On The Cover

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Articles

  • Perioperative Considerations in Patients With Concussion It is vital to delineate the best practice in the perianesthesia period to minimize additional damage to the concussed brain. There are currently no practice guidelines surrounding perianesthesia management of patients with concussion to guide practice. Further research is needed to identify evidence-based interventions for managing patients after concussion requiring anesthesia.
    Keywords: Concussion, mild-traumatic brain injury, neurometabolic cascade, secondary neurologic injury.
    Version: 2019;87(2):97-104. Authors: Daniel King, MNA, CRNA; Angela Collins-Yoder, PhD, RN, CCNS, ACNS-BC
  • High-Fidelity Mannequin Simulation versus Virtual Simulation for Recognition of Critical Events by Student Registered Nurse Anesthetists Early recognition of intraoperative critical events is essential in optimizing the health outcomes of surgical patients. Use of simulation in nurse anesthesia education allows students to practice recognizing changes in the patient’s condition in a safe learning environment. Second- and third-year student registered nurse anesthetists were randomly assigned to 2 groups to explore differences in recognizing intraoperative myocardial infarction (MI) using high fidelity mannequin simulation vs virtual simulation.
    Keywords: Critical event, high-fidelity simulation, nurse anesthesia, virtual simulation.
    Version: 2019;87(2):105-109. Authors: Lisa Rose Erlinger, PhD, CRNA; Andrew Bartlett, PhD; Amelia Perez, PhD, RN
  • To Block or Not to Block: Role of Ultrasonography in Guiding an Anesthetic Plan for a Patient With Charcot-Marie-Tooth Disease A 31-year-old man scheduled for a fifth metatarsal head resection secondary to osteomyelitis presented to the preoperative holding area for placement of an ultrasound-guided popliteal nerve block as part of a multimodal pain management plan. During the preoperative evaluation, a medical history of Charcot-Marie-Tooth disease was noted.
    Keywords: Charcot-Marie-Tooth, double-crush phenomenon, peripheral neuropathy, regional anesthesia, ultrasound.
    Version: 2019;87(2):110-113. Authors: Christian R. Falyar, DNAP, CRNA
  • A Randomized Controlled Trial of Anesthesia Guided by Bispectral Index Versus Standard Care: Effects on Cognition Postoperative cognitive dysfunction, a subtle deterioration of cognitive function after exposure to anesthetics, is reported in 10% to 50% of surgical cases. This study tested the impact on cognitive function of balanced anesthetic using electroencephalographic (EEG) guidance vs usual anesthesia. The authors’ findings provide data to support optimal anesthetic approaches to improve cognitive function after anesthesia with volatile anesthetics.
    Keywords: Anesthesia technique, mild cognitive impairment, postoperative cognitive dysfunction.
    Version: 2019;87(2):115-123. Authors: Zohn Centimole, PhD, CRNA; John Eichhorn, MD; Susan K. Frazier, PhD, RN, FAHA; Gregory A. Jicha, MD, PhD; Mary Kay Rayens, PhD; John F. Watkins, PhD; Sarah F. Centimole, MA; Debra K. Moser, PhD, RN, FAAN
  • Cardiovascular Complications in Patients Undergoing Noncardiac Surgery: A Cardiac Closed Claims Thematic Analysis A qualitative analysis of 34 closed malpractice claims with a cardiac-related event was conducted to determine common themes. Five common themes emerged: preanesthetic evaluation, normalization of deviance, medications, hemorrhage, and knowledge deficit/failed clinical reasoning.
    Keywords: Cardiac arrest, cardiovascular collapse, closed claims, malpractice.
    Version: 2019;87(2):124-130. Authors: Marjorie Geisz-Everson, PhD, CRNA; Lorraine Jordan, PhD, CRNA, CAE, FAAN; Kelly Wiltse Nicely, PhD, CRNA; Patrick McElhone, CRNA, APRN
  • A Primer to Pharmacogenetics of Postoperative Pain Management This article reviews genetic diversity in humans and the various ways in which this genetic variability may influence pharmacokinetics and pharmacodynamics of drugs. This knowledge will ensure that anesthesia providers can effectively tailor anesthesia care and postoperative pain management to improve outcomes.
    Keywords: Pharmacogenetics, pharmacogenomics, postoperative pain, primer, review.
    Version: 2019;87(2):131-137. Authors: Edwin N. Aroke, PhD, CRNA; Julie M. Kittelsrud, PhD, CNP
  • Impact of Education on Professional Involvement for Student Registered Nurse Anesthetists’ Political Activism: Does Education Play a Role? Two surveys were distributed to all 12 Pennsylvania nurse anesthesia educational programs to determine the quality and quantity of advocacy education incorporated into their program and how it affected the professional political involvement of senior student registered nurse anesthetists. Pearson r calculations were conducted to assess for correlations between variables. The results showed a strong positive correlation between advocacy education in nurse anesthesia educational programs and the impact it has on students’ professional advocacy involvement (r = 0.481, P = .001).
    Keywords: Advocacy education, CRNA advocacy, CRNA advocacy education, nurse anesthesia, nurse anesthesia advocacy education.
    Version: 2019;87(2):138-143. Authors: Jessica Poole, DNAP, CRNA; John Borza, DNP, MBA, CRNA; Louise Ann Cook, MS, CRNA.
  • Prevention and Treatment of Laryngospasm in the Pediatric Patient: A Literature Review Laryngospasm is an exaggeration of a protective reflex that prevents aspiration of foreign objects into the lower airway (eg, during swallowing). This evidence-based literature review explores the pathophysiology of laryngospasm and covers mechanical and pharmacologic prevention and treatment modalities in pediatric patients.
    Keywords: Laryngospasm, pediatric, prevention, protective reflex, treatment.
    Version: 2019;87(2):145-151. Authors: Shawn Collins, DNP, PhD, CRNA; Paul Schedler, MS, CRNA; Brad Veasey, MS, CRNA; Andrea Kristofy, MD; Mason McDowell, DNP, CRNA
  • AANA Journal Course: Update for Nurse Anesthetists—Assessing Frailty and Its Implications on Anesthesia Care and Postoperative Outcomes in Surgical Patients This article aims to explore the Phenotype Theory of Frailty and the Accumulated Deficits Theory of Frailty and possible anesthetic implications of incorporating frailty screening into patient care. Use of a modified frailty index as a tool in a high-quality preoperative evaluation may help practitioners risk-stratify patients. This can allow for earlier mobilization of care resources before surgery to improve outcomes.
    Keywords: Accumulated deficits of frailty, frailty, modified frailty index, phenotype of frailty, postsurgical outcomes.
    Version: 2019;87(2):152-159. Authors: Timothy J. Donoghue, DNAP, CRNA