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AANA Journal

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https://www.readbyqxmd.com/read/27501656/tranexamic-acid-in-anesthetic-management-of-surgical-procedures
#1
Jessica Mayeux, Kathy Alwon, Shawn Collins, Ian Hewer
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...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501655/unknown-pseudocholinesterase-deficiency-in-a-patient-undergoing-tiva-with-planned-motor-evoked-potential-monitoring-a-case-report
#2
Candace Binkley
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 study highlights the intraoperative and postoperative management of an elderly patient with an unknown pseudocholinesterase deficiency...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501654/preventive-dorzolamide-timolol-for-rising-intraocular-pressure-during-steep-trendelenburg-position-surgery
#3
Bonnie Lee Molloy, Xiamei Cong, Charles Watson
The 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. Dorzolamide-timolol ophthalmic drops reduce IOP and may ameliorate this effect...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501653/anesthetic-considerations-of-stiff-person-syndrome-a-case-report
#4
Kristi Hylan, An-Duyen Nguyen Vu, Katherine Stammen
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 involve the synthesis of γ-aminobutyric acid (GABA). Symptoms of SPS are precipitated by sudden unexpected movements, noises, and stress. Additionally, SPS has been linked with various autoimmune disorders, including diabetes mellitus, thyroid disease, pernicious anemia, and certain cancers...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501652/the-jehovah-s-witness-population-considerations-for-preoperative-optimization-of-hemoglobin
#5
Yasmine N Campbell, Melissa D Machan, Marquessa D Fisher
Most members of the Jehovah's Witness community refuse blood transfusions, and there are variations in what alternatives they will accept depending on their personal decisions. To provide culturally competent care, healthcare providers need to be knowledgeable about substitutions for blood administration as well as the risks and benefits of available alternatives so that they can inform their patients. It has been recognized in the literature that preoperative optimization of hemoglobin levels with alternative treatment modalities through a multidisciplinary approach can improve clinical outcomes in patients who refuse blood products...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501651/venous-thromboembolism-prophylaxis-in-plastic-surgery-a-literature-review
#6
Sergio Hernandez, Jorge Valdes, Moises Salama
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, affecting the incidence of VTE. Plastic surgeons underuse the substantiated literature and risk stratification tools that are available to decrease the incidence of VTE in the office-based surgical setting because of fear of bleeding or hematoma complications postoperatively...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501650/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-%C3%A2%C2%B5g-ml-of-fentanyl
#7
Darren Couture, Lisa Osborne, Jeffery A Peterson, Sharon M Clements, Andrew Sanders, Julie A Spring, Dennis L Spence
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. No significant difference was found in time to full motor recovery (saline group 83.18 ± 54 minutes vs control group 100...
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501649/hazardous-intraoperative-behaviors-what-s-at-risk
#8
LETTER
Joshua Philippon
No abstract text is available yet for this article.
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501648/response
#9
LETTER
Peter D Strube, Andrew D Perkins
No abstract text is available yet for this article.
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27501647/on-combat-anesthesia
#10
LETTER
Karl Kammer
No abstract text is available yet for this article.
June 2016: AANA Journal
https://www.readbyqxmd.com/read/27311154/thromboelastography-clinical-application-interpretation-and-transfusion-management
#11
COMPARATIVE STUDY
Shawn Collins, Carolyn MacIntyre, Ian Hewer
The coagulation cascade is a dynamic process dependent on many factors. It involves interaction between primary hemostasis, platelet clot formation, secondary hemostasis, thrombin generation, and fibrinolysis. The assessment of this process is particularly important in the surgical patient to properly manage hemostatic issues. Traditionally, coagulation tests used to guide transfusion management have included platelet count, activated partial thromboplastin time, prothrombin time, international normalized ratio, and activated clotting time, among others...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311153/using-a-structured-assessment-tool-to-evaluate-nontechnical-skills-of-nurse-anesthetists
#12
COMPARATIVE STUDY
Helle Teglgaard Lyk-Jensen, Peter Dieckmann, Lars Konge, Rikke Malene H G Jepsen, Lene Spanager, Doris Østergaard
Nontechnical skills are critical for good anesthetic practice but are seldom addressed explicitly in clinical training. The purposes of this study were (1) to evaluate the reliability and validity of the observation-based assessment tool Nurse Anaesthetists' Non-Technical Skills system (N-ANTS) and (2) to evaluate the effect of training nurse anesthetist supervisors in the use of N-ANTS. This system comprises a global rating score, 4 categories, and 15 elements to rate nurse anesthetists' nontechnical skills...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311152/use-of-personal-electronic-devices-by-nurse-anesthetists-and-the-effects-on-patient-safety
