On The Cover

This photo depicts a central line workshop created and attended by Duke University nurse anesthesia students. Duke University's nurse anesthesia program incorporates several faculty and CRNA led workshops during the course of the program that includes pig heart dissection, difficult airway workshop, crisis scenarios, and pediatric scenarios. Photo by Arnon Chamkasem, BSN.

Articles

  • Exploring Strategies to Increase and Sustain Membership in the American Association of Nurse Anesthetists The total numbers of Certified Registered Nurse Anesthetists (CRNAs) in the United States and members of the AANA have risen to an all-time high. However, the percentage of CRNAs who are AANA members has been slowly declining since 2006, particularly among newly certified nurse anesthetists. To develop new strategies to increase and sustain CRNA membership, the AANA conducted a translational research project.
    Keywords: Attitudes, generations, membership, professional associations, students.
    Version: 2016;84(6):396-403. Authors: Cynthia Ann Farina, MSN, CRNA, Wanda Wilson, PhD, CRNA, Kim FitzSimmons, MBA
  • A Patient Safety Dilemma: Obesity in the Surgical Patient Special populations (eg, obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy. This study examines the incidence of adverse outcomes in the obese surgical population through AHRQ Patient Safety Indicators. In this study, the surgical population was overwhelmingly positive for obesity. Body mass index (BMI) was also a significant positive predictor for 2 of 3 postoperative outcomes. This finding suggests that as BMI reaches the classification of obesity, the risk of these adverse outcomes increases.
    Keywords: AHRQ, obesity, patient safety, patient safety indicators, secondary data analysis.
    Version: 2016;84(6):404-412. Authors: Victoria Goode, PhD, CRNA Elayne Phillips, PhD, RN Pamela DeGuzman, PhD, RN Ivora Hinton, PhD Virginia Rovnyak, PhD Kenneth Scully, MS Elizabeth Merwin, PhD, RN
  • Low-Dose Vasopressin and Analogues to Treat Intraoperative Refractory Hypotension in Patients Prescribed Angiotensin-Converting Enzyme Inhibitors Undergoing General Anesthesia: A Systematic Review This review assessed the utility of vasopressin and vasopressin analogues for the treatment of refractory hypotension associated with angiotensin-converting enzyme (ACE) inhibitors in the perioperative setting. A systematic review of the literature was conducted using MEDLINE, Embase, and ProQuest. Six randomized controlled trials met eligibility criteria.
    Keywords: Angiotensin-converting enzyme inhibitor, perioperative, refractory hypotension, vasopressin.
    Version: 2016;84(6):413-419. Authors: Kara F. Hedman, DNP, CRNA, Carrie L. Mann, DNP, CRNA, Cheryl Spulecki, DNAP, MS, RN, CRNA, Jessica Castner, PhD, RN, FAEN, CEN, AE-C
  • Laryngospasm as a Cause of Unsuccessful Placement of Laryngeal Mask Airway ProSeal: A Case Report Laryngospasm is a potential complication encountered during anesthesia using a laryngeal mask airway (LMA). We report a case in which laryngospasm resulted in unsuccessful placement of an LMA ProSeal Airway (Teleflex Inc), and we discuss the various causes of unsuccessful placement of this type of airway device. The possibility of laryngospasm as a cause of failed placement of an LMA ProSeal must be considered in clinical practice.
    Keywords: Laryngeal mask airway, laryngospasm, LMA ProSeal, unsuccessful placement of LMA ProSeal.
    Version: 2016;84(6):420-422 Authors: Geetanjali T. Chilkoti, MD, Medha Mohta, MD, Sai Janani, MD
  • Laryngeal Mask Airway and Valsalva Maneuver During Ophthalmic Surgery: A Case Report Use of infraglottic airways (tracheal tubes) allows for positive pressure ventilation and maneuvers, such as holding continuous positive pressure in the airway to check for pleural and dural leaks. We describe the successful use of the laryngeal mask airway (LMA; Teleflex Inc) for general anesthesia, in which continuous positive airway pressure of 15 cm H2O held for 20 seconds allowed the neurosurgeon to identify the site of a cerebrospinal fluid leak and successfully repair the leak. A well-seated LMA can be successfully used to produce continuous positive pressure in the airway not exceeding 20 cm H2O for 20 seconds to facilitate surgical identification of CSF leaks.
    Keywords: Dural leak, laryngeal mask airway, positive pressure, Valsalva maneuver.
    Version: 2016;84(6):423-425. Authors: Pamela Lovett, DNP, CRNA, Rebecca Klingbeil, MSN, CRNA, Ronald Reimer, MD, Timothy Shine, MD
  • AANA Journal Course: Update for Nurse Anesthetists—Part 5—Use of Tranexamic Acid in Preventing Postpartum Hemorrhage Postpartum hemorrhage (PPH) continues to be a serious complication in both developed and underdeveloped countries. It remains the leading cause of maternal mortality in underdeveloped countries. Implementation of the World Health Organization guidelines of PPH treatment has reduced mortality. In addition, the prophylactic administration of tranexamic acid with uterotonic agents may contribute to the reduction of PPH. This evidence-based literature review of tranexamic acid will examine its mechanism of action as well as its effectiveness in prevention of PPH and blood loss reduction in elective surgery, obstetrics, and trauma.
    Keywords: Blood loss, cesarean delivery, postpartum hemorrhage, tranexamic acid, vaginal delivery.
    Version: 2016;84(6):427-438. Authors: Derrick C. Glymph, DNAP, CRNA Tito D. Tubog, DNAP, CRNA, CCRN-CSC-CMC, CEN Mariya Vedenikina, BSN