On The Cover

Rachel Beers Harrison, CRNA, MSN, performs a spinal anesthetic for a patient in Rwanda suffering from an obstetrical fistula. Rachel was a student when this photo was taken, participating in a partnership between the Wake Forest Baptist Health Nurse Anesthesia Program and the International Organization for Women’s Development. In Rwanda, patients travel from all corners of the country in response to a radio broadcast, and they live in communal tents while waiting for their surgery. The project allows women to lead fuller lives in their communities. (Photo taken by Sara Messenger, CRNA, MSN.)

Articles

  • To Press or Not to Press, and If So, With What? A Single Question–Focused Meta-analysis of Vasopressor Choice During Regional Anesthesia in Obstetrics Given the underlying assumption that reasonable maternal hemodynamics can be achieved with either ephedrine or phenylephrine, this focused meta-analysis addresses the impact of vasopressor choice on resultant neonatal Apgar scores during regional anesthesia. The literature was systematically searched for randomized trials of obstetric vasopressor use employing standard search tools. The current meta-analysis provides an updated, evidence-based validation of vasopressor use from the American Society of Anesthesiologists’ 2007 “Practice Guidelines for Obstetric Anesthesia.”
    Keywords: Apgar score, meta-analysis, neuraxial hypotension, obstetric hypotension, obstetric vasopressor, vasopressor.
    Version: 2013;81(4):261-264. Authors: Chuck Biddle, CRNA, PhD
  • Detection of Pneumothorax with Ultrasound Diagnosis of a pneumothorax in the perioperative area can be difficult. Traditional gold-standard modalities may not be available or feasible to institute. Ultrasound guidance allows the anesthesia provider a method of quickly ruling out this potentially life-threatening complication. This article details the use of sonography for fast and accurate diagnosis of pneumothorax.
    Keywords: Bat sign, lung sliding, pleural line, pneumothorax, seashore sign, ultrasound.
    Version: 2013;81(4):265-271. Authors: Jonathan P. Kline, CRNA, MSNA, David Dionisio, CRNA, Kevin Sullivan, CRNA, Trey Early, CRNA, Joshua Wolf, CRNA, Deanna Kline, CRNA, DNP,
  • Forced-Air Warming Design: Evaluation of Intake Filtration, Internal Microbial Buildup, and Airborne-Contamination Emissions Forced-air warming devices are effective for the prevention of surgical hypothermia. However, these devices intake nonsterile floor-level air, and it is unknown whether they have adequate filtration measures to prevent the internal buildup or emission of microbial contaminants. This article highlights the need for upgraded intake filtration, preferably high-efficiency particulate air filtration, on current generation forced-air warming devices.
    Keywords: Airborne contamination, filtration, forced-air warming, operating room ventilation, patient warming.
    Version: 2013;81(4):275-280. Authors: Mike Reed, MBBS, MD, FRCS, Oliver Kimberger, MD, Paul D. McGovern, BSc, MBBS, MRCS, PGCME, FHEA, Mark C. Albrecht, MStat, MBA, BSME
  • Use of a Positive Pressure Endoscopic Mask to Assist With Positive Pressure Ventilation in a Morbidly Obese Patient During Fiberoptic Intubation: A Case Report Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.
    Keywords: Airway stenting, endoscopic mask, fiberoptic intubation, morbid obesity, positive pressure ventilation.
    Version: 2013;81(4):282-284. Authors: Dewi De Jarnett, CRNA
  • Pediatric Posttransplant Anesthesia: A Summary Review of the Literature With Recommendations for Clinical Practice In the ambulatory surgical setting, patients may present with grossly abnormal oxygen saturation (Spo2) readings that, along with other disease pathology, make referral to an inpatient facility a straightforward decision. Patients presenting with unexplained slightly abnormal Spo2 readings might make evaluation as an appropriate candidate for the ambulatory setting more problematic. Little guidance is provided for these scenarios in current consensus documents. A retrospective analysis was performed.
    Keywords: Ambulatory surgery, oxygen saturation, perioperative, postoperative changes, Spo2.
    Version: 2013;81(4):292-296. Authors: Michael Seneca, CRNA, MSN, Mark Zapp, MD, Martha Seneca, FNP-BC, MSN
  • Severe Pulmonary Hypertension: A Noncardiac, Nonobstetric Surgical Case Study This report describes the noncardiac, nonobstetric surgical case of a 29-year old woman with idiopathic pulmonary arterial hypertension. This case study briefly summarizes the surgical case and then discusses history, current classifications, epidemiology, pathophysiology, contemporary treatments, and basic anesthetic management related to pulmonary hypertension.
    Keywords: Anesthesia management, noncardiac surgery, nonobstetric surgery, pulmonary hypertension.
    Version: 2013;81(4):297-302. Authors: Jennifer E. Andrews, CRNA, MSN, BSN, BSEd
  • Epidural Anesthesia for Cesarean Delivery Facilitated by Minimally Invasive Hemodynamic Monitoring in a Patient With Fontan Repair: A Case Report Anesthesia providers encounter patients with complex and rare conditions. One such example is the single ventricle congenital cardiac defect, which is corrected with Fontan reconstructive surgery. To care for patients who have undergone the Fontan procedure, the anesthesia provider needs an in-depth knowledge of the anatomy and physiology behind Fontan circulation. This article presents a brief overview of the anatomy and physiology of Fontan circulation.
    Keywords: Cesarean delivery, epidural, Fontan repair, Vigileo monitor.
    Version: 2013;81(4):303-306. Authors: Tyler Wilhelm, CRNA
  • AANA Journal Course: Update for Nurse Anesthetists – Part 3 – Tobacco Smoking Using a Waterpipe (Hookah): What You Need to Know Smoking tobacco using a waterpipe is increasing worldwide. Based on available evidence, there is no indication that waterpipe tobacco smoking is any less risky to patient health than cigarette smoking. Anesthesia providers should begin to assess patients for this form of tobacco use explicitly and should consider addressing it as they do cigarette smoking, with the additional precaution of presurgery carboxyhemoglobin measurement.
    Keywords: Carbon monoxide, hookah, nicotine, tobacco, waterpipe.
    Version: 2013;81(4):308-313. Authors: Thomas Eissenberg, PhD