item: #1 of 77 id: anesthj-10 author: Titch, CRNA, DNP, Frank J.; Holsinger, MD, Tracey; Vacchiano, CRNA, Phd, Charles; Blood-Siefried, CPNP, DNSc, Jane title: Improving Anesthetic Depth Assessment During Electroconvulsive Therapy with Bispectral Index Monitoring: A Pilot Quality Improvement Project date: 2015 words: 3045 flesch: 43 summary: Two anesthetized patients, who responded purposefully to verbal commands despite BIS values in the deep hypnotic range indicating sufficient anesthetic depth, were considered at risk for awareness under anesthesia. Given the response of the two patients with BIS values indicating sufficient anesthetic depth, these observations merit further studies to replicate our findings in the psychiatric population and further explore the potential value of BIS monitoring during ECT. keywords: anesthesia; awareness; bis; depth; ect; monitoring; patients; procedure; project cache: anesthj-10.pdf plain text: anesthj-10.txt item: #2 of 77 id: anesthj-113 author: Harville, Kate; Jenschke, PhD, CRNA, Monica title: Use of Clevidipine as an Alternative to Nitroglycerin in Cardiac Surgery date: 2019 words: 2268 flesch: 45 summary: The patient’s lack of hemodynamic response to IV nitroglycerin during this case was unexpected. However, IV nitroglycerin is a drug that anesthesia providers rely on during episodes of hemodynamic crisis in the operating room. keywords: clevidipine; nitroglycerin; patient cache: anesthj-113.pdf plain text: anesthj-113.txt item: #3 of 77 id: anesthj-117 author: Davis-Sandfoss, Tyler A.C.; Smith-Steinert, Rachel title: Noise Pollution in the Operating Room: Student Registered Nurse Anesthetist Education including Reduction Strategies and Tools date: 2020 words: 2447 flesch: 45 summary: None KEYWORDS: Anesthesia; noise; noise pollution; operating room; occupational safety Abstract Noise pollution in the operating room (OR) poses a safety concern to both patients and providers. The purpose of this project was to examine current evidence and implement education for student registered nurse anesthetists (SRNAs) regarding noise pollution in the OR. keywords: anesthesia; education; noise; operating; pollution; room; safety; test cache: anesthj-117.pdf plain text: anesthj-117.txt item: #4 of 77 id: anesthj-12 author: Hupman, SRNA, Angela; Eshkevari, PhD, CRNA, Ladan title: Propofol and Ketamine for Targeted Muscle Reinnervation after Limb Amputation: A Case Report date: 2013 words: 2221 flesch: 47 summary: »» Ketamine is an antagonist at various opioid receptors, making it an effective alternative in the treatment of chronic pain patients. AEJ2 ProPofol and Ketamine for targeted muscle reinnervation after limb amPutation: a case rePort Angela Hupman, BSN, SRNA Ladan Eshkevari, PhD, CRNA Keywords propofol, ketamine, TIVA, targeted muscle reinnervation, phantom limb pain. keywords: anesthetic; case; ketamine; pain; patient; propofol cache: anesthj-12.pdf plain text: anesthj-12.txt item: #5 of 77 id: anesthj-123 author: Noland, Ashley title: Intravenous Magnesium Sulfate for Multimodal Analgesia date: 2019 words: 2034 flesch: 40 summary: § Increased opioid administration is related to a higher incidence of respiratory depression, constipation, emesis, confusion, and prolonged length of hospital stay.3 § IV magnesium sulfate bolus of 30 mg/kg before induction followed by an intraoperative infusion at 10 mg/kg/hour resulted in significantly lower pain scores compared to a placebo group and decreased opioid consumption 24 hours following surgery.5 § Dabbagh et al. found that the group that received magnesium versus the control group that received normal saline required significantly lower doses of IV morphine in the first 24 hours postoperatively.8 § Postoperative administration of magnesium sulfate alone did not demonstrate a significant reduction in morphine consumption.12 § Lysakowski et al. discovered in a systemic review of randomized trials for magnesium sulfate as an adjuvant to postoperative analgesia there was no evidence that perioperative magnesium had favorable effects on postoperative pain intensity and analgesic requirements.13 § Further research is necessary to examine the use of IV magnesium sulfate for postoperative pain in different patient populations, safe and effective dosing ranges, and effects on analgesia for various surgeries. § Magnesium decreases the pre-synaptic release of acetylcholine (Figure 1), which reduces the sensitivity of the motor end plate and decreases the amplitude of the action potential.2 § The increase of extracellular magnesium with IV magnesium sulfate inhibits the inflammatory response by reducing inflammatory cytokines.6 Clinical Rationale: § Magnesium sulfate was given as a multimodal approach to decrease the amount of opioids required for pain relief and avoid the opioid side effects due to the patient’s history of postoperative nausea and vomiting. keywords: analgesia; magnesium; opioid; pain; patient; sulfate cache: anesthj-123.pdf plain text: anesthj-123.txt item: #6 of 77 id: anesthj-125 author: Barnett, Chelsea title: Opioid Free Anesthesia: A Gender Reassignment Case Report date: 2019 words: 1816 flesch: 43 summary: • Anesthesia was initiated with sevoflurane 1.0% end-tidal concentration and titrated between 0.5 to 0.8 minimum alveolar concentration (MAC) as tolerated in a mixture of medical air 1 L/min and oxygen 1 L/min. • Ketorolac 30 mg was administered intravenously at time of surgical