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airway, nurse anesthetist

Eric Noll, Shivam Shodhan, Arnavi Varshney, Christopher Gallagher, Pierre Diemunsch, F Barry Florence, Jamie Romeiser, Elliott Bennett-Guerrero
BACKGROUND: Aspiration of gastric contents is a leading cause of airway management-related mortality during anesthesia practice. Cricoid pressure (CP) is widely used during rapid sequence induction to prevent aspiration. National guidelines for CP suggest a target force of 10 N before and 30 N after loss of consciousness. However, few studies have rigorously assessed whether clinicians can be trained to consistently achieve these levels of force. We hypothesized that clinicians can be trained effectively to deliver 10-30 N during application of CP...
May 9, 2018: Anesthesia and Analgesia
W Robert Leeper, Elliott R Haut, Vinciya Pandian, Sajan Nakka, Jeffrey Dodd-O, Nasir Bhatti, Elizabeth A Hunt, Mustapha Saheed, Nicholas Dalesio, Adam Schiavi, Christina Miller, Thomas D Kirsch, Lauren Berkow
OBJECTIVE: A hospital-wide difficult airway response team was developed in 2008 at The Johns Hopkins Hospital with three central pillars: operations, safety monitoring, and education. The objective of this study was to assess the outcomes of the educational pillar of the difficult airway response team program, known as the multidisciplinary difficult airway course (MDAC). DESIGN: The comprehensive, full-day MDAC involves trainees and staff from all provider groups who participate in airway management...
April 5, 2018: Journal of Surgical Education
Ogedad Pierre, John F Lovejoy, Robert Stanton, Richard Skupski, Harold Previl, Jerry Bernard, Lia Losonczy, Mark Walsh
BACKGROUND: Five billion people, primarily in low-income and middle-income countries, cannot access safe, affordable surgical and anesthesia care, particularly for orthopaedic trauma. The rate-limiting step for many orthopaedic surgical procedures performed in the developing world is the absence of safe anesthesia. Even surgical mission teams providing surgical care are limited by the availability of anesthesiologists. Emergency physicians, who are already knowledgeable in airway management and procedural sedation, may be able to help to fulfill the need for anesthetists in disaster relief and surgical missions...
April 4, 2018: Journal of Bone and Joint Surgery. American Volume
Christopher Neuhaus, Aline Spies, Henryk Wilk, Markus A Weigand, Christoph Lichtenstern
BACKGROUND: The use of perioperative checklists has generated a growing body of evidence pointing toward reduction of mortality and morbidity, improved compliance with guidelines, reduction of adverse events, and improvements in human factor-related areas. Usual quality management metrics generally fall short in assessing compliance with their perioperative application. Our study assessed application attitudes and compliance with safety measures centered around the World Health Organization (WHO) "Safe Surgery Saves Lives" campaign as perceived by anesthesia professionals in Germany...
June 1, 2017: Journal of Patient Safety
Sherine F Hanna, Marianne Mikat-Stevens, James Loo, Raj Uppal, W Scott Jellish, Matthew Adams
STUDY OBJECTIVE: To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways. DESIGN: Randomized prospective study. SETTING: Large academic medical center. PATIENTS: Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination. INTERVENTIONS: After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21...
February 2017: Journal of Clinical Anesthesia
Kenneth A Wofford
Cannot intubate/cannot ventilate (CICV) situations during anesthesia are rare, potentially catastrophic to the patient, and difficult to predict. Widely adopted practice guidelines advocate an algorithmic approach to CICV situations in which the anesthetist: (a) recognizes the CICV situation, (b) calls for help, (c) steadily progresses through a variety of methods to ventilate the patient and secure the airway, (d) restores ventilation via an infraglottic airway if the patient cannot be safely awakened prior to becoming moribund...
