On The Cover

A Certified Registered Nurse Anesthetist (CRNA) on assignment in Honduras reassures an older patient. Many CRNAs routinely travel abroad to assist healthcare teams providing essential procedures to those in need. In the United States, CRNAs are vigilant patient advocates at the bedside who ensure patient safety during the administration of approximately 43 million anesthetics to patients each year. In some states, CRNAs are the sole providers in nearly 100 percent of rural hospitals. (Photo by Samantha Wharff, RN.)

Articles

  • Team Communication in the Operating Room: A Measure of Latent Factors From a National Sample of Nurse Anesthetists Medical errors more often result from miscommunication among providers than lack of medical knowledge. In this study, surveys were administered to a national sample of 3,000 nurse anesthetists to measure variables associated with communication behaviors.
    Keywords: Communication, collaboration, latent variables, teamwork.
    Version: 2018;86(1):11-18. Authors: Kristin Kirschbaum, PhD; Maura S. McAuliffe, PhD, CRNA, FAAN; Melvin Swanson, PhD
  • Relationship of Tympanic and Temporal Temperature Modalities to Core Temperature in Pediatric Surgical Patients Temperature monitoring is a standard of anesthesia care as listed in Standard V of the AANA's Standards of Nurse Anesthesia Practice. This study examines which temperature modality (tympanic vs temporal) best correlates with pediatric surgical patients' core rectal temperature.
    Keywords: Core temperature, pediatric surgical patients, temperature, temporal temperature, tympanic temperature.
    Version: 2018;86(1):19-26. Authors: Debra J. Minzola, PhD, MSN, CRNA; Rebecca Keele, PhD, PHCNS-BC
  • Identifying Patterns and Meanings Across the AANA Foundation Closed Claim Dataset Using Thematic Analysis Methods The AANA Closed Claim Research Team conducts comprehensive analyses of adverse anesthesia outcomes from medical malpractice claims, identifies causes of anesthesia patient injury and negative trends, provides data that can be used to facilitate nurse anesthesia educational curricula, and facilitates recommendations.
    Keywords: Adverse events, closed claims, nurse anesthesia, patient safety, thematic analysis.
    Version: 2018;86(1):27-31. Authors: Mary Golinski, PhD, CRNA
  • Anesthetic Management in Early Recovery After Surgery Protocols for Total Knee and Total Hip Arthroplasty This integrative review provides current, evidence-based anesthetic and analgesic recommendations for inclusion in an Enhanced Recovery After Surgery protocol for patients undergoing total knee arthroplasty or total hip arthroplasty.
    Keywords: Anesthetic management, Enhanced Recovery After Surgery protocol, total hip arthroplasty, total knee arthroplasty.
    Version: 2018;86(1):32-39. Authors: Laura Oseka, DNAP, CRNA; Shannon Pecka, PhD, CRNA
  • Opioid-Sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-Analysis Posthysterectomy pain is caused by abdominal incision and traumatic manipulation of the intra-abdominal structures. Optimal pain management consists of a multimodal pain regiment combined with transversus abdominis plane (TAP) block. Databases were searched for randomized controlled trials evaluating the opioid-sparing effects of TAP block in patients undergoing hysterectomy.
    Keywords: Hysterectomy, morphine consumption, opioid-sparing effect, pain scores, transversus abdominis plane block.
    Version: 2018;86(1):41-55. Authors: Tito D. Tubog, DNAP, CRNA; Jennifer L. Harenberg, MS, CRNA; Jill Mason-Nguyen, DNAP, CRNA; Terri D. Kane, DNAP, CRNA
  • Isolated Harlequin Syndrome Following Brachial Plexus Nerve Block via Interscalene Approach: A Case Report Interscalene brachial plexus blockade is used for postoperative pain management following shoulder surgery. A known but generally benign side effect of this technique is Horner syndrome. Another syndrome, known as harlequin syndrome, exists but does not appear to be as common. This article describes an occurrence of harlequin syndrome without observed ptosis or miosis following a postoperative interscalene nerve block.
    Keywords: Brachial plexus, harlequin syndrome, interscalene, regional anesthesia, sympathetic chain.
    Version: 2018;86(1):56-58. Authors: Joshua S. Adams, BSN, CRNA; Debra J. Minzola, PhD, CRNA
  • Pharmacologic Methods for Preventing Pruritus in Patients Receiving Intrathecal Opioids for Cesarean Delivery Neuraxial anesthesia with the addition of opioids is the preferred technique for cesarean delivery. However, pruritus associated with neuraxial opioids is reported by patients to be one of the most distressing side effects. Findings of this review were incorporated into protocols for pain management for patients undergoing cesarean delivery and receiving intrathecal opioids.
    Keywords: Complication, intrathecal, obstetrics, opioids, pruritus.
    Version: 2018;86(1):59-66. Authors: Katrina Vice-O'Con, DNAP, CRNA; Paul N. Austin, PhD, CRNA; Marilyn A. Pugh, PhD
  • Happy Puppet Syndrome: A Case Report of Anesthetic Management This case report details anesthesia management of a pediatric patient with happy puppet or Angelman syndrome (AS) presenting for otolaryngologic surgery. Despite the lack of adverse events in this case, clinicians must be aware of potential anesthetic complications that are unique to patients with AS and should proceed with caution.
    Keywords: Adverse events, Angelman syndrome, happy puppet syndrome, neurogenetic disorder.
    Version: 2018;86(1):67-71. Authors: Leonardo Campero, DNAP, CRNA
  • AANA Journal Course: Update for Nurse Anesthetists - Part 6 - Nitrous Oxide for the Management of Labor Analgesia Inhaled nitrous oxide is used in the labor process for analgesia, as well as for anxiolysis in many countries, but is rarely offered in the US. Because of its minimal invasiveness, high safety index, effectiveness, and relatively low cost, it is reemerging as a consideration for use during labor. This article reviews nitrous oxide and explores current practice standards for use of nitrous oxide in managing labor analgesia.
    Keywords: Analgesia, anxiolysis, labor, N2O, nitrous oxide.
    Version: 2018;86(1):72-80. Authors: Shawn Collins, DNP, PhD, CRNA; Adam T. Fiore, MS, CRNA; Jacob A. Boudreau, MS, CRNA; Ian Hewer, MSN, MA, CRNA