wound closure. • Gender Dysphoria • GD is defined as causing distress due to incongruity between one’s experienced or expressed gender and one’s assigned gender and/or primary or secondary sex characteristics.3 • Byne et al discussed the importance of assessing this patient population for suicidal ideation, due to increased risk factors for suicidality.3 According to Byne et al, up to 47% of transgender adults have considered or attempted suicide.3 • keywords: anesthesia; gender; ofa; opioid; patient cache: anesthj-125.pdf plain text: anesthj-125.txt item: #7 of 77 id: anesthj-126 author: Patson, Amber Lee Madrid title: Carnitine Palmitoyl Transferase, Type 1A (CPT1A): The Arctic Variant date: 2019 words: 2434 flesch: 47 summary: The child may need hospital admission to correct metabolic status by receiving intravenous (IV) or nasogastric (NG) administration of glucose.13 A standard maintenance rate of dextrose containing IV fluids is usually sufficient.13 Intra-operatively: • Blood glucose levels should be checked and maintained.14 • Inpatient AV- CPT1A children should continue glucose- containing IV fluids intra-operatively. • CPT1A is the isoform of CPT1 found in the liver.1 • CPT1A catalyzes the rate limiting step that imports long chain fatty acids into the mitochondrion, allowing for the production of ketones and subsequent ATP energy from the breakdown of fat.2 • CPT1A Arctic Variant is an inherited autosomal recessive variant resulting in 80% decreased activity of the CPT1A enzyme.3 • The c.1436C>T variant occurs in 26% - 80% of Arctic populations including Alaska, Canada, Greenland and Siberia.4,5 Background Physiology: • Normally, during periods of fasting, the body initially breaks down the hepatic glycogen supply into glucose.4 keywords: alaska; arctic; carnitine; cpt1a; fasting; fatty; glucose; variant cache: anesthj-126.pdf plain text: anesthj-126.txt item: #8 of 77 id: anesthj-127 author: Murdock, Skyler title: Verification of Ventilation before Neuromuscular Blocker Administration during Anesthetic Induction and Endotracheal Tube Insertion in the Non-Rapid Sequence Induction Setting date: 2019 words: 1863 flesch: 44 summary: A non-blinded anesthesia professional then administered either rocuronium 0.6 mg/kg or 0.9% saline, and repeat ventilation was performed 2 minutes later.5 • BVM ventilation scores were significantly better in the group that received rocuronium.5 • However, there is little published evidence to support this practice, and the administration of muscle relaxation before ensuring adequate BVM ventilation remains controversial.1-8 AEJ Skyler Murdock, BSN, RN, keywords: airway; bvm; induction; mask; nmb; patient; ventilation cache: anesthj-127.pdf plain text: anesthj-127.txt item: #9 of 77 id: anesthj-129 author: Coleman, Emily title: Perioperative Management Considerations for Patients on Methadone and Buprenorphine date: 2020 words: 3240 flesch: 37 summary: Methadone has also been utilized in acute pain management in anticipation of significant postoperative pain.4,6 Perioperative Management of Patients on Methadone The pharmacological profile of methadone including its potent analgesic effects and extensive half-life are important factors to consider perioperatively.1,2,4-7 Life threatening complications such as accumulated toxicity, opioid withdrawal, and overdose can occur in terms of methadone abuse or inadequate management.7 Current literature reports a single 40 mg dose of oral methadone could result in death, especially in opioid naïve patients. Peng PWH, Tumber PS, Gourlay D. Review article: perioperative pain management of patients on methadone therapy. keywords: agonists; anesthesia; buprenorphine; management; methadone; opioid; pain; patients; receptor; μor cache: anesthj-129.pdf plain text: anesthj-129.txt item: #10 of 77 id: anesthj-13 author: Grelson, SRNA, Megan title: Risk of Complications Using Laryngeal Mask Airway versus Endotracheal Tube During General Anesthesia in Pediatric Patients with Upper Respiratory Infections: A Narrative Review. Creation of the Upper Respiratory Infection Screening Tool© and Management Al date: 2013 words: 5029 flesch: 44 summary: LMAs have decreased amount of laryn- geal stimulation and decreased airway complications with URIs. creation of the uPPer resPiratory infection screening tool© and management algorithm for children Presenting for general anesthesia with uPPer resPiratory infection© Megan Grelson SRNA Keywords pediatric, upper respiratory infection, anesthesia, laryngeal mask airway, endotracheal tube keywords: airway; anesthesia; children; complications; lmas; risk; studies; uris cache: anesthj-13.pdf plain text: anesthj-13.txt item: #11 of 77 id: anesthj-130 author: Shores, Ryan; Fowler, Katherine; McDonough, John; Suralis, Amy; Scindele, Denise; Müller-Wolff, Tilman title: Rocuronium vs Succinylcholine: Emergency Airway Management of the COVID-19 Patient date: 2021 words: 2824 flesch: 34 summary: SARS CoV-2 is a highly contagious RNA virus that has caused widespread infections, severe respiratory disease, and deaths.1 A study conducted in Lombardy, Italy revealed that 88% of COVID-19 patients who were critically ill needed mechanical ventilation.14 In Italy, March 2020 up to 15% of all COVID-19 infected individuals were active healthcare staff.4 Alternative and safer airway management techniques must be used. Dtt T, Ek N, Vah M, Js L, Ga W, Jj P. Rocuronium versus succinylcholine