This photo depicts the preliminary set-up for a mock induction performed by student registered nurse anesthetists who are early in their clinical practice at Allegheny School of Anesthesia/La Roche College at Allegheny General Hospital in Pittsburgh, Pennsylvania. From left to right: Philip Lynch, RN, BSN; Jimmy Sauter, RN, BSN; and Alyssa Rodecker, RN, BSN. (Photo by Jim Judkis.)
Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature ReviewVenous thromboembolism (VTE) is a major health concern because it increases morbidity and mortality after a surgical procedure. A number of well-defined, evidence-based guidelines are available delineating suitable use of prophylaxis to prevent deep vein thrombosis and pulmonary embolism. Despite the available literature, there are clear gaps between recommendations and clinical practice. This literature review determines existing VTE risk using assessment models available to aid in the implementation of protocols for VTE prevention, specifically for high-risk cosmetic surgical patients in office-based settings.
The Jehovah’s Witness Population: Considerations for Preoperative Optimization of HemoglobinMost members of the Jehovah’s Witness community refuse blood transfusions, and there are variations in what alternatives they will accept. Healthcare providers need to be knowledgeable about substitutions for blood administration. This article illuminates the current beliefs of Jehovah’s Witnesses regarding receiving blood products, discusses ethical and legal considerations for the nurse anesthetist, discusses the risks of blood transfusions, and examines transfusion alternatives. Finally, this article considers a multidisciplinary approach to the optimization of preoperative hemoglobin levels.
Anesthetic Considerations of Stiff-Person Syndrome: A Case ReportStiff-person syndrome (SPS) is a neurologic disorder characterized by painful involuntary episodes of severe muscle rigidity affecting the axial muscles and extremities. Although the etiology of SPS is unknown, it is suspected to interact with the synthesis of ?-aminobutyric acid (GABA). Because of the effect of SPS on GABA synthesis and SPS medications, inhalational agents and neuromuscular blockers have the potential to cause prolonged hypotonia following anesthesia, resulting in respiratory failure despite full reversal of neuromuscular blockade. This case report highlights the anesthetic management of a 56-year-old woman with diagnosed SPS undergoing a hemicolectomy for a colon mass using total intravenous anesthesia.
Preventive Dorzolamide-Timolol for Rising Intraocular Pressure During Steep Trendelenburg Position SurgeryThis study purpose was to evaluate preventive use of dorzolamide-timolol ophthalmic solution (Cosopt) during laparoscopic surgery with the patient in steep Trendelenburg (ST) position. Periorbital swelling, venous congestion, and elevated intraocular pressure (IOP) may produce low ocular perfusion. Prompt IOP reduction is important because 30- to 40-minute episodes of acute IOP elevations can result in retinal ganglion cell dysfunction. Dorzolamidetimolol ophthalmic drops reduce IOP and may ameliorate this effect. A double-blind randomized experimental study was conducted to test the effect of dorzolamidetimolol on IOP elevation during laparoscopic surgeries in ST position.
Unknown Pseudocholinesterase Deficiency in a Patient Undergoing TIVA with Planned Motor Evoked Potential Monitoring: A Case ReportPseudocholinesterase abnormalities are a genetic cause of aberrant metabolism of the depolarizing muscle relaxant succinylcholine. This article examines a case where succinylcholine was chosen to facilitate intubation due to its ultra-short duration and the request of the surgeon to monitor motor evoked potentials. Following succinylcholine administration the neurophysiologist was unable to obtain motor evoked potentials. This case report highlights the intraoperative and postoperative management of an elderly patient with an unknown pseudocholinesterase deficiency.
Keywords: Anesthesia, dibucaine number, motor evoked potentials, psuedocholinesterase deficiency.
Version: 2016;84(3):198-200.Authors: Candace Binkley, MSN, CRNA
AANA Journal Course: Update for Nurse Anesthetists—Part 2—Tranexamic Acid in Anesthetic Management of Surgical ProceduresBlood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots. This journal course reviews extensive research demonstrating that antifibrinolytics such as TXA decrease blood loss and in some studies reduce allogeneic transfusion requirements. In addition, this journal course addresses concerns that use of antifibrinolytics increases embolic events, reviews research that demonstrates TXA does not increase the incidence of vascular occlusive events, and describes meth ods of TXA use in cardiac and orthopedic surgical procedures, neurosurgery, and obstetrics.