On The Cover

Setting up for obstetric fistula repair surgery in Kigali, Rwanda, Jobina Ruiz, BSN, a Northeastern University student registered nurse anesthetist, fills the halothane vaporizer and checks airway equipment. Ms Ruiz participated in a global anesthesia immersion experience with the International Organization for Women and Development. Photo by Sundeep Mathur.

Articles

  • Breaking Through the Economic Barriers of Anesthesia Information Management Systems Anesthesia information management systems (AIMS) are being increasingly used to assist the delivery and documentation of anesthesia services. The major benefits of AIMS: to (1) reduce costs, (2) facilitate quality assurance and quality improvement processes, (3) increase the accuracy and completeness of the anesthesia record, and (4) improve adherence to recommended guidelines. The major drawback is cost. This article identifies 2 of the main elements of AIMS that exist in IT and data systems already present in a hospital. This project showed that it is possible to achieve 2 of the major benefits of an AIMS without the cost of purchasing one.
    Keywords: Anesthesia information management system, cost reduction, critical access hospital, quality assurance.
    Version: 2016;84(5):316-321. Authors: Brian A. Gutmann, DNP, CRNA, ARNP, Amy J. Cosimano, EdD, RN, Cormac T. O’Sullivan, PhD, CRNA, ARNP
  • Apneic Oxygenation: A Method to Prolong the Period of Safe Apnea A difficult intubation poses one of the most challenging tasks for anesthesia professionals. Unanticipated difficult mask ventilation and intubation may result in serious complications. Nine articles were selected for appraisal: 6 randomized control trials, 2 prospective studies, and 1 retrospective study. Multiple apneic oxygenation techniques demonstrated effectiveness at delaying the onset of hypoxemia during the apnea period. Prolonging the apneic window changes the nature of airway management in patients at high risk of desaturation and when an unanticipated difficult airway arises.
    Keywords: Apneic oxygenation, aventilatory mass flow, difficult airway, high-flow nasal cannula, nasopharyngeal oxygen insufflation.
    Version: 2016;84(5):322-328. Authors: Matt Pratt, MBA, BSN, BAAS, EMT-P, Ann B. Miller, DNP, CRNA, ARNP
  • Factors Influencing Patient Safety During Postoperative Handover Patient safety continues to be a major concern for healthcare providers and organizations. Handovers, also called handoffs, serve as the transfer of postoperative care from the anesthesia provider to the postanesthesia care unit provider. Ineffective handovers result in gaps in care and potential harm to the patient. This scoping review demonstrates a multilevel analysis of factors affecting handovers and patient safety.
    Keywords: Anesthesia, communication, handovers, patient safety, postanesthesia care unit.
    Version: 2016;84(5):329-338. Authors: Monica Rose, MSN, CRNA Susan D. Newman, PhD, RN, CRRN
  • Novel Use of Clevidipine for Intraoperative Blood Pressure Management in Patients With Pheochromocytoma Pheochromocytomas are rare tumors that produce excessive epinephrine and norepinephrine, leading to multiple manifestations of catecholamine surges. This article reports the planned and successful use of clevidipine (Cleviprex) as the “sole agent” for intraoperative blood pressure management in 2 adult patients with a diagnosis of pheochromocytoma undergoing elective open adrenalectomy.
    Keywords: Calcium channel blocker, catecholamine surge, clevidipine, intraoperative hypertension, pheochromocytoma.
    Version: 2016;84(5):343-347. Authors: Eric J. Lindstrom, CRNA Ahmed F. Attaallah, MD, PhD
  • Perioperative Management of Juvenile Nasopharyngeal Angiofibroma: A Retrospective Analysis of 56 Patients From a Single Tertiary Care Institute The present study was undertaken with the primary aim to analyze a large number of surgically treated patients with juvenile nasopharyngeal angiofibroma (JNA) in respect to preoperative embolization, different surgical procedures, and JNA stages. The authors conclude that most of the JNA surgeries do not require replacement of more than 2 U of blood intraoperatively. Only 1 intravenous line is required in stages IB and IIA because of less blood loss. Not all patients need to be kept intubated electively in the postoperative period.
    Keywords: Anesthesia, blood transfusion, juvenile nasopharyngeal angiofibroma.
    Version: 2016;84(5):348-356. Authors: Jyotsna Punj, MD, Saurav Chopra, MBBS, Aayushi Garg, MBBS, Ravindra Pandey, MD, Vanlol Darlong, MD, Renu Sinha, MD, Chandralekha, MD
  • Postoperative Supplemental Oxygen Is Unnecessary in Low-Risk Cesarean Delivery Parturients Under Spinal Anesthesia: An Observational Study The incidence of maternal oxygen desaturation after cesarean delivery in the postanesthesia care unit (PACU) has not been thoroughly reported. The purpose of this study was to evaluate the incidence of desaturation and to describe the frequency of supplemental oxygen administration in patients being monitored in the PACU. The incidence of postoperative oxygen desaturation in healthy parturients undergoing elective cesarean delivery under spinal anesthesia was uncommon. Routine administration of supplemental oxygen in the PACU is therefore unnecessary.
    Keywords: Cesarean delivery, desaturation, healthy parturient, postanesthesia care unit, spinal block.
    Version: 2016;84(5):358-361. Authors: Namtip Triyasunant, MD, Arunotai Siriussawakul, MD, Akarin Nimmannit, MD, Arpakorn Kunawudhi, MD, Anchala Jirakulsawat, RN
  • AANA Journal Course: Update for Nurse Anesthetists—Part 4—Perioperative Vision Loss: Considerations and Management Perioperative vision loss (POVL) associated with routine surgical procedures is a rare but catastrophic event. Although no clear direct cause of POVL has been determined, it is theorized that decreased ocular perfusion pressure of the optic nerve is responsible for POVL. This AANA Journal course article will investigate theories as to why POVL occurs, risk factors associated with POVL, anatomy related to POVL, preventive measures that may help to reduce risk of POVL, and interventions that the anesthesia provider can implement.
    Keywords: Perioperative visual loss, postoperative vision loss, prone surgery, steep Trendelenburg.
    Version: 2016;84(5):363-370. Authors: Kathleen Alwon, MSN, CRNA, Ian Hewer, MSN, MA, CRNA