for rapid sequence induction intubation. keywords: cov-2; covid-19; disease; intubation; patients; rocuronium; sars; succinylcholine; sugammadex cache: anesthj-130.pdf plain text: anesthj-130.txt item: #12 of 77 id: anesthj-132 author: Berman, Brianna title: Patient Blood Management date: 2021 words: 1303 flesch: 52 summary: • Establishing guidelines for PBM can help mitigate risks and ensure that blood transfusions are appropriate. • Major risks of blood transfusions include hemolytic reactions, acute lung injury, volume overload, and deadly infections such as hepatitis and HIV.2 • keywords: blood; management; patient; transfusion cache: anesthj-132.pdf plain text: anesthj-132.txt item: #13 of 77 id: anesthj-134 author: Leazenby, Jinah title: Dexmedetomidine versus Propofol for Cardiopulmonary Bypass date: 2020 words: 1404 flesch: 43 summary: Plasma glucose maintained with insulin drip 1-3U/hour • Cerebral oximetry monitoring WNL • Case Totals: 2000mL crystalloid, UOP 1100 mL, EBL 100mL, 5 hours of anesthesia time. • Patient remained intubated and transferred to ICU on dexmedetomidine at 0.4mcg/kg/hr and norepinephrine at 0.03mcg/kg/min. Postoperative Evaluation • PostOp keywords: dexmedetomidine; icu; infusion; patient; propofol; surgery cache: anesthj-134.pdf plain text: anesthj-134.txt item: #14 of 77 id: anesthj-136 author: McGowan, Levi Scott title: Reducing the Carbon Footprint of the Anesthesia Provider date: 2021 words: 847 flesch: 42 summary: The atmospheric concentrations of CO2 has increased by 40% with most accumulation of greenhouse gases occurring after 1970.¹ ● The United States (US) healthcare industry accounts for over 8% of total carbon dioxide emissions.³ ● Anesthesia contributes to about 5% percent of the total carbon emissions in healthcare. ● Generic propofol has one of the lowest costs and lowest carbon footprints. keywords: anesthesia; carbon; footprint cache: anesthj-136.pdf plain text: anesthj-136.txt item: #15 of 77 id: anesthj-138 author: Ybarra, Amy L. title: Intraoperative Dexmedetomidine for Analgesia during Burn Excision and Grafting date: 2020 words: 1052 flesch: 46 summary: • Patient exhibited signs of stimulation only one time during the 5-hour procedure, and was medicated with dexmedetomidine 5 mcg and dilaudid 0.5 mg. • Postoperative pain scores and Richmond Agitation-Sedation Scale (RASS) were lower with dexmedetomidine. • • Total surgery time was approximately 5 hours. keywords: burn; dexmedetomidine; excision; pain; patient cache: anesthj-138.pdf plain text: anesthj-138.txt item: #16 of 77 id: anesthj-139 author: Strickland, Bevin Rene; Strickland, Daniel M title: Mobile Anesthesia Applications as Point-of-Care Tools for CRNAs in Clinical Practice date: 2020 words: 1612 flesch: 57 summary: The purpose of this study was to assess the use of mobile anesthesia apps used by CRNAs as point-of-care (POC) tools in their anesthesia practice. Data reported was collected from a survey designed to sample CRNAs who have been in practice for three years or less (“recent” graduates) and who utilize mobile anesthesia apps. keywords: anesthesia; apps; care; mobile; practice; use cache: anesthj-139.pdf plain text: anesthj-139.txt item: #17 of 77 id: anesthj-14 author: Harvey, SRNA, Jaclyn title: Anesthesia for a Patient with Osteogenesis Imperfecta, Achondroplastic Dwarfism and History of Malignant Hyperthermia date: 2024 words: 2272 flesch: 44 summary: Patients with osteogenesis imperfect (OI) are placed at high risk during anesthesia for both physiological and anatomical reasons. In addition, 50% of patients who experience an MH crisis had previously received a triggering agent without showing symptoms.3 In this case report a patient presents to a tertiary care hospital with all three of these conditions. keywords: anesthesia; history; hyperthermia; malignant; osteogenesis; patient cache: anesthj-14.pdf plain text: anesthj-14.txt item: #18 of 77 id: anesthj-141 author: Samons, David a; Samons, Jissel; Tolosa, Manuel title: Barriers and Determinants that Influence Membership in the American Association of Nurse Anesthetists date: 2022 words: 4345 flesch: 48 summary: However, the total number of CRNAs who are AANA members increased by only 34.6% within that same 10-year period.5 Membership with the AANA allows the organization to continue to provide education, guidance, and fight to maintain and further the scope of practice for CRNAs. Data were limited specific to nurse anesthetist’s professional organiza- tions, however, common themes and results emerged throughout the literature: benefits of professional membership, methods used to collect data, reasons why professionals do or do not join their professional organization, and involvement within the profession- al organization. keywords: aana; anesthesia; crnas; data; florida; membership; nurse; organization; professional; survey cache: anesthj-141.pdf plain text: anesthj-141.txt item: #19 of 77 id: anesthj-143 author: Fisher, Audrey title: The Anesthetic Management of a Patient with Hereditary Coproporphyria date: 2021 words: 1273 flesch: 41 summary: • Triggering agents include many anesthetic agents that have been labeled porphyrinogenic; see Table 1. • Safe anesthetic management of patients with HCP demands understanding of this disease process. • HCP causes accumulation of porphyrins and porphyrin precursors which lead to neurotoxicity and subsequent acute attack in the presence of known