On The Cover

Pam Bender, BSN, RN, the director of surgical services at Braxton County Memorial Hospital (BCMH) in Gassaway, West Virginia accompanied her son into the operating room during his induction of anesthesia for a tonsillectomy. Pam captured this picture of Mike Frame, CRNA, DMP, as he was preparing for her son’s induction of anesthesia. BCMH is a critical access hospital nestled in the mountains of rural West Virginia. CRNAs proudly serve as the sole anesthesia professionals at BCMH. (Photo taken by Pam Bender, BSN, RN.)

Articles

  • A Review of the Evidence for Active Preoperative Warming of Adults Undergoing General Anesthesia A search strategy to identify systematic reviews and investigations in peer-reviewed journals was undertaken to identify evidence examining the efficacy of preoperative warming. Most studies support the implementation of active preoperative warming.
    Keywords: Adult, anesthesia, body temperature, heating, prewarming.
    Version: 2013;81(5):351-356. Authors: Michael C. Roberson, CRNA, DNAP, Loraine S. Dieckmann, PhD, Ricardo E. Rodriguez, PhD, Paul N. Austin, CRNA, PhD
  • Impact of Goal-Directed Perioperative Fluid Management in High-Risk Surgical Procedures: A Literature Review Guidelines for the perioperative administration of fluid are often based on static hemodynamic targets. Such formulaic approaches fail to address the roles of tissue oxygenation and end-organ perfusion in achieving positive long-term patient outcomes. This article reviews randomized controlled trials measuring the impact of perioperative goal-directed therapy on outcomes among patients undergoing high-risk procedures.
    Keywords: Fluid management, goal-directed therapy, hemodynamic monitoring, optimization, perioperative.
    Version: 2013;81(5):357-368. Authors: Crystal D. Trinooson, CRNA, MS Michele E. Gold, CRNA, PhD
  • Use of a Left-Sided Double-Lumen Endotracheal Tube in a Patient With a Prior Left Pneumonectomy The early identification of a newly developing carcinoma on the right upper pulmonary lobe warranted surgical resection. This case report describes the intraoperative anesthetic management of a right upper lobe wedge resection and attributes the uneventful intraoperative outcome to a strategically and skillfully placed left double-lumen endotracheal tube.
    Keywords: Double-lumen endotracheal tube, pneumonectomy, pulmonary lobe wedge resection.
    Version: 2013;81(5):369-375. Authors: John Lang, DO, Michael Hartman, CRNA, DNP
  • Anesthetic Management of a Patient With Congenital Insensitivity to Pain: A Case Report Congenital insensitivity to pain is a rare inherited disorder, which is a part of the hereditary sensory and autonomic neuropathy (HSAN) family. It is imperative for anesthesia providers to understand which type of HSAN their patient experiences and to conduct a thorough preoperative interview because a different interpretation of sensory loss may occur in each HSAN category.
    Keywords: Congenital insensitivity to pain, hereditary sensory and autonomic neuropathy, pain.
    Version: 2013;81(5):376-378. Authors: Laura M. Parrott, CRNA
  • Development of an Amygdalocentric Neurocircuitry-Reactive Aggression Theoretical Model of Emergence Delirium in Posttraumatic Stress Disorder: An Integrative Literature Review The purposes of this integrative literature review were to present a synopsis of current literature describing PTSD, the amygdalocentric neurocircuitry, emergence delirium, reactive aggression, and the interaction of general anesthetics and the amygdalocentric neurocircuitry; synthesize this evidence; and develop a new theoretical model.
    Keywords: Amygdalocentric neurocircuitry, emergence delirium, posttraumatic stress disorder, reactive aggression, veteran.
    Version: 2013;81(5):379-384. Authors: Jason McLott, CRNA, MSN Jerry Jurecic, CRNA, MSN Luke Hemphill, CRNA, MSN Karen S. Dunn, PhD, RN, FGSA
  • ​Anesthetic Implications of Myasthenia Gravis: A Case Report Myasthenia gravis is an autoimmune neuromuscular disorder. The resultant respiratory and cardiovascular implications are a primary cause of mortality. The case presented demonstrates the anesthetic challenges involved, with a focus on the overall approach, pharmacologic considerations, physiological changes, and an emphasis on preoperative optimization.
    Keywords: Anesthesia, myasthenia gravis, neuromuscular disorder.
    Version: 2013;81(5):386-388. Authors: Eugene Postevka, CRNA, MSN
  • A Novel Approach to Improving the Safety of Patients Undergoing Lumbar Laminectomy Checklists serve to increase safety, improve consumer satisfaction, and reduce mortality and morbidity. This research project examined the use of a checklist for nurse anesthetists who provide care for patients undergoing spinal surgery. The checklist addressed specific positioning needs as a means of decreasing mortality and morbidity.
    Keywords: Checklist, ischemic optic neuropathy, malpositioning, postoperative vision loss, Trendelenburg position.
    Version: 2013;81(5):389-393. Authors: Edward M. Salkind, CRNA, DNAP
  • Anesthetic Management of a Simultaneous Emergency Craniotomy and Cesarean Delivery Fetal heart tone monitoring is a frequently used tool during nonobstetric maternal surgery. The case of a parturient requiring an emergency craniotomy, during which fetal heart tone monitoring demonstrated fetal distress patterns, is presented. A simultaneous emergency craniotomy and emergency cesarean delivery proceeded with favorable outcomes.
    Keywords: Cesarean delivery, concurrent surgery, craniotomy, fetal heart tone, monitoring.
    Version: 2013;81(5):394-398. Authors: Blaire Wouters, CRNA, MNA David B. Sanford, CRNA, EMT-P
  • AANA Journal Course: Update for Nurse Anesthetists – Part 4 – Transcatheter Aortic Valve Replacement If aortic stenosis is left untreated, survival in symptomatic patients averages only 2 to 3 years. Surgical aortic valve replacement is the only definitive treatment, yet 30% of elderly patients are not considered candidates. Transcatheter aortic valve replacement is an innovative, high-tech, less invasive alternative.
    Keywords: Aortic stenosis, cardiac anesthesia, hybrid operating room, transcatheter aortic valve implantation, transcatheter aortic valve replacement.
    Version: 2013;81(5):399-408. Authors: Peggy Contrera, CRNA, MSN, Mary Cushing, CRNA, MS