January 2017: Annual Review of Nursing Research
James M Boiano, Andrea L Steege
Scavenging systems and administrative and work practice controls for minimizing occupational exposure to waste anesthetic gases have been recommended for many years. Anesthetic gases and vapors that are released or leak out during medical procedures are considered waste anesthetic gases. To better understand the extent recommended practices are used, the NIOSH Health and Safety Practices Survey of Healthcare Workers was conducted in 2011 among members of professional practice organizations representing anesthesia care providers including physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants...
October 2, 2016: Journal of Occupational and Environmental Hygiene
Sharon Kibwana, Damtew Woldemariam, Awoke Misganaw, Mihereteab Teshome, Leulayehu Akalu, Adrienne Kols, Young Mi Kim, Samuel Mengistu, Jos van Roosmalen, Jelle Stekelenburg
BACKGROUND: Efforts to address shortages of health workers in low-resource settings have focused on rapidly increasing the number of higher education programs for health workers. This study examines selected competencies achieved by graduating Bachelor of Science and nurse anesthetist students in Ethiopia, a country facing a critical shortage of anesthesia professionals. METHODS: The study, conducted in June and July 2013, assessed skills and knowledge of 122 students graduating from anesthetist training programs at six public universities and colleges in Ethiopia; these students comprise 80% of graduates from these institutions in the 2013 academic year...
January 2016: Education for Health: Change in Training & Practice
L B L Benoist, N de Vries
Drug-induced sleep endoscopy (DISE) is a rapidly growing method to evaluate airway collapse in patients receiving non-CPAP therapies for sleep-disordered breathing (SDB). The growing number of DISEs has consequences for the organization of clinical protocols. In this paper we present our recent experiences with DISE, performed by an ENT resident, with sedation given by a nurse anesthetist, in an outpatient endoscopy setting, while the staff member/sleep surgeon discusses the findings and the recommended treatment proposal on the same day...
September 2015: European Archives of Oto-rhino-laryngology
Roy Phitayakorn, Rebecca D Minehart, Maureen W Hemingway, May C M Pian-Smith, Emil Petrusa
BACKGROUND: Emotional stability is important for individual and team performance during operating room (OR) emergencies. We compared physiologic and psychological anxiety assessments in OR teams during simulated events. METHODS: Twenty-two teams participated in a "cannot intubate/cannot ventilate" simulation. Participants completed the State-Trait Anxiety Inventory and wore a galvanic skin response (GSR) sensor. Differences in State-Trait Anxiety Inventory scores and GSR levels were analyzed...
January 2015: American Journal of Surgery
Benjamin L Hartland, Timothy J Newell, Nicole Damico
Awake, spontaneously breathing humans sigh on average 9 to 10 times per hour. The sigh is a normal homeostatic reflex proposed to maintain pulmonary compliance and decrease the formation of atelectasis by recruiting collapsed alveoli. The induction and maintenance of anesthesia with muscle paralysis and a fixed tidal volume abolish the sigh. Without periodic sighs, patients are left susceptible to atelectasis and its negative sequelae. The prevalence of atelectasis has been estimated to be as high as 100% in patients undergoing general anesthesia...
August 2014: AANA Journal
William Whitacre, Loraine Dieckmann, Paul N Austin
Some providers advocate using laryngeal mask airways (LMAs) for procedures performed in the prone position to meet the demands of quicker operating room turnover time requirements, staffing reductions and the desire to expedite patient recovery in the postoperative period. We provide an update to a 2010 systemic review examining the use of LMAs in patients in the prone position. Six peer-reviewed articles described the use of LMAs in prone patients: a randomized controlled trial, 2 description studies, a case series, and 2 case reports...
April 2014: AANA Journal
Preet Mohinder Singh, Anjan Trikha, Renu Sinha, Vimi Rewari, Rashmi Ramachandran, Anuradha Borle
This study compared 2 well-accepted and safe methods of pediatric inhalation induction using sevoflurane. Incremental and fixed 8% induction methods were evaluated for economic outcomes by comparing the amount of liquid sevoflurane consumed. We also tried to establish the relation between cost of induction and demographic parameters in both groups. One hundred pediatric patients scheduled for ophthalmologic examination under anesthesia were randomly divided into 2 equal groups. The amount of sevoflurane consumed in both groups was computed using the Dion method...