triggering agents. keywords: agents; anesthetic; hcp; management; patient; porphyria cache: anesthj-143.pdf plain text: anesthj-143.txt item: #20 of 77 id: anesthj-144 author: Overla, Trey title: Spinal Anesthesia for Total Joint Replacement date: 2021 words: 298 flesch: 31 summary: The purpose of this scientific poster is to explore and discuss the potential benefits of using spinal anesthesia rather than general anesthesia for total knee arthroplasty or total hip arthroplasty. KEYWORDS: spinal anesthesia, general anesthesia, anesthesia, total joint arthroplasty, total joint replacement, total hip replacement, total knee replacement Abstract Total joint arthroplasty is one of the most performed surgical procedures in the developed world with millions of total hip and total knee replacements taking place each year.1 keywords: anesthesia cache: anesthj-144.pdf plain text: anesthj-144.txt item: #21 of 77 id: anesthj-146 author: Kunisawa, Yoshiya title: Anesthesia Management of Venous Gas Embolism with Hepatectomy date: 2021 words: 211 flesch: 28 summary: KEYWORDS: venous gas embolism, venous air embolism, GE, VAE, hepatectomy Evidence suggests that venous gas embolisms are very common with certain procedures but often subclinical. keywords: gas cache: anesthj-146.pdf plain text: anesthj-146.txt item: #22 of 77 id: anesthj-147 author: Vanek, Dean Allen title: Dexmedetomidine as an Anesthetic Adjunct in Off-Pump Coronary Artery Bypass Grafting: A Case Report date: 2021 words: 294 flesch: 19 summary: The focus of this case report is to analyze the impact dexmedetomi- dine has on perioperative opioid consumption, postoperative recovery, and hemodynamic effects that result. Precedexâ, dexmedetomidine, off-pump coronary artery bypass grafting, alpha-2 agonist, cardiac surgery Abstract This case report describes the implementation of a dexmedetomidine (Precedexâ) infusion in a patient undergoing off- pump coronary artery bypass grafting (OPCABG). keywords: bypass; dexmedetomidine cache: anesthj-147.pdf plain text: anesthj-147.txt item: #23 of 77 id: anesthj-148 author: Juch, Elaine title: Anesthetic Management of a Patient with Von Willebrand Disease date: 2021 words: 219 flesch: 43 summary: Von Willebrand Disease, Type I, Bleeding, Desmopressin, Transesophageal echocardiogram Abstract This case report describes an anesthesia-related issue encountered during a watchman device placement and transesophageal echocardiogram (TEE) where profuse perioperative esophageal bleeding ensued in a patient with Von Willebrand disease (VWD) keywords: bleeding cache: anesthj-148.pdf plain text: anesthj-148.txt item: #24 of 77 id: anesthj-15 author: Bonner, SRNA, Ashley; Welliver, DNP, CRNA, ARNP, Mark title: Evidence is Inconclusive that Forcedair Warming Devices Increase Surgical Site Contamination or Infection date: 2014 words: 3943 flesch: 40 summary: Recently, Reed joined the authors of the Belani et al3 study and conducted a similar experiment on the most current and widely AEJ used FAW device. conclusIon The studies in this review primarily focused on the disrup- tion of OR airflow and microbial contamination and emissions AEJ of FAW devices and could only infer potential effect on surgical site contamination. keywords: air; contamination; devices; faw; filter; heat; infection; patient; site; study; warming cache: anesthj-15.pdf plain text: anesthj-15.txt item: #25 of 77 id: anesthj-151 author: Justice, Cody Ryan title: Magnesium Sulfate: A Multi-Modal Adjunct for Post-Operative Analgesia date: 2021 words: 299 flesch: 26 summary: Magnesium sulfate, multi-modal, post-operative, non-opioid, and analgesia Abstract The goal of multi-modal analgesia is to minimize the use of opioid analgesics intra-operatively and in recovery.1 Magnesium sulfate(MgSO4), a physiological cation, serves as a multi-modal adjunct in the reduction of opioid use in the peri-operative setting.2,7 Historically, opioids have been the choice of providers in treating and controlling pain.2,4 Recent literature supports the use of a multi-modal approach to control pain and reduce the amount of opioid used.1-6,8 MgSO4, an inexpensive and safe alternative to opioids, has been shown to reduce the amount of opioids used in recovery.3,6 MgSO4 is an endogenous electrolyte and antagonist at the NMDA receptor blocking the entry of calcium into the cell.2,3,7 The purpose of this case report is to analyze the analgesic effects of MgSO4 in multi-modal pain management. keywords: magnesium cache: anesthj-151.pdf plain text: anesthj-151.txt item: #26 of 77 id: anesthj-152 author: Nicholson, Samantha title: Hypotension and Bradycardia with Sugammadex Administration date: 2021 words: 190 flesch: 19 summary: Samantha Nicholson is a Registered Nurse pursuing her DNP in Nurse Anesthesia at Texas Christian University KEYWORDS: sugammadex, Bridion®, reversal agent, adverse drug reaction Abstract The Food and Drug Administration (FDA) approved sugammadex for use as a reversal agent for nondepolarizing muscle relaxants.1 Sugammadex binds free molecules of muscle relaxant, specifically rocuronium and vecuronium, resulting in a rapid offset of neuromuscular blockade.2 When compared to the use of neostigmine and glycopyrrolate for reversal, sugammadex has shown to be faster and able to provide reversal for deeper blockades.2 However, this new drug is not without risks. No. 5 2021 Educated Hand Publishing LLC “The Science Behind the Art” Volume 9 - No.5 