On The Cover

MAJ Peter Strube, CRNA, MSNA, APNP, ARNP, ANC, USA, (right) is assisted by Spanish anesthesia provider Jorge Gomez in the delivery of care to a trauma patient in Herat, Afghanistan.

Articles

  • Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia.
    Keywords: Esmolol, opioid sparing, perioperative analgesia and anesthesia.
    Version: 2015;83(3):167-177. Authors: Megan Harless, CRNA, MSN Caleb Depp, CRNA, MSN Shawn Collins, CRNA, DNP, PhD Ian Hewer, CRNA, MSN, MA
  • Identification of a Very High Cuff Pressure by Manual Palpation of the External Cuff Balloon on an Endotracheal Tube The most common complication due to intubation is a high cuff pressure. A high cuff pressure can cause postanesthetic tracheal mucosal injuries in patients undergoing surgery. The aim of this cross-sectional study was to describe whether anesthetic nurses and anesthesiologists identified a very high cuff pressure by manual palpation of the external cuff balloon on an endotracheal tube.
    Keywords: Anesthesia staff, cuff pressure, cuff pressure manometers, manual palpation.
    Version: 2015;83(3):179-182. Authors: Pia Hedberg, RNA, PhD Carolina Eklund, RNA, MSc Sandra Högqvist, RNA, MSc
  • Healthcare Utilizing Deliberate Discussion Linking Events (HUDDLE): A Systematic Review "Huddle moments" can be described as a preparatory briefing among healthcare providers for the purpose of exchanging information and bringing awareness to patient safety concerns. A historical background of huddle communication is described, and a systematic literature review was conducted on preoperative briefing and huddle communication. This article provides a systematic review of HUDDLE communication and gives future evidence based recommendations on how the huddle can be used in healthcare.
    Keywords: Communication, huddle, interprofessional communication, preoperative brief, team brief.
    Version: 2015;83(3):183-188. Authors: Derrick C. Glymph, CRNA, DNAP Maria Olenick, PhD, FNP, RN Salvatore Barbera, MHA, FACHE Ellen Leslie Brown, EdD, MS, RN, FAAN Lauren Prestianni, CRNA, MSN Crystal Miller, CRNA, MSN
  • Anesthesia Information Management Systems: An Underutilized Tool for Outcomes Research Perioperative outcomes research using anesthesia information management systems (AIMS) is an emerging research method that has not been comprehensively reviewed. This review reports an initial analysis of the use of AIMS for perioperative patient outcomes research from articles published between January 1980 and January 2013.
    Keywords: Anesthesia information management systems, observational study, perioperative outcomes research, risk factors.
    Version: 2015;83(3):189-195. Authors: Fengyan Deng, CRNA, DNP Joanne V. Hickey, PhD, RN
  • Implementation of Mass Transfusion Protocol in the Outpatient Operating Room Setting: A Case Study The current definition of massive transfusion is replacement of 5 U of packed red blood cells in 3 hours because of uncontrolled hemorrhage or replacement of the entire blood volume within a 24-hour period. The prompt activation of a transfusion protocol can quickly restore hemodynamic stability. This case study demonstrates the effectiveness of using a massive transfusion protocol in an outpatient setting.
    Keywords: Communication, intraoperative hemorrhage, massive transfusion protocol.
    Version: 2015;83(3):196-199. Authors: Holly-May Robins, CRNA, DNAP, MBA Brenda Warner, CRNA, MS
  • Low-Flow Anesthesia, Low Fresh Gas Flow, and Oxygen Flush: An Interesting Interplay Identification and analysis of critical respiratory alarms during use of an advanced anesthesia workstation is essential in the intraoperative period. We present and discuss a scenario in which there was activation of a fresh gas flow alarm during low-flow anesthesia intraoperatively and use of oxygen flush to counteract it led to a diluted concentration of the inspired anesthetic agent.
    Keywords: Dräger Primus ventilator, fresh gas decoupling, low-flow anesthesia, oxygen flush.
    Version: 2015;83(3):200-202. Authors: Byrappa Vinay, MD, DNB, DM Kadarapura Nanjundaiah Gopalakrishna, DNB, DM Kamath Sriganesh, MD, DNB, DM
  • Does Moral Distress Differ Between California Certified Registered Nurse Anesthetists in Independent Versus Medically Supervised Practice: An Exploratory Study This study’s purpose was to determine if moral distress levels differed between certified registered nurse anesthetists (CRNAs) working in medically supervised versus independent practice in California. A 63-question survey was administered to 1,190 California CRNAs.
    Keywords: Anesthesia, ethics, independent practice, medical supervision, moral distress.
    Version: 2015;83(3):203-209. Authors: Michael Dumouchel, CRNA, DNP Michael Boytim, CRNA, EdD Nicholas Gorman, EdD, MPH Penny Weismuller, DrPH, RN
  • AANA Journal Course: Update for Nurse Anesthetists—Part 2—Venous Thromboembolism: New Concepts in Perioperative Management Venous thromboembolism (VTE) is a serious pathophysiologic condition that is a major cause of morbidity and mortality, especially during the perioperative period. A collective term, VTE is used to describe a blood clot that develops inside the vasculature and results in a deep vein thrombosis and/or a pulmonary embolism (PE). This article reviews the current approaches to pharmacologic and nonpharmacologic prevention and management of VTE during the perioperative period. Identification and treatment of deep vein thrombosis and acute PE are also described.
    Keywords: Antithrombotic therapy, deep vein thrombosis, pulmonary embolism, venous thromboembolism.
    Version: 2015;83(3):211-. Authors: Sass Elisha, CRNA, EdD Jeremy Heiner, CRNA, EdD John Nagelhout, CRNA, PhD, FAAN Mark Gabot, CRNA, MSN