February 2014: AANA Journal
Christine Zambricki, Carol Schmidt, Karen Vos
This case report describes an unexpected event that took place as a result of using improvised equipment. The patient, a 16-year-old female undergoing complex oral surgery, suffered bilateral pneumothorax following the improper use of an airway support device. During the immediate postoperative period with the patient still intubated, oxygen tubing was attached to a right angle elbow connector with the port closed and 10 L/minute oxygen flow was administered to the patient in a manner that did not allow the patient to exhale...
February 2014: AANA Journal
Maliwan Oofuvong, Sirikarn Siripruekpong, Jumras Naklongdee, Rewadee Hnookong, Chareefar Lakateb
OBJECTIVE: To compare the incidence and severity of emergence agitation, recovery profile, and adverse events between desflurane and sevoflurane anesthesia in unpremedicated pediatric ambulatory urologic surgery patients. MATERIAL AND METHOD: The study was conducted among 136 healthy children, aged six months to nine years, and randomized to two groups, sevoflurane and desflurane, during maintenance anesthesia with laryngeal mask airway. Recovery profile and perioperative adverse events were recorded...
November 2013: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Kemal T Saracoglu, Zeynep Eti, Ayse D Kavas, Tumay Umuroglu
BACKGROUND: It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video-assisted laryngoscope devices for the management of difficult pediatric airway. METHODS: Forty-five anesthesiology residents and nurse anesthetists participated in the study. Macintosh, Miller, Storz Miller, and McGrath Mac curved laryngoscopes were used for tracheal intubation of 3-6-month Airsim Pierre Robin manikin...
March 2014: Paediatric Anaesthesia
Bryan Haslam, Shawn Collins
A case is described of postoperative right hypoglossal neurapraxia after general anesthesia and interscalene block with endotracheal intubation for left total shoulder arthroplasty. Postoperative hypoglossal neurapraxia has been reported in cases, yet it remains a rare complication of anesthesia-related interventions. In this case report, postulated causes of hypoglossal neurapraxia are presented. A review of the literature pertaining to anesthesia-related causes of hypoglossal nerve injury is included. Anesthesia providers should be aware of the course of cranial nerve XII as it relates to the position of the head and neck and use of airway instrumentation...
June 2013: AANA Journal
Kimy R Harbin, Teresa E Norris
Burn injury is a leading cause of life-threatening trauma worldwide, affecting more than 450,000 Americans each year, and is associated with an average mortality rate of 0.8%. Patients with an increased risk of death from burn injuries include elderly patients and patients with large burns or inhalation injury. Providing optimal care for patients with major burn injuries requires the coordinated effort of multidisciplinary teams in which anesthesia providers play a critical role. Anesthetic management for burn surgery can be technically challenging because of difficult airway management and vascular access, as well as cognitively demanding because of dramatic pathophysiologic changes that compromise hemodynamic stability and alter patient response to many anesthetic agents...
December 2012: AANA Journal
Melissa D Machan
Current procedures for cleaning anesthesia airway equipment as assessed by the presence of visible and occult blood on laryngoscope blades and handles as labeled "ready for patient use" has been reported to be ineffective. Human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) are 2 commonly seen pathogens that frequently are found in the healthcare setting. It has been shown that HBV can survive on a dry surface for at least 7 days and both HIV and HBV are transmitted via blood. The potential for cross-contamination from airway equipment to patient has been shown in several studies...
August 2012: AANA Journal
Jeffrey S Greathouse, Jamie L Stuart, William A White
Airway management following severe gasoline burn injury can be difficult. Because patients with severe burns may be treated at a variety of hospitals that provide emergent care, it is valuable for Certified Registered Nurse Anesthetists who work in such facilities to have an understanding of the care of these patients. Airway management is an extremely important consideration in the care of burn victims. If not done in a timely manner, lethal complications may result. This article reports the experience of caring for a female who was involved in an altercation, doused with gasoline, and set on fire...
August 2012: AANA Journal
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