2021 Anesthesia eJournal - Online ISSN 2333-2611 Page 9 Hypotension and Bradycardia with Sugammadex Administration Samantha Nicholson, BSN, RN, CCRN Affiliation: Texas Christian University Grant/Financial Support: None Biographical data: keywords: sugammadex cache: anesthj-152.pdf plain text: anesthj-152.txt item: #27 of 77 id: anesthj-153 author: Serrano, Anne Marie title: Decreased Pulse Oximetry Readings in Asymptomatic Patient with Hemoglobin Grifton date: 2021 words: 474 flesch: 49 summary: No. 7 2021 Educated Hand Publishing LLC “The Science Behind the Art” Volume 9 - No.7 2021 Anesthesia eJournal - Online ISSN 2333-2611 Page 13 Decreased Pulse Oximetry Readings in Asymptomatic Patient with Hemoglobin Grifton Anne Marie Serrano1, Christian R Serrano2, and Monica Jenschke3 Affiliation: 1 Anne Marie Serrano, BSN, RN, Texas Christian University, School of Nurse Anesthesia, Fort Worth, TX 2 Christian R Serrano, MS, BS, Department of Biology, University of Texas at San Antonio, San Antonio, TX 3 Monica Jenschke, PhD, CRNA, Texas Christian University, School of Nurse Anesthesia, Fort Worth, TX Grant/Financial Support: None Biographical data: The patient in this case study presented with a baseline SpO2 of 84% with a known diagnosis of hemoglobin Grifton. keywords: grifton; hemoglobin cache: anesthj-153.pdf plain text: anesthj-153.txt item: #28 of 77 id: anesthj-154 author: Bumatay, Ashley Jane title: Submental Intubation for LeFort Type III Fracture date: 2021 words: 158 flesch: 30 summary: Submental intubation, oral/maxillofacial fractures, LeFort Type III fracture Abstract This case report describes the use of submental intubation for an open reduction internal fixation (ORIF) LeFort Type III fracture encountered at Methodist Dallas Medical Center operating room (OR). Submental intubation is an alternative airway route for oral/ maxillofacial surgeries when nasotracheal intubation or tracheostomies are not indicated. keywords: intubation cache: anesthj-154.pdf plain text: anesthj-154.txt item: #29 of 77 id: anesthj-155 author: Gatehouse, Jessica title: Off-label Rescue Agents for Vasoplegic Syndrome after Cardiopulmonary Bypass date: 2022 words: 220 flesch: 38 summary: Methylene blue is used to treat vasoplegic syndrome (VS) when higher dose vasopressors are ineffective. Texas Christian University Grant/Financial Support: None KEYWORDS: Methylene blue, Vasoplegia, Cardiopulmonary bypass, Cardiac Surgery, Hydroxocobalamin Abstract Cardiovascular disease is the number one cause of death in the United States today1. keywords: syndrome cache: anesthj-155.pdf plain text: anesthj-155.txt item: #30 of 77 id: anesthj-156 author: Hipps, Hugh Hayden title: Perioperative Management of a Patient Receiving Suboxone date: 2021 words: 241 flesch: 25 summary: Suboxone, buprenorphine-naloxone, pain management, postoperative pain, perioperative pain. These findings are limited to outpatient surgical procedures when postoperative pain is expected to be mild/moderate thus, it is imperative that the anesthesia plan be tailored to the individual patient and surgical procedure after analysis of the risks vs benefits profile. keywords: pain cache: anesthj-156.pdf plain text: anesthj-156.txt item: #31 of 77 id: anesthj-16 author: Benoit, BSN, RRNA, Joelle; Welliver, DNP, CRNA, ARNP, Mark title: Open-Globe Eye Injuries and Choice of Muscle Relaxant: A Review of the Evidence date: 2014 words: 3480 flesch: 42 summary: The rocuronium group (n=15) displayed a reduction in IOP post induction (P=0.01) with an increase in values post intubation; however they did not exceed baseline values. Nondepolarizing NMBAs, particu- larly rocuronium, administered prior to, or in place of, succinyl- choline have been found to lessen IOP elevation after induction and intubation. keywords: administration; induction; intubation; iop; nondepolarizing; pressure; succinylcholine cache: anesthj-16.pdf plain text: anesthj-16.txt item: #32 of 77 id: anesthj-161 author: Harris, David E title: Congenital Long QT Syndrome:: A cardiac ion channelopathy with important anesthetic considerations date: 2024 words: 5700 flesch: 47 summary: Sevoflurane prolonged the QTc interval and increased transmural dispersion of repolariza- tion in a patient with long QT syndrome 3: a case report. SCN5A mutations associated with an inherited cardiac arrhythmia, long QT syndrome. keywords: anesthesia; cardiac; clqts; doi; heart; interval; long; lqt1; patients; qtc; risk; sevoflurane; syndrome; tdp cache: anesthj-161.pdf plain text: anesthj-161.txt item: #33 of 77 id: anesthj-163 author: Jordan, Ryan R title: Preoperative Optimization of the Asthmatic Patient date: 2022 words: 1591 flesch: 34 summary: Introduction • Asthma is a common respiratory condition affecting millions of people worldwide • Bronchospasms are a defining feature of asthma in which the smooth muscle of the airway contracts and narrows (figure 1)1 • Preventing intraoperative bronchospasm decreases the risk of postoperative respiratory complications • Preoperative pharmacologic interventions are a well- documented method for reducing intraoperative bronchospasm and postoperative respiratory issues. keywords: anesthesia; asthma; bronchospasm; patient; preoperative; texas cache: anesthj-163.pdf plain text: anesthj-163.txt item: #34 of 77 id: anesthj-165 author: Jordan, Haley Marie; Diehl, Roseann title: Ondansetron Prior to Spinal Anesthesia to Prevent Hypotension During Cesarean