Jeffrey Molter, CRNA, MSN, MBA, performs a peribulbar block, while Barb Finley, RN, retracts the upper eyelid on a patient at Park West Surgical Center, Akron, Ohio. "The patient is about to undergo cataract surgery," said Molter. "Approximately 2,500 cataract and oculoplastic procedures are performed each year at the facility." (Photo taken by Wendy Corcoran, RN)
Isobaric Spinal Anesthesia: A Suitable Approach for a Morbidly Obese PatientMorbid obesity is a relatively common and vastly increasing condition that can have a profound impact on morbidity and mortality during the administration and maintenance of general and regional anesthesia. This case report discusses the advantages of regional versus general anesthesia in the morbidly obese patient population, in conjunction with an analysis of the various types of spinal anesthetics. This is followed by a focused discussion related to the management of a morbidly obese patient undergoing a nonelective orthopedic procedure.
Awake Video Laryngoscope Intubation: Case Report of a Patient With a Nasopharyngeal MassVideo laryngoscopes have been shown to improve visualization of the glottic opening and have become a useful aid in managing difficult airways. The purpose of this article is to summarize the use of a video laryngoscope for an awake intubation and to suggest alternative uses of these devices in other awake intubation scenarios. The case report presented offers a description of successful awake intubation using a video laryngoscope in a patient with a large pedunculated mass arising from the nasopharynx and extending down into the oropharynx.
Keywords: Awake intubation, difficult airway, video laryngoscope.
Anesthetic Implications of Postpolio Syndrome: New Concerns for an Old DiseasePolio vaccines have essentially eradicated the disease in the United States; however, poliovirus infection survivors who experienced a paralytic attack can see a return of some symptoms, which is postpolio syndrome. The authors conclude that the anesthetist must preoperatively assess the patient and be aware of the need to select short-acting anesthetic agents whenever possible and protect the patient because of inherent muscle weakness, painful joints and muscles, cold intolerance, and reduced protective reflexes.
Ease of Intubation With the Parker Flex-Tip or a Standard Mallinckrodt Endotracheal Tube Using a Video Laryngoscope (GlideScope)Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT) and the standard Mallinckrodt. To the authors’ knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope.
A Cesarean Hysterectomy for Invading Placenta Percreta: Anesthetic Safety Considerations – A Case ReportPatients presenting with abnormal placentation have a complicated surgical course and a high mortality rate. The author offers a case study of a patient with an invading placenta percreta who presented with a number of risk factors associated with this disease. A review of the current literature yields recommendations for anesthetic management of this challenging and potentially life-threatening obstetric scenario. This case underlines the importance of a well-coordinated multidisciplinary approach to a complex condition.
Emergency Cesarean Delivery in Primigravida With Portal Hypertension, Esophageal Varices, and PreeclampsiaThe incidence of cirrhosis and advanced portal hypertension during pregnancy is low, and the literature is scarce with regard to the anesthetic management of a parturient with this coexisting disease. In this case report, the authors discuss the successful perioperative management of a parturient with a history of cirrhosis and portal hypertension with esophageal varices and mild preeclampsia who presented at 38 weeks’ gestation in active labor with a breech presentation requiring emergency cesarean delivery.
AANA Journal Course: Update for Nurse Anesthetists – Part 4 – Is That Snoring Something to Worry About? Anesthetic Implications for Obstructive Sleep ApneaObstructive sleep apnea (OSA) is a chronic disease that is underdiagnosed. It is characterized by repetitive pauses in breathing during sleep that can last for several seconds and can subsequently cause hypoxia-related complications. The authors state that patients having diagnostic procedures or surgeries in which sedation or anesthesia will be received should be evaluated for OSA to prevent or reduce postoperative complications. While research into the effects of surgery and anesthesia on sleep and with patients affected by OSA is ongoing, compliance with these recommendations, along with vigilance, will help ensure that many patients with OSA can be managed safely during their surgical experience.