Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. In this AANA Journal, an article on epidural catheters in the presence of low back tattoos appears on page 197. The anesthetist on the cover is wearing Biogel Skinsense nonlatex gloves, manufactured by Mölnlycke Health Care, Gothenburg, Sweden. (Photo taken by Dawn Welliver, CRNA, MS.)
Keywords: Alternative therapies, guided imagery, postoperative outcomes, same-day surgery.
Version: 2010;78(3):181-188.Authors: Maj Eric A. Gonzales, CRNA, MS, USAF, NC
Capt Rachel J.A. Ledesma, CRNA, MS, USAF, NC
Capt Danielle J. McAllister, CRNA, MS, USAF, NC
Lt Col Susan M. Perry, CRNA, MS, USAF, NC
Lt Col Christopher A. Dyer, CRNA, MS, USAF, NC
CDR John P. Maye, CRNA, PhD, NC, USN
Lumbar Epidural Catheter Placement in the Presence of Low Back Tattoos: A Review of the Safety Concerns The authors report that the available evidence does not identify any specific risks associated with epidural catheter placement through low back tattoos, although tissue coring with tissue transport to deeper sites has been confirmed. A strong evidence-based guideline for placing epidural needles and catheters through tattoos remains an unfulfilled goal. The authors recommend the avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.
Caudal Anesthesia in a Patient With Severe Pulmonary HypertensionPulmonary hypertension (PHTN) is a severe disease that can cause profound hemodynamic alterations in the body. The author states that the anesthesia provider needs to be vigilant and recognize the unique anesthetic considerations in order to avoid catastrophic outcomes. She concludes that caudal anesthesia is used today primarily in the pediatric population; however, this case report emphasizes the importance of maintaining the skills necessary to perform caudal anesthesia in adults.
Overview of Complex Regional Pain Syndrome and Recent Management Using Spinal Cord Stimulation Complex regional pain syndrome (CRPS) is a puzzling condition characterized by various abnormalities involving the peripheral and central nervous system. The author explains that its precise cause and progressive stages are under investigation, as little definitive knowledge currently exists.The unique symptoms and presentations within individual patients make it paramount for practitioners to keep abreast of progress in the diagnosis, management, and outcomes of CRPS.
Keywords: Nausea and vomiting, pain, regional blocks.
Version: 2010;78(3):215-220.Authors: CPT Young J. Yauger, CRNA, MSN, ANC, USA
LCDR Jay A. Bryngelson, CRNA, MSN, NC, PHS
LT Kaori Donohue, CRNA, MSN, NC, PHS
CPT Lori A. Lawhorn, CRNA, MSN, ANC, USA
MAJ (ret) Brian M. Pitcher, CRNA, MSN, ANC, USA
COL Bruce A. Schoneboom, CRNA, PhD, FAAN, ANC, USA
Dorraine D. Watts, RN, PhD
Case Report: Anesthetic Management of Acute Fatty Liver of Pregnancy in the Postpartum PeriodAcute fatty liver of pregnancy (AFLP) is a potentially fatal metabolic disorder that manifests during the third trimester. Early diagnosis, termination of pregnancy, and treatment of complications associated with AFLP significantly reduce maternal morbidity and mortality. In this case report, the author describes the management of a woman with AFLP in whom acute liver failure rapidly developed after a vaginal delivery with epidural analgesia at a small overseas hospital.
Keywords: Acute fatty liver of pregnancy, epidural anesthesia for labor, long-chain hydroxyacyl-coenzyme-A dehydrogenase deficiency, morphine metabolites, neuraxial anesthesia.
Version: 2010;78(3):223-228.Authors: LCDR Dennis Spence, CRNA, PhD, NC, USN
Effects of Arterial Blood Pressure on Rebleeding Using Celox and TraumaDEX in a Porcine Model of Lethal Femoral Injury Uncontrolled bleeding remains the leading cause of preventable death in trauma. This study was designed to identify the systolic blood pressure and mean arterial pressure at which rebleeding occurs when a clot is formed by a hemostatic agent, Celox or TraumaDEX, compared with a standard dressing. The authors conclude that Celox and TraumaDEX are statistically and clinically more effective in preventing rebleeding compared with the standard dressing (control) in the presence of elevated systolic and mean arterial blood pressures.
Version: 2010;78(3):230-236.Authors: James M. Burgert, CRNA, MSNA
Brian T. Gegel, CRNA, MSN
Capt Robert Austin III, CRNA, MSN, USAF, NC
Capt Alejandro Davila, CRNA, MSN, USAF, NC
CPT Jacob Deeds, CRNA, MSN, ANC, USA
Capt Lonnie Hodges, CRNA, MSN, USAF, NC
CPT Andrew Hover, RN, BSN, ANC, USA
Maj Cheryl Lockhart, RN, BSN, USAF, NC
CPT John Roy, CRNA, MSN, ANC, USA
CPT Glenn Simpson, CRNA, MSN, ANC, USA
CPT Stephen Weaver, CRNA, MSN, ANC, USA
Capt William Wolfe, CRNA, MSN, USAF, NC
Don Johnson, RN, PhD
Apoptosis: Understanding Programmed Cell Death for the CRNA Apoptosis, or programmed cell death, is a physiologic mechanism employed by most multicellular organisms to maintain homeostasis of body tissues. The purpose of this article is to review current information about the process of apoptosis, the role of apoptosis in comorbid diseases, and the implications of the effects of anesthesia drugs on normal apoptotic mechanisms that need to be evaluated as potential sources of risk or benefit to surgical patients.
AANA Journal Course: Update for Nurse Anesthetists – Part 2 – Cystic Fibrosis: A Systems ReviewCystic fibrosis is a fatal genetic disorder that affects many organ systems in the body. It is traditionally thought of as a childhood disease affecting the lungs and pancreas, which does not accurately describe the disease in its entirety. Many organ systems are affected, from the heart and lungs to the reproductive system, and may warrant alterations in an anesthetic plan. This review highlights the pathologic conditions associated with multiple systems, therapy regimens, and potential complications and suggests anesthetic implications.