Delivery date: 2022 words: 1528 flesch: 43 summary: Conclusions & Practice Recommendations • Consider 4 mg ondansetron administration prior to spinal insertion to improve BP and decrease vasopressor use during elective cesarean section • Ondansetron administration as a sole intervention may not be ideal, so use as an adjunct in a multimodal approach to decreasing overall maternal hypotension • Protocol implementation may be excessive evidence utilization. • Total medication administration: 150 mcg phenylephrine, 800 mL LR • EBL: 800 mL Postoperative course • VS: HR: BP: 122/67, HR: 75 References 1. keywords: anesthesia; cesarean; hypotension; ondansetron; spinal; university cache: anesthj-165.pdf plain text: anesthj-165.txt item: #35 of 77 id: anesthj-166 author: Busalacchi, Anna title: The Effectiveness of Total Intravenous Anesthesia (TIVA) in Functional Endoscopic Sinus Surgery (FESS) date: 2022 words: 1355 flesch: 37 summary: • Anesthetic technique has shown to affect visibility of the sinonasal mucosa and dictate the outcomes of blood loss and operative time. At time of closure: propofol infusion turned off, ondansetron 4 mg IV, ketorolac 30 mg IV, acetaminophen 1 g IV • No vital sign abnormalities throughout case noted • Estimated blood loss of case: 50 mL, calculated by amount in canister with irrigation subtracted Postoperative Course: • Reversed with sugammadex 200 mg IV, extubated and transferred to PACU with oral airway in place and dressing under nose placed and secured by surgeon • PACU vital signs: HR 74, BP 133/70 mmHg, RR 18, SpO2 95% keywords: anesthesia; blood; loss; sinus; surgery cache: anesthj-166.pdf plain text: anesthj-166.txt item: #36 of 77 id: anesthj-167 author: Nagel, Christine title: Negative Pressure Pulmonary Edema (NPPE) date: 2023 words: 1565 flesch: 36 summary: “The Science Behind the Art” Volume 10 - No.3 2022 Anesthesia eJournal - Online ISSN 2333-2611 Page 1 Negative Pressure Pulmonary Edema Christine Nagel, RN, BSN, CCRN Affiliation: Texas Christian University Grant/Financial Support: None KEYWORDS: Negative pressure pulmonary edema, NPPE, Laryngospasm Abstract Negative pressure pulmonary edema (NPPE) is a rare but dangerous complication of general anesthesia potentially causing anoxic brain injury and a 5% mortality, if not promptly recognized and treated. Negative pressure pulmonary edema: report of case series and review of literature. keywords: edema; nppe; pressure; pulmonary cache: anesthj-167.pdf plain text: anesthj-167.txt item: #37 of 77 id: anesthj-168 author: Walker, Gage title: Protamine Reaction in Cardiovascular Surgery date: 2023 words: 1950 flesch: 39 summary: Intubation: DL x 1, Grade I view, ETT 8.0 • Maintenance: Sevoflurane titrated to effect, IVP sufentanil, vecuronium for muscle relaxation • Emergence: Postoperative ventilatory support, dexmedetomidine infusion @ 0.5 mcg/kg/hr • Severe reaction after administration of protamine with BP dropping as low as 32/17 mmHg • Treated with norepinephrine, epinephrine, vasopressin and calcium chloride • Methylene blue was administered, and the patient was placed on an IABP • Decision: to heparinize again and place the patient back on CPB • Known hemodynamic effects are associated with protamine and on rare occasions, true anaphylaxis. keywords: heparin; patient; protamine; reaction; removal; use cache: anesthj-168.pdf plain text: anesthj-168.txt item: #38 of 77 id: anesthj-17 author: Mileto, CRNA, DNP, Lisa; Penprase RN, PhD, CNOR, Barbara title: Job Satisfaction Among Certified Registered Nurse Anesthetist: A Multigenerational Analysis date: 2014 words: 4467 flesch: 43 summary: Understanding factors that influence CRNA job satisfaction can enhance the work environment and prove to be beneficial to all generations of CRNAs. The factors influencing CRNA job satisfaction that were examined in this study are central concepts in the Nursing Work Index - Revised (NWI-R) survey, including autonomy, control over practice setting, nurse-physician relationships, and organizational support.6 Table 1 defines these factors. keywords: anesthesia; anesthetists; baby; crnas; generation; job; job satisfaction; mean; nurse; satisfaction; survey; work cache: anesthj-17.pdf plain text: anesthj-17.txt item: #39 of 77 id: anesthj-170 author: Steinkampf, Christopher title: Effect of Dexmedetomidine on Incidence of Emergence Delirium in Adult Nasal Surgery date: 2023 words: 1244 flesch: 39 summary: Gaps in knowledge: long-term effects of dexmedetomidine beyond PACU and 24h, bolus vs. infusion vs. combination, applicability to ASA > II, applicability to other surgeries Effect of Dexmedetomidine on Incidence of Emergence Delirium in Adult Nasal Surgery Christopher Steinkampf BSN, RN, Texas Christian University Evidence Search Strategy • Databases: PubMed and EMBASE • Keywords: anesthesia, dexmedetomidine, emergence, nasal surgery • Further limits: publication date 2011 to 2021, “English only”, and “human only” • 29 studies were identified • Evidence was refined by focusing on RCT, systematic reviews, and meta-analyses • Five RCTs were chosen based on their research procedures and primary outcomes References 1. • Secondary positive effects, such as hemodynamic stability, analgesia, and decreased antiemetic requirements, were observed, but these qualities need to be further studied with an appropriate sample population • keywords: dexmedetomidine; emergence; group; nasal; surgery cache: anesthj-170.pdf