On The Cover

University of South Florida (USF) nursing faculty develop a simulation scenario. The picture was taken at the Center for Advanced Medical Learning and Simulation in Tampa where the USF Nurse Anesthesia Program is housed. (Note: In an actual case involving invasive procedure, the C-arm would be covered by a sterile drape.) Pictured: LaSonya Marlbrough, DNP, CRNA; Erik Rauch, DNP, CRNA, DAAPM, NSPMC; and Alan Todd, DNP, CRNA. Photo by Ryan Noone.

Articles

  • Evaluation of Testing as a Method to Assess Continued Competency in Nurse Anesthesia Practice: A Systematic Review Competency in healthcare practice has become a priority for sustaining the goals of quality and safety in patient care delivery. Evaluating maintenance of competency for practitioners beyond their initial licensure and credentialing has become a topic of focus in recent years. A systematic review was conducted to evaluate testing as a method of assessing continued competency in nurse anesthesia practice.
    Keywords: Assessment, competency, recertification, systematic review testing.
    Version: 2016;84(4):239-245. Authors: Dru Riddle, PhD, DNP, CRNA, Kathy Baker, PhD, RN, ACNS-BC, FAAN, Alysha Sapp, MLIS
  • Laundering Methods for Reusable Surgical Scrubs: A Literature Review Surgical site infection is one of the most frequent and serious postoperative complications. The potential for scrub uniforms to carry bacteria has been shown in several studies. The purpose of this literature review is to determine if facility-laundered surgical scrubs are superior in the prevention of surgical site infections for patients undergoing surgery over home-laundering methods, to evaluate the appropriateness and safety of surgical staff laundering scrub uniforms at home, and to provide recommendations for the laundering of reusable surgical scrubs.
    Keywords: Facility laundering of hospital garments, home laundering of hospital uniforms, hospital uniform laundering guidelines, laundering of surgical scrub uniforms.
    Version: 2016;84(4):246-252. Authors: Christina M. Vera, DNP, CRNA, Tony Umadhay, PhD, CRNA, Marquessa Fisher, DNP, CRNA
  • Pulse Perfusion Values to Predict Eye Opening After Intravenous Anesthesia: An Explorative Study Variables measured in modern pulse oximetry apparatuses include a graphic pulse curve and a specified perfusion value (PV) that could be a sensitive marker for detecting differences in sympathetic activity. We hypothesized that there is a correlation between a reduction of PV and the time to eye opening after anesthesia with propofol-remifentanil.
    Keywords: Carbon dioxide, inspiratory and expiratory oxygen, intravenous anesthesia, perfusion, plethysmography, pulse oximeter.
    Version: 2016;84(4):255-259. Authors: Bruno Enekvist, PhD, CRNA, Anders Johansson, PhD, CRNA
  • Changing Endotracheal Tube Taping Practice: An Evidence-based Practice Project The purpose of this evidence-based, quality improvement practice project was to increase anesthesia providers’ knowledge and awareness of the taping practice for securing the endotracheal tube that increases the patient’s exposure to pathogens and the risk of nosocomial infections. A change in the taping practice by anesthesia providers was the desired outcome.
    Keywords: Anesthesia, anesthesia equipment, contamination, disinfection, hand hygiene.
    Version: 2016;84(4):261-270. Authors: Lois Krug, DNP, CRNA, ARNP, Melissa D. Machan, DNP, CRNA, ARNP, Jose Villalba, MD
  • Prolongation of Subarachnoid Block With Concomitant Use of Intravenous Dexmedetomidine: An Evidence-based Review A failed subarachnoid block due to prolonged surgical duration continues to be a challenging problem for anesthesia providers. This evidence-based review updates a 2013 systematic review describing the use of intravenous dexmedetomidine as an extrathecal spinal adjunct therapy capable of extending the duration of a subarachnoid block. Eight randomized controlled trials published after the 2013 systematic review met the inclusion criteria. The evidence continues to support the use of intravenous dexmedetomidine as an effective method for prolonging the duration of motor and sensory blockade and postoperative analgesia in a subarachnoid block, with minimal side effects.
    Keywords: Dexmedetomidine, duration, intravenous, spinal, subarachnoid.
    Version: 2016;84(4):271-278. Authors: William L. Johnson, DNAP, CRNA, Marilyn A. Pugh, PhD
  • Anesthetic Management of Unstable Cervical Spine: Is Intubating LMA CTrach a Right Choice? A Case Report The LMA (Laryngeal Mask Airway) CTrach (LMA North America Inc) is widely used for airway management in patients undergoing cervical spine immobilization. Three important concerns in these patients are stabilization of the neck, prevention of aspiration of regurgitated gastric contents, and hypoxia. The standard maneuver—down-up down maneuver—applied to the LMA CTrach to improve the glottis view has been reported to cause pulmonary aspiration in cases of regurgitation of gastric contents in predisposed patients. In the present case report, the LMA CTrach was used to facilitate endotracheal intubation in an anesthetized and paralyzed patient.
    Keywords: Cervical spine immobilization, laryngeal mask airway, LMA CTrach, prophylaxis.
    Version: 2016;84(4):280-282. Authors: Geetanjali T. Chilkoti, MD, Ashok Saxena, MD, FAMS
  • AANA Journal Course: Update for Nurse Anesthetists—Part 3—Awareness With Recall: A Systematic Review This article provides a systematic review of awareness with recall, also called intraoperative awareness. Major topics of this review include the incidence and causes of this phenomenon, in addition to an examination of current strategies for prevention of intraoperative awareness. Awareness with recall creates substantial physical and/or psychological distress for the patient, representing a continued threat to patient safety. Factors related to cases of awareness include those of the patient, surgical procedure, anesthesia provider, and system in which providers deliver care.
    Keywords: Anesthesia awareness, depth-of-anesthesia monitors, electroencephalogram.
    Version: 2016;84(4):283-288. Authors: Caitlin Sullivan, DNAP, CRNA