On The Cover

Tamara Wojciechowski, CRNA, FAAPM, NSPM-C, a Certified Registered Nurse Anesthetist and also a Fellow of the American Academy of Integrated Pain Management, is pictured asking a student to identify the spinous and transverse processes of the lumbar spine during one of the AANA’s Jack Neary Pain Management Workshops. Wojciechowski is currently completing a PhD in Health Sciences with a focus on anatomical composition.

(Photo by Christopher Bettin, MA.)

Articles

  • Emergent Bilateral Face-lift Hematoma: A Case Report The face-lift, or rhytidectomy, is a common surgical procedure in the United States. Facial hematoma is the most frequent complication after face-lift. Sometimes an emergent expanding hematoma may require general anesthesia and can present difficulty in securing the airway. This article reviews the frequency and causes of an expanding hematoma and how it affects anesthesia care.
    Keywords: Airway, face-lift, hematoma, postoperative complication.
    Version: 2018;86(3):188-193. Authors: Ann-Marie Whitney, MSNA, CRNA
  • Should Continuous Subcutaneous Insulin Infusion (CSII) Pumps Be Used During the Perioperative Period? Development of a Clinical Decision Algorithm According to the CDC, there are 30.3 million Americans with diabetes mellitus (DM). It is estimated that more than 400,000 individuals with DM are using continuous subcutaneous insulin infusion (CSII) pumps as a method to maintain blood glucose control. A multidisciplinary team at a large military medical center was formed to develop a decision-making algorithm to assist anesthesia providers in caring for patients with CSII pumps.
    Keywords: Continuous subcutaneous insulin infusion, diabetes mellitus, hyperglycemia, hypoglycemia, insulin.
    Version: 2018;86(3):194-200. Authors: LCDR Shannan Rotruck, MSN, CRNA, NC, USN; LCDR Lauren Suszan, DNP, MSN, CRNA, NC, USN; Robert Vigersky, MD, COL(ret) MC, USA; CAPT John Rotruck, MD, MBA, MC, USN; Carlton Brown, MD; John Capacchione, MD; L. Alan Todd, DNP, CRNA, CHSE
  • Improving Patient Outcomes Through Closed-Claims Analysis: Salient Characteristics and Patterns Associated With Respiratory Events A retrospective, exploratory research design was used to analyze salient characteristics and patterns associated with closed claims involving Certified Registered Nurse Anesthetists (CRNAs) in which a respiratory event caused the adverse outcome. Respiratory events were the most frequent cause of adverse outcomes in the current database (34%). The respiratory adverse outcomes often resulted in mortality or significant and permanent morbidity (69%) and were largely preventable (81%).
    Keywords: Adverse patient outcomes, closed claims research, hypoventilation, respiratory complications, standard of care.
    Version: 2018;86(3):201-208. Authors: Sandra L. Larson, PhD, CRNA, APN, FNAP; Robert W. Matthews, PhD, CRNA; Lorraine Jordan, PhD, CRNA, CAE, FAAN; Maria T. Hirsch, DNAP, CRNA
  • Anesthetic Management of a Patient With Type 1 von Willebrand Disease and Uterine Placental Abruption: A Case Report Von Willebrand disease is the most common inherited blood disorder, occurring in about 1% of the population. This article examines the anesthetic management of a parturient with a known diagnosis of von Willebrand disease who presented to the labor and delivery unit in active labor and with a suspected uterine placental abruption.
    Keywords: Abruption, anesthesia, placenta, uterus, Von Willebrand.
    Version: 2018;86(3):209-212. Authors: Michael C. Roberson, DNAP, CRNA; Morgan D. Wigley, BSN, RN-C; Paul N. Austin, PhD, CRNA
  • Reexamining Metoclopramide’s Role in the Prevention of Postoperative Nausea and Vomiting: A Secondary Analysis Postoperative nausea and vomiting (PONV) continue to be among the most undesirable and distressing complications following general anesthesia, affecting up to 70% of patients with multiple known risk factors. This study reexamines the effectiveness of metoclopramide in the prevention of PONV when stratified by PONV risk scores.
