On The Cover

Michael Rieker, CRNA, DNP, director of the Nurse Anesthesia Program at Wake Forest University Baptist Medical Center, Winston-Salem, NC, begins a combined spinal-epidural block on a patient for her cesarean section. The photo was taken at Methodist Medical Center in Peoria, Ill, where Dr Rieker was formerly the lead nurse anesthetist for Obstetrics. (Photo taken by Angie Symonds, RN.)

Articles

  • The Universal Oxygen Connector Patients benefit from the administration of supplemental oxygen in the perioperative period. Supplemental oxygen has been shown to decrease postoperative hypoxemia, infection, and in some cases, nausea and vomiting. In this article, the authors describe the benefits of using the Universal Oxygen Connector, that is, how it decreases material waste, decreases hospital costs, saves time and effort and, most importantly, promotes patient safety by providing a versatile system for oxygen delivery.
    Keywords: Perioperative oxygen administration, supplemental oxygen, Universal Oxygen Connector.
    Version: 2006;74:30-34. Authors: Mark A. Lauer, CRNA, MS Rebecca L. M. Gombkoto, CRNA, MS
  • Converting from an endotracheal tube to tracheostomy: Description of a proposed alternative approach Replacing an existing endotracheal (ET) tube with a tracheostomy tube can be a challenging and high-risk procedure for the patient, surgeon, anesthetist, and operating room staff. In this article, the author details an approach designed to reduce the risks involved, and, at the same time, provide a safe, efficient, and simplified approach to surgically securing the airway.
    Keywords: Airway fire, elective tracheostomy, long-term ventilation, surgical airway.
    Version: 2006;74:35-38. Authors: Keene B. Pickard, CRNA, MSNA
  • Off-pump coronary artery bypass grafting: A case report This article briefly outlines the historical evolution of cardiac surgery that led to the development of the technology necessary to perform off-pump coronary artery bypass grafting (OPCAB). A case report of a 72-year-old female who underwent OPCAB is outlined. Included is a discussion of some of the benefits and potential complications of coronary artery bypass grafting and OPCAB, along with anesthetic considerations for OPCAB procedures.
    Keywords: Anesthesia, coronary artery bypass grafting, off-pump coronary artery bypass, history.
    Version: 2006;74:39-44. Authors: Leanne P. Behny, CRNA, MSN
  • Gorham disease: An intraoperative case study Gorham disease is a rare chronic disorder that is characterized by the abnormal proliferation of thin-walled capillaries and small lymphatic vessels that results in the massive osteolysis of adjacent bone. The case presented involves a 47-year-old man with Gorham disease complicated by unilateral chylothorax who was treated with thoracic duct ligation. The anesthetic implications associated with Gorham disase are discussed, and nonsurgical primary and adjunctive treatments for chylothorax are summarized.
    Keywords: Chylothorax, Gorham disease, osteolysis, vanishing bone disease.
    Version: 2006;74:45-48. Authors: James Underwood, CRNA, MSN John Buckley, CRNA, MSN Bill Manning, CRNA, MSN
  • The role of COX-2 inhibitors in the perioperative setting: Efficacy and safety—A systematic review A new class of nonsteroidal anti-inflammatory drugs (NSAIDs) selective for cylooxygenase-2 (COX-2) offers new options for managing perioperative pain; however, new and conflicting data have emerged regarding all nonsteroidal anti-inflammatory drugs, including those selective for COX-2. This article reviews 30 prospective studies on the role of COX-2 selective inhibitors in the perioperative setting. The studies examined a variety of variables, including efficacy, perioperative opioid reduction, and effects on platelet aggregation and renal function.
    Keywords: COX-2, cyclooxygenase-2, perioperative pain, platelet aggregation, renal function.
    Version: 2006;74:49-60. Authors: Melissa Holmes Zemmel, CRNA, MSNA
  • AANA Journal Course, Part 6 Update for nurse anesthetists -- Migraine development, treatments, research advances, and anesthesia implications The purpose of this AANA Journal course is to update anesthesia providers on the phenomenology and biological mechanisms underlying migraines. As experts in pain management who encounter this common ailment, anesthesia providers frequently are consulted to assist in patient care. Effective assessment and treatment of migraine will lead to better anesthesia management. Discussion includes age of onset and prevalence of migraines, clinical diagnoses of headaches, major factors in migraine development, pharmacological intervention, anesthesia management, and recent pharmacological research.
    Keywords: Anesthesiology, calcitonin gene-related peptide, migraine, trigeminal nerve, vasodilation.
    Version: 2006;74:61-68. Authors: LTC Joseph O'Sullivan, CRNA, MS, AN, USA Joseph T. McCabe, PhD