Peter J. Kosbab, CRNA, shown with patient at Mercy Memorial Hospital System, Monroe, Michigan. Procedure: Robotic (DaVinci) assisted total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. Kosbab notes: "Our anesthesia department use a clear, transparent OR drape. This creates a sterile barrier between the anesthesia personnel and the sterile surgical field. We hang the drape 4 to 5 feet above the level of the OR table. This prevents irrigation fluids and body secretions from spraying anesthesia personnel and/or contaminating the sterile OR field. The transparent drape allows the anesthetist to view the patient and all contact anesthesia equipment." (Photo by Marketing Department, Mercy Memorial Hospital.)
Anesthetic Management of Patients With Major Burn InjuryBurn injury is a leading cause of life-threatening trauma worldwide, affecting more than 450,000 Americans each year and is associated with an average mortality rate of 0.8%. Patients with an increased risk of death from burn injuries include elderly patients and patients with large burns or inhalation injury. Providing optimal care for patients with major burn injuries requires the coordinated effort of multidisciplinary teams in which anesthesia providers play a critical role. Anesthetic management for burn surgery can be technically challenging because of difficult airway management and vascular access, as well as cognitively demanding because of dramatic pathophysiologic changes that compromise hemodynamic stability and alter patient response to many anesthetic agents. This article reviews the literature related to the pathophysiology and clinical management of major burn injuries and highlights the key concepts relevant to the delivery of safe and efficacious anesthesia for these patients.
Rethinking the Paradigm: Evaluation of Ketamine as a Neurosurgical AnestheticAlthough anesthetists have long assumed that ketamine’s role in neuroanesthesia is limited because of its association with increased intracranial pressure, this article presents a review of recent clinical literature suggesting otherwise. When ketamine is used as an adjuvant anesthetic agent along with mechanical ventilation to maintain normocapnia, ketamine does not have adverse cerebral hemodynamic effects. Furthermore, ketamine possesses a unique pharmacologic profile that provides analgesia, bronchodilation, and sympathetic stimulation, thereby reducing patients’ vasoactive agent requirements. Caution must be exercised because of ketamine’s action at the N-methyl-d-aspartate receptor (NMDAR), as ketamine may antagonize both neuroprotective and neurodestructive NMDAR-mediated pathways. This article examines how ketamine may prove to be a safe part of a neuroanesthetic regimen, and it should no longer be considered absolutely contraindicated as a result of its cerebral hemodynamic effects.
Descriptors of Anesthesia Support Personnel From the Perspective of Practicing Certified Registered Nurse AnesthetistsAnesthesia support personnel provide direct support to anesthesia providers. They bring extra supplies or equipment, prepare equipment for the case, maintain and clean equipment, and generally function as directed by the anesthesia provider. Given the importance of anesthesia support personnel in maintaining equipment essential to safe anesthesia practice, it is necessary to ensure that these individuals are properly trained and capable of complying with safety standards. However, the literature describing this population is limited and shows variation in the utilization and qualifications of these personnel. A prospective, descriptive survey of Certified Registered Nurse Anesthetists was conducted to describe the education, training, job functions, and work environment of anesthesia support personnel. Results (N = 354) indicated that utilization of anesthesia support personnel varies by hospital but has a propensity for greater utilization at larger medical centers that have a level I or II trauma center. Formal supervision of these personnel is limited. Their tasks tended to be more frequently directed at equipment management, with a smaller portion of anesthesia support personnel performing tasks related to direct patient care. This article illustrates how further research is needed to adequately describe this population.
Keywords: Anesthesia equipment, anesthesia support personnel, anesthesia technicians.
Version: 2012;80(6):453-459.Authors: Mary Bryant Ford, CRNA, PhD
AANA Journal Course: Update for Nurse Anesthetists – Part 5 – The Perioperative Implications of Posttraumatic Stress DisorderPosttraumatic stress disorder (PTSD) is an anxiety disorder that develops after exposure to a traumatic event and is characterized by symptoms of reexperiencing, emotional numbing, persistent arousal, and avoidance. Approximately 6.8% of the people in the United States will be diagnosed with PTSD at some point in their lives. The presence of PTSD in a surgical patient can be important because PTSD is associated with the use of psychoactive medications, risky health behaviors, cardiovascular comorbidities, depression, chronic pain, and cognitive dysfunction, all of which may influence the risk of perioperative morbidity and mortality. In addition, patients with PTSD are anxious around unfamiliar people and in unfamiliar environments. The purposes of this Journal course are to provide anesthetists with a working knowledge of the symptoms, treatments, and comorbidities associated with PTSD and to suggest ways of interacting with patients with the disorder that increase trust and decrease the risk of evoking posttraumatic symptoms in the perioperative environment.