Student nurse anesthetists at Middle Tennessee School of Anesthesia (MTSA) in Madison, Tennessee, perform a fiberoptic intubation in the Simulations Skills Center. The Center is a part of a $3 million dollar expansion/renovation at the school. Pictured (l to r) are: Misenga Kabongo, placing a femoral arterial line using an arrow catheter; Huy Nguyen, managing fluids and various drips; Amber Todaro, performing the intubation; and Dawn Price, managing the tongue and having suction available. (Photo by Jim Closser, MTSA vice president for Advancement & Alumni.)
Comparison of 2 Laryngeal Tracheal Anesthesia Techniques in Reducing Emergence PhenomenaEndotracheal intubation (ETT) can cause emergence phenomena (EP) including coughing, sore throat, and dysphonia. Two methods used to prevent EP are the administration of local anesthetics directly onto airway structures using a specialized laryngotracheal instillation of topical anesthesia tube or the placement of a local anesthetic into the ETT cuff. The purpose of this research was to determine which method was better at preventing EP. The study demonstrated greater efficacy in decreasing the incidence and severity of EP by placing an alkalinized solution of lidocaine into the ETT cuff on intubation.
Anesthesia in a Child with Pyruvate Dehydrogenase Deficiency: A Case ReportPyruvate dehydrogenase deficiency is an ´-linked mutation causing deficiencies of pyruvate dehydrogenase phosphatase that results in elevated lactic acid and is aggravated by the ingestion of carbohydrates in the diet. In this case report, the authors report a pediatric patient with pyruvate dehydrogenase deficiency who presented for a left foot tendon transfer with an Achilles tendon lengthening secondary to left ankle equinus. The pathophysiology of pyruvate dehydrogenase deficiency is discussed as well as anesthetic management in patients with this deficiency.
Anesthesia for Cesarean Delivery in an Achondroplastic Dwarf: A Case ReportThe authors describe the anesthetic management of an achondroplastic dwarf who underwent cesarean delivery. There are more than 100 different types of dwarfism, and achondroplasia is the most common form of this rare condition. Limited neck extension, foramen magnum stenosis, a large tongue, large mandible, and atlanto-axial instability can lead to increased difficulty of airway management. The authors conclude that adequate preparation and planning are fundamental for successful anesthetic management of an achondroplastic dwarf undergoing cesarean delivery.
Keywords: Achondroplastic dwarf, difficult airway, general anesthesia, regional anesthesia.
Multidisciplinary Management of Peripartum Cardiomyopathy During Repeat Cesarean Delivery: A Case ReportPeripartum cardiomyopathy (PPCM) is a potentially fatal form of heart failure associated with pregnancy. The worldwide incidence of PPCM is about 1 in 3,000 to 1 in 15,000 pregnancies. This case report illustrates the recognition of peripartum cardiomyopathy and the risks early in pregnancy. It also describes the appropriate medical management, including transesophageal echocardiography, and the need for collaboration of multiple medical specialists before and during delivery to provide the best possible outcome for both mother and infant.
AANA Journal Course: Update for Nurse Anesthetists—Part 5—Implications of Immune Function to Anesthesia CareMultiple aspects of perianesthesia care and the perioperative environment can influence the functions of the immune system. This course reviews basic immune system functions and potential sources of immune system–altering perioperative stress. The effects of commonly used anesthesia drugs, opioids, and adjunct drugs on immune function are discussed. Patient populations at risk for increased morbidity due to perioperative immune depression are identified, along with patient-specific measures nurse anesthetists can take to reduce postoperative immune dysfunction.