Jackie Rowles, CRNA, MBA, FAAPM, performs a provocative discography at Indianapolis Neurosurgical Group's Comprehensive Pain Management Center in Indianapolis, Ind, where she performs diagnostic and therapeutic injections of the spine. The procedure requires placement of specialized needles into the center of each disc tested. The discs are pressurized by the injection of contrast material, and the patient's response is recorded. Information from this procedure is used in the determination for potential fusion or disc replacement surgery. For more information on this procedure, see the "Guest Editorial."
Anesthesia information management systemsDocumentation is the last component of anesthesia patient management to be affected by technology, explains the author, who provides information related to the patient and businesses related uses of computerized anesthesia record keeping. The author states that knowledge of these topics will provide nurse anesthetists with the ability to have valid input in the purchase and implementation of an information management system.
Keywords: Automated, database, documentation, information management, vendor.
Version: 2005;73:178-181.Authors: Joe R. Williams, CRNA, MS
Suspected pharyngoesophageal perforation after a difficult intubation: A case reportAlthough uncommon and rarely reported, pharyngoesophageal perforation has medical and legal consequences of substantial proportion. Perforation of the upper aerodigestive system may result in severe airway complications that include pneumothorax, pneumonia, mediastinitis, and retropharyngeal abscess. In this case report, the authors point out that knowledge of and prompt attention to the cardinal signs of pharyngoesophageal injury in partnership between the anesthetist and the surgical team were the key instruments in ruling out this potentially devastating diagnosis.
Are patients with obstructive sleep apnea syndrome appropriate candidates for the ambulatory surgical center?Obstructive sleep apnea syndrome (OSAS) is a disease process affecting every phase of anesthesia care delivery. The authors explain that patients with OSAS undergoing procedures at ambulatory surgery centers may be at increased risk because they are discharged to home. The influence of residual anesthetics, analgesia, airway edema, and disruption of sleep cycles may result in significant postoperative apneic events in this patient population.
Keywords: Ambulatory surgery center, obstructive sleep apnea syndrome, respiratory complications.
Version: 2005;73:197-205.Authors: Daniel D. Moos, CRNA, MS
Matt Prasch, CRNA, MS
David E. Cantral, MD
Ben Huls, CRNA, MS
James D. Cuddeford, CRNA, MA
Use of a remifentanil and propofol combination in outpatients to facilitate rapid discharge homeThe purpose of this study was to evaluate whether the combination of remifentanil and propofol facilitated shorter recovery time and decreased charges compared with conventional balanced anesthesia. The authors studied patients who underwent elective outpatient surgery. They concluded that a remifentanil-propofol combination is more cost effective than conventional balanced anesthestics and enables some patients to bypass the PACU, resulting in quicker discharge.
Insertion of a folded laryngeal mask airway around a palatal torusIn this review article, the author states that a palatal torus is a common benign bony exostosis that should be recognized by the anesthesia provider during the preoperative anesthetic assessment. A palatal torus can hinder insertion of the laryngeal mask airway (LMA) when using the standard LMA insertion technique, therefore, modification must be made to the operator's insertion technique with a folded LMA around a palatal torus.
AANA Journal Course, Part 2 Update for nurse anesthetists -- An overview of multiple sclerosis and implications for anesthesiaMultiple sclerosis (MS) is unpredictable, as are the effects of anesthesia in patients with MS. In this AANA Journal course, an overview of MS has been provided for anesthesia providers for a better understanding of the disease process, including an explanation of the pathophysiologic features, symptoms and manifestations, diagnosis, pharmacologic treatments, risks and potential effects of surgery, and the use of general vs regional anesthesia. Patients should be informed and understand that exacerbations of MS are possible following surgery and anesthesia.
Keywords: Anesthesia, general anesthesia, multiple sclerosis, regional anesthesia.
Version: 2005;73:217-224.Authors: Kristina M. Schneider, RN, MSN