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AANA Journal

Abigail Conley, Chuck Biddle, Kevin Baker
The reflex arc is the functional unit allowing the human body to continuously, and unconsciously, adapt to its internal and external milieus. We review a broad range of autonomic reflexes controlling blood pressure, ensuring tissue oxygenation, and otherwise acting in concert to maintain homeostasis. Normal activity, pathophysiologic insult, and pharmacologic impairment of this reflex activity are discussed, with special consideration to the care of the anesthetized patient.
April 2017: AANA Journal
Shelley D Truax-Waits
The practice of epidural analgesia in laboring women began to emerge in the 1970s. It is now a common method of pain relief for patients in labor and is used by 63% of women in the hospital setting. The patient who has had a previous cesarean delivery can benefit from having an epidural anesthetic placed early to expedite an emergency, such as a uterine rupture, if necessary. At one time there was a concern for placing an epidural anesthetic in laboring women who had a previous cesarean delivery. It was feared that the epidural anesthesia would mask abdominal pain that may present with a ruptured uterus and delay diagnosis...
April 2017: AANA Journal
Jill A Mason-Nguyen, Ricardo E Rodriguez
The use of laryngeal mask airways with morbidly obese patients remains controversial. A recent legal case involving the use of a laryngeal mask airway with a morbidly obese patient who aspirated during the anesthetic found the anesthesia providers negligent. We sought evidence examining the use of laryngeal mask airways with obese patients undergoing surgery. One Cochrane systematic review and a randomized controlled trial met our inclusion criteria. Subjects received general anesthesia with a laryngeal mask airway...
April 2017: AANA Journal
Kathleen A Hammond, Suzanne T Brown, Lisa Marie Bernardo, Laura Palmer, Richard Henker
Because of a critical shortage of anesthesia providers in Belize, the Belize Ministry of Health initiated support for the creation of a nurse anesthesia education program. Developed in collaboration with Health Volunteers Overseas and the University of Belize, the nurse anesthesia education program graduated 10 nurse anesthetists. This article describes the 24-month nurse anesthesia education program’s design, implementation, and evaluation. Challenges and opportunities experienced during the program are outlined as lessons learned for planning similar programs...
April 2017: AANA Journal
Tito D Tubog, Terri D Kane, Marilyn A Pugh
Hypotension and bradycardia are common adverse effects following spinal anesthesia. Ondansetron has been studied in the attenuation of spinal anesthesia– induced hypotension (SIH) and bradycardia because of its antagonistic effect on the Bezold-Jarisch reflex. The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to determine the efficacy of intravenous (IV) ondansetron in reducing the incidence of SIH and bradycardia. Thirteen RCTs were included in this analysis, totaling 1,225 subjects...
April 2017: AANA Journal
Deanna M Martin, N David Yanez, Miriam M Treggiari
The goal of this project was to optimally sort waste material in the operating room (OR) environment and divert waste such that streams of low-cost disposal, including recyclable material, could be maximized. Using the Lean Six Sigma method, we followed 5 steps to define, measure, analyze, improve, and control. Descriptive statistics were used to describe OR characteristics during the study period. Two-sample Student t test with assumption of unequal variance was used to compare the daily weight of solid waste, regulated medical waste, and recyclable waste between the 2-week baseline period and the 2-week implementation period...
April 2017: AANA Journal
Adam C Adler
Propofol is one of the most commonly used agents by anesthesia providers. Despite its excellent safety profile, numerous drawbacks and patient safety issues remain. This article is a focused review of the common issues surrounding propofol administration as they relate to infection, pediatric sedation, and the propofol infusion syndrome.
April 2017: AANA Journal
Randy E Ashman, Susan J Appel, Arnel J Barba
Previous research demonstrates that monitoring and adjusting pressures in endotracheal (ET) tubes 30 cm H2O or less and laryngeal mask airways (LMAs) 60 cm H2O or less decrease rates of postoperative pharyngolaryngeal complications. In this evidencebased practice project we examined whether a multistep intervention (departmental education plus reference cards in operating rooms plus addition of cuff pressure documentation variable in electronic anesthesia record) would increase the frequency of providers monitoring intracuff pressures and decrease the rate of high intracuff pressures...
April 2017: AANA Journal
Jay Tumulak, Steve Johnston, Patty Adams
Poorly managed postoperative pain decreases patient satisfaction, impedes early patient mobilization, lengthens inpatient hospital stay, and increases healthcare costs. Multimodal analgesia with local anesthetics is considered most effective for postoperative pain management. This study compared patients undergoing lumbar fusion who received plain bupivacaine from May 2011 until August 2012 with those who received liposomal bupivacaine from September 2012 until May 2013. The aim was to determine which preparation reduced postoperative opioid use the most...
