On The Cover

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.)

Articles

  • Effects of a 30-mL Epidural Normal Saline Bolus on Time to Full Motor Recovery in Parturients Who Received Patient-Controlled Epidural Analgesia With 0.125% Bupivacaine With 2 µg/mL of Fentanyl Previous research suggests that an epidural bolus of 30 mL of normal saline after vaginal delivery may decrease the time for recovery from motor block. A double-blind, randomized controlled study was conducted in 46 parturients to determine if a 30-mL normal saline bolus or sham administered via epidural approach after delivery reduces the time to full motor recovery and the time to 2-dermatome regression.
    Keywords: Epidural, motor block, normal saline, parturient, washout.
    Version: 2016;84(3):159-165. Authors: CDR Darren Couture, PhD, CRNA, NC, USN, CAPT Lisa Osborne, PhD, CRNA, NC, USN, LCDR Jeffery A. Peterson, MSN, CRNA, NC, USN, LCDR Sharon M. Clements, MSN, CRNA, NC, USN, CDR Andrew Sanders, MSN, MBA, MHCA, CRNA, NC, USN, LT Julie A. Spring, MSN, CRNA, NC, USN, CDR Dennis L. Spence, PhD, CRNA, NC, USN
  • Venous Thromboembolism Prophylaxis in Plastic Surgery: A Literature Review Venous 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.
    Keywords: Chemoprophylaxis, deep vein thrombosis, low-molecular-weight heparin, venous thromboembolism, plastic surgery.
    Version: 2016;84(3):167-172. Authors: Sergio Hernandez, DNP, CRNA, Jorge Valdes, DNP, CRNA, Moises Salama, MD
  • The Jehovah’s Witness Population: Considerations for Preoperative Optimization of Hemoglobin Most 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.
    Keywords: Bloodless surgery, elective surgery, Jehovah's Witnesses, transfusion alternatives.
    Version: Authors: Yasmine N. Campbell, DNP, CRNA, Melissa D. Machan, DNP, CRNA, Marquessa D. Fisher, DNP, CRNA
  • Anesthetic Considerations of Stiff-Person Syndrome: A Case Report Stiff-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.
    Keywords: Moersch-Woltman syndrome, stiff-man syndrome, stiff-person syndrome, stiff-limb syndrome, total intravenous anesthesia.
    Version: 2016;84(3):181-187. Authors: Kristi Hylan, DNP, CRNA, An-Duyen Nguyen Vu, CRNA, Katherine Stammen, MD
  • Preventive Dorzolamide-Timolol for Rising Intraocular Pressure During Steep Trendelenburg Position Surgery This 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.
    Keywords: Chemosis, intraocular pressure, ischemic optic neuropathy, ocular perfusion pressure, postoperative visual loss.
    Version: 2016;84(3):189-196. Authors: Bonnie Lee Molloy, PhD, CRNA Xiamei Cong, PhD, RN Charles Watson, MD, FCCM
  • Unknown Pseudocholinesterase Deficiency in a Patient Undergoing TIVA with Planned Motor Evoked Potential Monitoring: A Case Report Pseudocholinesterase 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 Procedures Blood 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.
    Keywords: Antifibrinolytic, coagulant, surgery, surgical blood loss, transexamic acid.
    Version: 2016;84(3):201-209. Authors: Jessica Mayeux, MSN, CRNA, Kathy Alwon, MSN, CRNA, Shawn Collins, DNP, PhD, CRNA, Ian Hewer, MSN, MA, CRNA