    Keywords: Metoclopramide, nausea and vomiting, postoperative, prophylaxis, risk.
    Version: 2018;86(3):213-219. Authors: Amy J. Masiongale, DNP, CRNA; Jane T. Garvin, PhD, RN, FNP-BC; Marguerite J. Murphy, DNP, RN; Vallire D. Hooper, PhD, RN, CPAN, FAAN; Jan Odom-Forren, PhD, RN, CPAN, FAAN; James I. Masiongale, DNP, CRNA; Stephen W. Looney, PhD
  • Subanesthetic-Dose Ketamine to Decrease Emergence Delirium in the Surgical Patient With Posttraumatic Stress Disorder Recently, emergence delirium (ED) has been associated with patients with posttraumatic stress disorder (PTSD). Currently, no research exists to support best practice in this population. Identification of the pathophysiologic alterations that occur in ED and PTSD can guide pharmacotherapy. Emerging evidence suggests that glutaminergic dysfunction plays a role in ED and PTSD.
    Keywords: Emergence delirium, glutamate, ketamine, NMDA antagonist, posttraumatic stress disorder.
    Version: 2018;86(3):220-224. Authors: Kristina Hintzsche, MSNA, CRNA
  • Investigation of the Anxiolytic and Antidepressant Effects of Crocin, a Compound from Saffron (Crocus sativus L), in the Male Sprague-Dawley Rat Finding alternative treatments to reduce the personal and financial burden for patients with anxiety and depression, while maintaining patient safety, is vital. The purposes of this study were to determine if crocin produces anxiolytic and/or antidepressant effects using rat models for anxiety and behavioral despair and to determine the effects of crocin at the benzodiazepine site on the γ-aminobutyric acid type A receptor.
    Keywords: Anxiolysis, crocin, depression, saffron, Sprague-Dawley rat.
    Version: 2018;86(3):225-233. Authors: Tomás E. Ceremuga, PhD, CRNA, LTC(ret), ANC, USA; Melissa P. Ayala, BSN, RN, CCRN; CPT Ryan W. Chicoine, BSN, RN, CCRN; CPT Sung M. Chun, BSN, RN, CCRN; CPT James M. DeGroot, BSN, RN, CCRN; Devin T. Henson, BSN, RN, CCRN; CPT Seth A. Randall, BSN, RN, CCRN; CPT Leah R. Stanley, BSN, RN, CCRN; COL Denise M. Beaumont, DNAP, CRNA
  • Maternal and Fetal Outcomes With Early Neuraxial Engagement in Obese Parturients Research indicates the combination of obesity and pregnancy is correlated with increased morbidity, mortality, and healthcare costs. The clinical inquiry of this study was: Does early neuraxial placement in obese parturients decrease the rate of cesarean delivery, decrease use of general anesthesia, and improve fetal Apgar scores?
    Keywords: Anesthesia, neuraxial, obesity, parturient.
    Version: 2018;86(3):234-241. Authors: Sheila Ray, DNP, CRNA; Beverly Bradley, PhD, RN
  • AANA Journal Course: Update for Nurse Anesthetists—Herbal Medications and Anesthesia Case Management Herbal medicine use in the United States has increased substantially. Despite this upward trend, patients often fail to disclose use of these medicines to their healthcare provider. Because herbal medicines have the potential to adversely react with medications used in the perioperative period, anesthesia providers should be aware of the purported uses of common herbal supplements, potential drug interactions with these medicines or possible contaminants, and the anesthetic implications for patients who use these medicines.
    Keywords: Anesthesia, herbal supplements, herb-drug interactions, perioperative complications, traditional Chinese herbal medicine.
    Version: 2018;86(3):242-248. Authors: Timothy J. Donoghue, DNAP, CRNA
  • Online Content: Letters
    Keywords: Letters
    Version: Authors: Linda Welch, DNP, CRNA; Nitin Manohar, MD, DNB, DM; Gajanan, Fultambkar, DNB; Sagar Bandishte, MD, DNB; Keerthi Shankar Rao, DA, DNB; Deepti Srinivas, PDF; Jiale Hu, RN, MScN; Yan Yang, RN, MScN