April 2017: AANA Journal
Joseph E Pellegrini, Paloma Toledo, David E Soper, William C Bradford, Deborah A Cruz, Barbara S Levy, Lauren A Lemieux
Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effot to reduce the incidence of surgical site infection...
February 6, 2017: AANA Journal
Derrick C Glymph, Tito D Tubog, Mariya Vedenikina
Postpartum hemorrhage (PPH) continues to be a serious complication in both developed and underdeveloped countries. It remains the leading cause of maternal mortality in underdeveloped countries. Implementation of the World Health Organization guidelines of PPH treatment has reduced mortality. In addition, the prophylactic administration of tranexamic acid with uterotonic agents may contribute to the reduction of PPH. This evidence-based literature review of tranexamic acid will examine its mechanism of action as well as its effectiveness in prevention of PPH and blood loss reduction in elective surgery, obstetrics, and trauma...
December 2016: AANA Journal
Pamela Lovett, Rebecca Klingbeil, Ronald Reimer, Timothy Shine
The use of a supraglottic airway, also called laryngeal mask airway (LMA), is gaining in popularity for delivery of general anesthesia in certain situations and is shown to be safe. Use of infraglottic airways (tracheal tubes) allows for positive pressure ventilation and maneuvers, such as holding continuous positive pressure in the airway to check for pleural and dural leaks. We describe the successful use of the LMA (Teleflex Inc) for general anesthesia, in which continuous positive airway pressure of 15 cm H2O held for 20 seconds allowed the neurosurgeon to identify the site of a cerebrospinal fluid (CSF) leak and successfully repair the leak...
December 2016: AANA Journal
Geetanjali T Chilkoti, Medha Mohta, Sai Janani
Laryngospasm is a potential complication encountered during anesthesia using a laryngeal mask airway (LMA). We report a case in which laryngospasm resulted in unsuccessful placement of an LMA ProSeal Airway (Teleflex Inc), and we discuss the various causes of unsuccessful placement of this type of airway device. Laryngospasm causes increased resistance to gas flow by inducing closure of vocal cords, aryepiglottic fold, and periglottic tissue. In this case report, the laryngospasm-induced increased resistance to gas flow was manifested by exaggerated outward movement of the LMA ProSeal following its connection to gas flows and thus resulted in failed airway placement...
December 2016: AANA Journal
Kara F Hedman, Carrie L Mann, Cheryl Spulecki, Jessica Castner
This review assessed the utility of vasopressin and vasopressin analogues for the treatment of refractory hypotension associated with angiotensin-converting enzyme (ACE) inhibitors in the perioperative setting. A systematic review of the literature was conducted using MEDLINE, Embase, and ProQuest. Six randomized controlled trials met eligibility criteria. In the perioperative setting, continued use of ACE inhibitors within 24 hours before surgery remains controversial. Authors of the reviewed studies suggested that the morning dose of the ACE inhibitor be held, and those patients experienced decreased catecholamine use postoperatively and shorter duration of decreased mean arterial pressure...
December 2016: AANA Journal
Victoria Goode, Elayne Phillips, Pamela DeGuzman, Ivora Hinton, Virginia Rovnyak, Kenneth Scully, Elizabeth Merwin
Patient safety and the delivery of quality care are major concerns for healthcare in the United States. Special populations (eg, obese patients) need study in order to support patient safety, quantify risks, advance education for healthcare-workers, and establish healthcare policy. Obesity is a complex chronic disease and is considered the second leading cause of preventable death in the United States with approximately 300,000 deaths per year. Obesity is recognized by the Agency for Healthcare Research and Quality (AHRQ) as a comorbid condition...
December 2016: AANA Journal
Cynthia Ann Farina, Wanda Wilson, Kim FitzSimmons
The total numbers of Certified Registered Nurse Anesthetists (CRNAs) in the United States and members of the American Association of Nurse Anesthetists (AANA) have risen to an all-time high. However, the percentage of CRNAs who are AANA members has been slowly declining since 2006, particularly among newly certified nurse anesthetists. To develop new strategies to increase and sustain CRNA membership, the AANA conducted a translational research project that explored evidence-based determinants of individuals' decisions to join professional associations, current membership practices and patterns, results of a recent member needs survey, and socialization of student registered nurse anesthetists (SRNAs) into the AANA...
December 2016: AANA Journal
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December 2016: AANA Journal
Mark J Silberman
No abstract text is available yet for this article.
December 2016: AANA Journal
Brenda Wands
No abstract text is available yet for this article.
December 2016: AANA Journal
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