On The Cover

Student registered nurse anesthetist Stephanie Walls, BSN, precepts physician assistant student Shawn Joy during a lumbar puncture workshop. Following the AHRQ call for interprofessional education as a means of improving patient safety, the nurse anesthesia program at Wake Forest School of Medicine finds opportunities to collaborate with other resident programs in educational activities that are mutually beneficial. (Photo by Michael Rieker, CRNA, DNP, FAAN.)

Articles

  • Methods to Improve Success With the GlideScope Video Laryngoscope Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. Evidence from lower-level sources suggested that several interventions were helpful, including using a controllable stylet, a fiberoptic bronchoscope in conjunction with the GlideScope, or an intubation guide, and twisting the endotracheal tube to facilitate passage into the trachea.
    Keywords: Airway, anesthesia, complications, GlideScope, video laryngoscope, video laryngoscopy.
    Version: 2015;83(6):389-397. Authors: Darrell Nemec, CRNA, DNAP, Paul N. Austin, CRNA, PhD, Loraine S. Silvestro, PhD
  • Malfunction of the Expiratory Valve During Spontaneous Ventilation The integrity of inspiratory and expiratory unidirectional valves is very important in the normal functioning of an anesthetic circle breathing system. We describe our experience of an emergency manipulation of a ceramic valve disk of a circle breathing system (Dräger Fabius GS, Dräger Medical Inc) that altered its characteristics and led to rebreathing only during spontaneous ventilation.
    Keywords: Ceramic valve disk, expiratory valve, rebreathing.
    Version: 2015;83(6):400-402. Authors: Byrappa Vinay, MD, DNB, DM, Kadarapura Nanjundaiah Gopala Krishna, DM, Manohar Nitin, MD
  • Comparison of Successful Intubation Between Video Laryngoscopy View Before Attempted Intubation and Direct Laryngoscopic Intubation by Student Registered Nurse Anesthetists: A Pilot Study Airway management is a primary focus when student registered nurse anesthetists (SRNAs) begin clinical rotations in their nurse anesthesia program. Successful endotracheal intubation requires both knowledge of and experience with the airway and its structures. Lack of clinical maturity and unfamiliarity with the patient airway intensifies student anxiety in the clinical arena. The purpose of this pilot study was to examine the success rate of direct laryngoscopy by 9 SRNAs who were just entering clinical practice rotations.
    Keywords: Airway, direct laryngoscopy, intubation, student registered nurse anesthetists, video laryngoscopy.
    Version: 2015;83(6):403-408. Authors: Brenda Wands, CRNA, PhD, Debra Minzola, CRNA, MSN
  • Discovery of Modern Anesthesia: A Counterfactual Narrative about Crawford W. Long, Horace Wells, Charles T. Jackson, and William T. G. Morton The discovery of anesthesia occurred during a narrow time span in the mid-19th century, but there is no agreement about who deserves credit for this important American contribution to medicine. Based mostly on an examination of primary sources, the authors examine how formal and informal interactions between the principals affected their careers, lives, and attribution of credit for the discovery of anesthesia.
    Keywords: Discovery of anesthesia, Charles T. Jackson, Crawford W. Long, W. T. G. Morton, Horace Wells.
    Version: 2015;83(6):410-415. Authors: Manisha S. Desai, MD, Sukumar P. Desai, MD
  • Influence of Patients’ “Sense of Coherence” on Main Postoperative Variables in the Postanesthesia Care Unit: A Cross-Sectional Study The objective of this study was to investigate whether patients’ sense of coherence (SOC) ability to comprehend their whole situation and their capacity to use available resources—influences acute postoperative complications in the postanesthesia care unit (PACU). The authors hypothesized that patients’ SOC would be negatively related to their experience of pain and nausea, consumption of opioids, and length of stay in the PACU—the higher the SOC, the lower the experience of pain and nausea, less consumption of opioids, and shorter PACU stay.
    Keywords: Postanesthesia care unit, postoperative pain, sense of coherence.
    Version: 2015;83(6):417-423. Authors: Dorthe Hasfeldt, MSC, RNA, Helle Terkildsen Maindal, PhD, MPH, Palle Toft, PhD, MD, Jørgen T. Lauridsen, PhD, Cand.scient.oecon, Regner Birkelund, DrPhil, PhD, MSC
  • AANA Journal Course: Update for Nurse Anesthetists—Part 5—A Review of Nonsteroidal Anti-Inflammatory Drugs It is essential that nurse anesthetists are aware of the potential side effects and interaction of drugs that patients are taking before administering an anesthetic. Among the most commonly taken medications are nonsteroidal antiinflammatory drugs (NSAIDs). Because these drugs have become almost ubiquitous, there is a risk of underestimating potential effects, which may be harmful for the patient undergoing anesthesia and surgery. These effects can range from mild to severe and can be exacerbated by drug interactions with many commonly administered medications. This review of NSAID pharmacology and interactions is intended to serve as an update and refresher for nurse anesthetists to increase their awareness of the potential untoward effects of postoperative bleeding, gastrointestinal bleeding, asthma, hepatic and renal toxicity, and cardiovascular events.
    Keywords: Adverse drug effects, drug interactions, nonsteroidal anti-inflammatory drugs.
    Version: 2015;83(6):425-433. Authors: Gregory Bozimowski, CRNA, DNP