#13
Lauren R Snoots, Brenda A Wands
Certified Registered Nurse Anesthetists (CRNAs) provide high-quality patient care to ensure patient safety. Strict vigilance and prompt response is required of the CRNA to make critical decisions. Distractions during anesthesia delivery may threaten patient safety. Personal electronic devices (PEDs) have become an integral tool used by 90% of adults. Adaptation of PEDs has permitted their integration into current anesthesia practice. Although technologic advancements have improved accessibility to resources and communication, they also serve as a source of distraction...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311151/design-of-an-evidence-based-second-victim-curriculum-for-nurse-anesthetists
#14
REVIEW
Regina G Daniels, Ruth McCorkle
The "second victim" phenomenon--when a healthcare provider experiences adverse events because of the adverse events of a patient--is not well known or understood among healthcare professionals, including Certified Registered Nurse Anesthetists (CRNAs). No published research is currently available on the impact of second victim specifically in CRNAs, but it is known that second victim poses major challenges for healthcare professionals. Therefore, it is important to acknowledge its occurrence and to develop an educational curriculum based on the available evidence in order to promote peer and organizational support infrastructures...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311150/local-anesthetic-adjuvants-providing-the-longest-duration-of-analgesia-for-single-injection-peripheral-nerve-blocks-in-orthopedic-surgery-a-literature-review
#15
REVIEW
Jason A Patacsil, Maura S McAuliffe, Leah S Feyh, Lorie L Sigmon
Inadequate pain relief after surgery may delay surgical recovery, decrease patient satisfaction, increase length of stay, raise the risk of hospital readmissions, and increase overall healthcare costs. One way to decrease postoperative pain for patients undergoing orthopedic surgery is through the use of peripheral nerve blocks. Anesthesia providers can add many adjuvants to local anesthetics to improve quality and prolong duration of analgesia. The purpose of this literature review is to evaluate local anesthetic adjuvants to peripheral nerve blocks...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311149/effect-of-ultrasound-guided-placement-of-difficult-to-place-peripheral-venous-catheters-a-prospective-study-of-a-training-program-for-nurse-anesthetists
#16
Kohyar Partovi-Deilami, Jesper K Nielsen, Ann M Moller, Sara-Sophie S Nesheim, Vibeke L Jorgensen
Patients with difficult intravenous access (DIVA) often experience discomfort because of failed attempts to place peripheral venous catheters (PVCs); however, ultrasound guidance may improve this problem with catheter placement. The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients. This prospective observational study with a pre/post design focused on inpatients with DIVA referred for PVC placement, a service provided by nurse anesthetists in most Scandinavian hospitals...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311148/intrathecal-spread-of-injectate-following-an-ultrasound-guided-selective-c5-nerve-root-injection-in-a-human-cadaver-model
#17
Christian R Falyar, Caroline Abercrombie, Robert Becker, Chuck Biddle
Ultrasound-guided selective C5 nerve root blocks have been described in several case reports as a safe and effective means to anesthetize the distal clavicle while maintaining innervation of the upper extremity and preserving diaphragmatic function. In this study, cadavers were injected with 5 mL of 0.5% methylene blue dye under ultrasound guidance to investigate possible proximal and distal spread of injectate along the brachial plexus, if any. Following the injections, the specimens were dissected and examined to determine the distribution of dye and the structures affected...
April 2016: AANA Journal
https://www.readbyqxmd.com/read/27311147/caution-predatory-journals-want-your-business
#18
LETTER
John Aker
No abstract text is available yet for this article.
April 2016: AANA Journal
https://www.readbyqxmd.com/read/26939390/residual-neuromuscular-blockade
#19
Anna L Plummer-Roberts, Christina Trost, Shawn Collins, Ian Hewer
This article provides an update on residual neuromuscular blockade for nurse anesthetists. The neuromuscular junction, pharmacology for producing and reversing neuromuscular blockade, monitoring sites and methods, and patient implications relating to incomplete reversal of neuromuscular blockade are reviewed. Overall recommendations include using multiple settings when employing a peripheral nerve stimulator for monitoring return of neuromuscular function and administering pharmacologic reversal when the train-of-four ratio is below 0...
February 2016: AANA Journal
https://www.readbyqxmd.com/read/26939389/anesthetic-considerations-for-the-patient-with-cyclic-vomiting-syndrome
#20
Jennifer Garces
Cyclic vomiting syndrome (CVS) is characterized by intense vomiting, recurrent emergency department visits, and return to usual health status between episodes. This syndrome was first described in 1882 in a case series of pediatric patients, but there is growing understanding that CVS may occur in other age groups. This case report describes a 23-year-old with a history of CVS diagnosed in adolescence presenting for revision of a tibial plateau fracture. The patient underwent general anesthesia and had an uneventful perioperative course...
February 2016: AANA Journal
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