On The Cover

New Hampshire Certified Registered Nurse Anesthetist Nicole Boswell, MSN, CRNA, provides attentive care during general anesthesia throughout corrective abdominal surgery. On this trip Medical Ministry International provided care for 77 major and 35 minor surgeries to the people of Monte Plata, Dominican Republic. (Photo by Dana Ortega.)

Articles

  • Understanding Bone Cement Implantation Syndrome Bone cement implantation syndrome (BCIS) is a rare and potentially fatal perioperative complication of cemented bone surgery. This article reviews the history of bone cement and its associated hazards, etiology/ pathophysiology and clinical presentation of BCIS, preoperative assessment, planning for cemented procedures, and anesthetic management of BCIS.
    Keywords: Anesthesia, arthroplasty, bone cement implantation syndrome, methyl methacrylate.
    Version: 2018;86(6):433-441. Authors: Cheryl B. Hines, EdD, CRNA
  • Complications Related to Laryngeal Mask Airway Use and a Postoperative Diagnosis of Reinke Edema: A Case Study This case report describes a partial airway obstruction encountered with the use of a laryngeal mask airway and the inability to deliver adequate tidal volumes despite manipulation and device exchange. The patient later received a diagnosis of Reinke edema, a polypoid degeneration of the true vocal folds, which caused a ball-valve effect intermittently obstructing the glottic aperture with ventilation from excessive bulk and redundancy of the true vocal folds.
    Keywords: Ball-valve obstruction, cigarette smoking, gastroesophageal reflux disease, polypoid degeneration, Reinke edema.
    Version: 2018;86(6):443-445. Authors: LCDR Danielle K. Cuevas, DNP, CRNA, NC, USN; CDR Raymond Bonds, DNP, CRNA, CHSE, NC, USN; CDR Angela Powell, MD, MC, USN
  • A Certified Registered Nurse Anesthetist’s Transition to Manager The purpose of this exploratory qualitative study was twofold: (1) to identify common experiences or barriers that arise during the first year as Certified Registered Nurse Anesthetists (CRNAs) move into management and (2) to identify knowledge, skills, abilities, and resources needed to ensure a smooth and successful career transition for new CRNA managers. Results of this investigation may assist current and future CRNA managers to be better prepared.
    Keywords: First-time manger, hybrid manager, nurse manager, physician manager.
    Version: 2018;86(6):447-454. Authors: Jennifer Martens, DNAP, CRNA; Jane Motz, DNAP, CRNA; Lawrence Stump, MEd, CRNA
  • Methylene Blue as an Adjunct to Treat Vasoplegia in Patients Undergoing Cardiac Surgery Requiring Cardiopulmonary Bypass: A Literature Review The term vasoplegia describes hypotension refractory to vasopressor therapy, a common finding related to cardiac surgery requiring cardiopulmonary bypass. High doses of vasoactive agents are associated with adverse effects such as peripheral and mesenteric ischemia. Databases were systematically searched for literature on methylene blue as an adjunct therapy to treat vasoplegia. Fifteen articles were selected. The quality of the studies was evaluated using the US Preventive Services Task Force grading tool, and a chart was created to present the components of each study.
    Keywords: Cardiac surgery, methylene blue, refractory hypotension, vasoplegia.
    Version: 2018;86(6):455-463. Authors: Vanessa N. Arevalo, DNP, CRNA; Megan L. Bullerwell, DNP, CRNA
  • Thematic Analysis of Obstetric Anesthesia Cases From the AANA Foundation Closed Claims Database Maternal morbidity and mortality in the United States continues to be high. Understanding parturient complications and causes of death is critical to determine corrective actions. Analysis of closed malpractice claims identifies preventable morbidity and mortality, evaluates patient care, and offers recommendations for improvement.
    Keywords: Errors, maternal, morbidity, mortality, preventable errors.
    Version: 2018;86(6):464-470. Authors: Beth Ann Clayton, DNP, CRNA; Marjorie A. Geisz-Everson, PhD, CRNA; Bryan Wilbanks, PhD, DNP, CRNA
  • Mobile Computing Devices in the Perioperative Environment: A Survey Exploring Uses and Experiences Among Certified Registered Nurse Anesthetists The use of mobile computing devices (MCDs) such as smartphones, tablet computers, and laptops among Certified Registered Nurse Anesthetists (CRNAs) in the clinical area may provide benefits as well as pose risks. A descriptive survey design was used. Findings from the study reveal that CRNAs believe there are many important benefits as well as major risks associated with using MCDs.
    Keywords: CRNA, distraction, informatics, mobile computing device, vigilance.
    Version: 2018;86(6):471-478. Authors: Anne Marie Hranchook, DNP, CRNA; Barbara B. Penprase, PhD, RN, CNE, ANEF; Ronald J. Piscotty, PhD, RN-BC
  • Implementation of an Education Program for an Ultrasound-Guided Liposomal Bupivacaine Transversus Abdominis Plane (TAP) Block Protocol for Open Abdominal Procedures Anesthetists at the authors’ facility had varying education and training with placing transversus abdominis plane (TAP) blocks and with the use of liposomal bupivacaine limiting the utilization of this regional anesthetic technique for patients undergoing abdominal surgical procedures. An expansive literature review suggested that ultrasound-guided liposomal bupivacaine TAP blocks were safe and effective.
    Keywords: Exparel, liposomal bupivacaine, TAP block, transversus abdominis plane block.
    Version: 2018;86(6):479-487. Authors: Lisa O’Driscoll, DNP, CRNA, NC, USN; Robert G. Girolamo, DNP, CRNA; Christopher Crerar, DNP, CRNA; Walter Williamson, MSN, CRNA; Chad Moore, DNP, CRNA; Kenneth Wofford, PhD, CRNA; Raymond Bonds, DNP, CRNA
  • Intravenous Dexamethasone as an Analgesic: A Literature Review Multimodal analgesia has demonstrated a benefit in patient outcomes following a surgical procedure. A review of the literature was conducted. Multiple studies were found that demonstrated dexamethasone’s ability to lower postoperative pain scores and reduce the amount of opioids required to achieve adequate pain scores.
    Keywords: Analgesic adjunct, dexamethasone, multimodal analgesia.
    Version: 2018;86(6):488-493 Authors: Sean G. Moore, MSN, CRNA
  • AANA Journal Course: Update for Nurse Anesthetists—Cryoneurolysis for the Treatment of Sensory Nerve Pain Acute and chronic pain account for high costs both societally and economically, estimated in the United States to be $635 billion. Cryoneurolysis is a minimally invasive, nonsurgical, nonpharmacologic pain management technique that uses cold temperatures to ablate the sensory nerves that cause pain. Because of its safe and reversible nature, cryoneurolysis should be considered as part of a multimodal pain management plan.
    Keywords: Acute pain, chronic pain, cryoanalgesia, cryoneurolysis, nonpharmacologic pain management.
    Version: 2018;86(6): 495-503. Authors: Alison Smiley, CRNA; Jason McGuire, PhD, CRNA