Michael Heck, CRNA, MS, APRN, performs a bilateral ultrasound-guided continuous oblique subcostal transversus abdominis plane block for a patient who has undergone an open hiatal hernia repair. He is assisted by block nurse Priscilla Silchuk, BSN, at The Medical Center in Bowling Green, Kentucky. (Photo taken by Barbara Wortham, RN.)
Difficult Intubation Resulting in Surgical Repair of Esophageal and Hypopharyngeal PerforationAlthough rare, perilous injury of the aerodigestive tract due to traumatic endotracheal intubation can have devastating consequences for patient and provider. This case report presents a 70-year-old woman scheduled for an elective hip arthroplasty. Intraoperatively she was unable to be intubated, and her operation was canceled. In the postanesthesia care unit, the patient underwent an otolaryngologyconsultation and was admitted for observation of reactive airway edema. Pharyngoesophageal perforation was diagnosed several days later and required surgical repair.
Primary Cesarean Delivery Results in Emergency Hysterectomy due to Placenta Accreta: A Case StudyPlacenta accreta is a major cause of obstetric hemorrhage, a situation that remains the most significant cause of maternal morbidity and mortality worldwide. It is generally recognized that a previous cesarean delivery increases the risk ofplacenta accreta. However, the risk also increases with previous intrauterine procedures. This case study demonstrates the success of quickly initiating protocol interventions necessary to prevent disseminated intravascular coagulation and maternal mortality, and it reviews current literature on risk identification, management, and treatment of obstetric hemorrhage resulting from placenta accreta.
Methods of Identifying and Managing the Difficult Airway in the Pediatric PopulationThe goal of this literature review is to provide the anesthesia practitioner with the skill set to detect and prepare for a difficult pediatric airway. This article provides an overview of preoperative assessment techniques, normal pediatric airway anatomy, and respiratory physiology. An emphasis is placed on some common syndromes and their related anatomical abnormalities that can compromise the airway, as well as anesthetic approaches recommended to successfully secure a potentially difficult airway.
Music in the Operating Room: Is It a Safety Hazard?Since 1960, hospital noise levels have risen around the world. Nowhere in the healthcare setting is noise more prevalent than in the operating room. Although noise in the OR is unavoidable, music is a choice. The purpose of this literature review is to provide further insight into the ramifications of the presence of music in the OR, evaluate its appropriateness in relation to care and safety for the patient and staff, and provide information for future research.
Keywords: Music in the operating room, noise-induced hearing loss, noise in the operating room, safety hazards in the operating room.
Alice Magaw: A Model for Evidence-Based PracticeThe model of evidence-based practice (EBP) of Alice Magaw places the practice of nurse anesthesia as an early pioneer in patient safety and is prophetic to the aims of the Institute of Medicine. This article illustrates how Magaw used her vast expertise in anesthetic administration to develop protocols and a body of knowledge that could be used as a template for practitioners near and far. This early use of EBP principles places nurse anesthesia at the forefront of the model and the movement to provide high-quality care.
Keywords: Evidence-based practice, Institute of Medicine, Alice Magaw, patient safety.
Version: 2015;83(1):50-55.Authors: Victoria Goode, CRNA, MSNA
AANA Journal Course: Update for Nurse Anesthetists—Part 6—Surgical Site Infection and Prevention Guidelines: A Primer for Certified Registered Nurse AnesthetistsEach year 500,000 surgical site infections occur in the US. Surgical site infections are the second most common healthcare-associated infections resulting in readmissions, prolonged hospital stays, higher medical costs, and increased morbidity and mortality. Surgical site infections are preventable in most cases by following evidence-based guidelines for hand hygiene, administration of prophylactic antibiotics, and perioperative patient temperature management. The Certified Registered Nurse Anesthetist can provide transparent high-quality care by implementing evidence-based guidelines for timely and appropriate antibiotic use, maintenance of normothermia, and hand washing.
Keywords: Antibiotic prophylaxis, hand washing, hypothermia, Surgical Care Improvement Project, surgical site infection.