation, and evaluation.
    Keywords: Developing countries, Health Volunteers Overseas, international nurse anesthesia, international nurse anesthesia curriculum, nurse anesthesia education.
    Version: 2017;85(2):123-129. Authors: Kathleen A. Hammond, DNP, MSN, CRNA, Suzanne T. Brown, CRNA, Lisa Marie Bernardo, PhD, MPH, RN, Laura Palmer, DNP, MNEd, CRNA, Richard Henker, PhD, CRNA, FAAN
  • Laryngeal Mask Airway Use in Morbidly Obese Patients Undergoing General Anesthesia The use of laryngeal mask airways with morbidly obese patients remains controversial. A recent legal case involving the use of a laryngeal mask airway with a morbidly obese patient who aspirated during the anesthetic found the anesthesia providers negligent. We sought evidence examining the use of laryngeal mask airways with obese patients undergoing surgery.
    Keywords: Complications, endotracheal intubation, general anesthesia, laryngeal mask airway, morbid obesity.
    Version: 2017;85(2):130-135. Authors: Jill A. Mason-Nguyen, DNAP, MSN, CRNA, Ricardo E. Rodriguez, PhD
  • Considerations of Epidural Analgesia in a Patient With Suspected Uterine Rupture The practice of epidural analgesia in laboring women began to emerge in the 1970s. It is now a common method of pain relief for patients in labor and is used by 63% of women in the hospital setting. The patient who has had a previous cesarean delivery can benefit from having an epidural anesthetic placed early to expedite an emergency, such as a uterine rupture, if necessary.
    Keywords: Epidural analgesia, epidural sieve, hypotension, uterine rupture
    Version: 2017;85(2):136-139. Authors: Shelley D. Truax-Waits, MSN, CRNA
  • AANA Journal Course: Update for Nurse Anesthetists—Part 1—A Tour of Autonomic Reflex Activity Relevant to Clinical Practice The reflex arc is the functional unit allowing the human body to continuously, and unconsciously, adapt to its internal and external milieus. The authors review a broad range of autonomic reflexes controlling blood pressure, ensuring tissue oxygenation, and otherwise acting in concert to maintain homeostasis. Normal activity, pathophysiologic insult, and pharmacologic impairment of this reflex activity are discussed, with special consideration to the care of the anesthetized patient.
    Keywords: Abigail Conley, MSNA, CRNA, Chuck Biddle, PhD, CRNA, Kevin Baker, MSNA, CRNA
    Version: 2017;85(2):141-147. Authors: Autonomic reflexes, clinical practice, external milieu, reflex activity