plain text: anesthj-170.txt item: #40 of 77 id: anesthj-173 author: Sedberry, Colton title: Transesophageal Echocardiography Use for Orthotopic Liver Transplant date: 2023 words: 1920 flesch: 42 summary: • TEE should be used based on the anesthesia provider’s judgment along with other monitoring tools. • Initial hemodynamic values: CVP 22, PA pressure 33/21, CI 2.4 • Hemodynamic infusions: Epinephrine and norepinephrine. keywords: echocardiography; liver; olt; tee; transesophageal; transplant cache: anesthj-173.pdf plain text: anesthj-173.txt item: #41 of 77 id: anesthj-186 author: Whiteley, Kristina Alexis title: Comparison of Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Pain Management date: 2023 words: 1352 flesch: 40 summary: Compared to the gold standard epidural, TAP blocks result in significantly less opioid consumption, postop pain, and incidences of hypotension, with no difference in opioid consumption at 72 hrs2 • When compared to QL blocks, TAP blocks are shown to have increase patient pain scores, opioid consumption, and number of patients requiring analgesia postoperatively3 Quadratus Lumborum Block vs. Transversus Abdominis Plane Block Kristina “Alexis” Whiteley, BSN, RN, Texas Christian University Case Summary Pre-Anesthetic Evaluation • 58-year-old disabled female, NKDA, ASA 2, BMI 31.2 • History of pancreatic head mass & obstructive jaundice status post biliary stent • Medical history: anxiety & GERD • Surgical history: EGD & ERCP • Home medications: pantoprazole 40 mg PO q morning • Preoperative medications: acetaminophen 650 mg PO, celecoxib 200 mg PO, gabapentin 300 mg PO, transdermal scopolamine & midazolam 2 mg IV Intraoperative Course • General anesthesia induction: RSI with IV ketamine 50 mg, lidocaine 100 mg, & propofol 150 mg; muscle relaxation via succinylcholine 120 mg • Antibiotics & adjuncts: cefepime 2 g, dexamethasone 8 mg, magnesium sulfate 2 g bolus, lidocaine drip 2000 mg/500 mL at 2 mg/min • Maintenance: isoflurane, rocuronium titrated to twitches, 1 PRBC & 2 PLT received • Opioids & pain adjuncts: fentanyl 200 mcg, hydromorphone 2 mg, ketamine 10 mg/hr for a total of 50 mg Postoperative Course • Postoperative QL block: keywords: block; plane; tap cache: anesthj-186.pdf plain text: anesthj-186.txt item: #42 of 77 id: anesthj-203 author: Mishra, Puneet; Wanderer, Jonathan P; Edwards, David A; Eagle, Susan S; Bruehl, Stephen P; Semler, Matthew W; Mishra, Kelly L title: A Review Evaluating Intravascular Access for High Volume Resuscitation: Can You Keep Up? date: 2023 words: 2393 flesch: 52 summary: AEJ Volume 11- No. 1, 2023 Glossary of Terms: IV = intravenous mL/min = milliliters/minute Q = flow rate n = viscosity r = radius l = length of tubing PIVs = Peripheral Intravenous Catheters PICCs = Peripherally Inserted Central Catheters CVCs = Central Venous Catheters RICs = Rapid Infusion Catheters IO = Intraosseous MAC = Arrow® Poiseuille’s Law states that flow rate (Q) is proportional to the pressure gradient along the IV tubing and inversely proportional to the viscosity (n) of the fluid as well as the length of the tubing (l ). keywords: access; catheters; flow; rates cache: anesthj-203.pdf plain text: anesthj-203.txt item: #43 of 77 id: anesthj-210 author: Lambert, Michael C; Ward, Robyn C; Riddle, J Dru title: Turnover Factors for Certified Registered Nurse Anesthetists: A Scoping Review date: 2024 words: 3633 flesch: 47 summary: Given the tremendous cost of occupational turnover (hereafter referred to as turnover) in healthcare4, as well as evidence that turnover impacts the quality of healthcare delivery5, exploring the evidence related to turnover factors for CRNAs is important. The objective of this scoping review is to understand the extent and type of evidence in relation to turnover factors for CRNAs in the U.S. Review question What factors are associated with turnover for CRNAs in the U.S.? keywords: burnout; crnas; factors; intention; job; nurse; review; satisfaction; studies; turnover cache: anesthj-210.pdf plain text: anesthj-210.txt item: #44 of 77 id: anesthj-22 author: Flowers, BSN, RRNA, Becky title: Neuromuscular Monitoring: Does the use of acceleromyography in comparison to the unaided clinical assessment result in lower occurrences of postoperative residual neuromuscular blockade in patients admitted to the post anesthesia care unit? date: 2015 words: 4518 flesch: 38 summary: The purpose of this report was to determine whether objective acceleromyography compared with subjective peripheral twitch monitors and clinical assessment is more effective in decreasing the occurrence of postoperative residual neuromuscular blockade. However, the change in practice from qualitative to quantitative monitoring is accompanied by hesitancy and uncertainty from practitioners across the nation who underestimate the occurrence of postoperative residual neuromuscular blockade and its consequences. keywords: acceleromyography; blockade; monitoring; neuromuscular; patients; ratio; tof; use cache: anesthj-22.pdf plain text: anesthj-22.txt item: #45 of 77 id: anesthj-26 author: Tracey, MSN, CRNA, Andy title: Student Nurse Anesthetists’ Views on CRNA Role Transition date: 2015 words: 2222 flesch: 48 summary: Thematic analysis using constant comparison was completed within and across focus groups. Following the methodology of similar research, a study using focus groups was implemented to explore how student registered nurse anesthetists (SRNAs) think about their role transition and its influencing factors.3 METHODOLOGY Focus group methodology is considered a naturalistic approach.4,5 Focus groups are viewed as a type of group interview to gain perspectives on specific issues. keywords: anesthesia; focus; nurse; role; srnas; transition cache: anesthj-26.pdf plain text: anesthj-26.txt item: #46 of 77 id: anesthj-28 author: Borza, DNP, MBA, CRNA, John Michael; Kaufmann, Dr.PH, FNP-BC, Judith A.; Cline, PhD, MBA, Thomas W. title: Reducing Intravenous Narcotic Documentation Errors On the Electronic Anesthesia Record: A Quality Improvement Project date: 2015 words: 4544 flesch: 43 summary: Anesthesia eJournal Volume 3 Issue 2 2015 AEJ Educated Hand Publishing LLC “The Science Behind the Art” Anesthesia eJournal - Online ISSN 2333-2611 Medication errors are an important public health problem with high human and financial costs. Medication errors in anesthesia can result in patient morbidity or mortality and should be preventable. keywords: anesthesia; care; documentation; errors; evidence; medication; medication errors; patient; quality; rate; review; study cache: anesthj-28.pdf plain text: anesthj-28.txt item: #47 of 77 id: anesthj-32 author: Reid, CRNA, MSNA, Jo; Austin,CRNA, PhD, Paul N.; Rodriguez, PhD, Ricardo E. title: The Laryngeal Mask Airway: Is It Safe for Pediatric Adenotonsillectomy? date: 2015 words: 3713 flesch: 48 summary: There were no statistically significant demographic differences among the LMA success, LMA failure, and ETT groups. Age, type of surgery, mode of ventilation, and surgeon were associated with LMA failure. keywords: airway; anesthesia; ett; evidence; laryngeal; lma; mask; subjects; t&a cache: anesthj-32.pdf plain text: anesthj-32.txt item: #48 of 77 id: anesthj-33 author: Flanagan, DNP, CRNA, Annabelle Lea Hicks title: Anesthetic management of a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like symptoms (MELAS): a case study date: 2016 words: 4198 flesch: 36 summary: The use of succinylcholine in MELAS patients with muscle wasting can still predispose patients to hyperkalemia, but not as a result of the disease itself. The metabolic burden in MELAS patients can be reduced by avoidance of the following: lactate in intravenous fluids, hypothermia, prolonged fasting, and postoperative nausea vomiting. keywords: acidosis; anesthesia; case; hyperthermia; management; melas; metabolic; muscle; myopathy; patient; stroke; syndrome cache: anesthj-33.pdf plain text: anesthj-33.txt item: #49 of 77 id: anesthj-34 author: Deeds, DNP, CRNA, ANC, USA, Jacob Lee; Shaw, DNAP, CRNA, ANC, USA, Priscilla N.; Elliot, DNP, CRNA, ANC, USA, Aaron R.; Morgan, DNP, CRNA, Brett T. title: An Anesthesia Quality Improvement Plan to Improve Postoperative Pain Outcomes after Hysterectomy date: 2016 words: 5529 flesch: 43 summary: Postoperative pain is nondiscriminatory, affecting patients across the surgical spectrum. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. keywords: acetaminophen; analgesic; anesthesia; data; gabapentin; hysterectomy; implementation; opioid; outcomes; pacu; pain; patients; project; regimen; time cache: anesthj-34.pdf plain text: anesthj-34.txt item: #50 of 77 id: anesthj-38 author: Dukatz, MSN, CRNA, Tamra; Hurst, MSN, CRNA, Emma; Golinski, PhD, CRNA, Mary; Rosenblatt, MD, Solomon; Sakharova, MD, Alla; Van Loon, MS, James title: An Institutional Peri-operative Intravenous Insulin Infusion Algorithm: Evaluation and Recommendations date: 2016 words: 5682 flesch: 47 summary: Values are mean ± SD, unless otherwise indicated. of insulin infusion to achievement of blood glucose target and the average perioperative blood glucose values after infusion initiation were recorded. The highest rate of insulin infusion, the presence of IV dextrose initiation, and the occurrence of insulin infusion discontinuation, either temporarily or permanently during the perioperative time frame, were documented. keywords: algorithm; blood; glucose; group; infusion; insulin; patients; perioperative; pump; target; time cache: anesthj-38.pdf plain text: anesthj-38.txt item: #51 of 77 id: anesthj-39 author: Kline, CRNA, MSNA, Jonathan title: Reliable needle visualization during ultrasound guided regional and vascular procedures. A simple solution to steep angle echogenicity loss with any ultrasound system, based on target depth. date: 2015 words: 2797 flesch: 55 summary: anesthesiology, increased needle visualization under ultrasound, law of sines, needle visualization, needle enhancement, ultrasonography Abstract Reliable Needle Visualization During Ultrasound-Guided Regional Procedures: A Simple Solution to Steep-Angle Echogenicity Loss Based on Target Depth Jonathan Kline, CRNA, MSNA Affiliation: Director of Education at Twin Oaks Anesthesia Services. Because depth readings are a fairly standard display in the ultrasound industry, we decided to use this single variable to provide a map for allowing increased needle visualization based on this piece of readable information. keywords: angle; depth; loss; needle; probe; ultrasound; visualization cache: anesthj-39.pdf plain text: anesthj-39.txt item: #52 of 77 id: anesthj-45 author: Gillikin, MSN, MSNA DNP, CRNA, Karen Elizabeth; Apatov, MSN, MHS, PhD, CRNA, Nathaniel title: The Effectiveness of an Anesthesia Handoff Tool: An Electronic Health Record Application to Enhance Patient Safety date: 2016 words: 4624 flesch: 44 summary: Twelve patient care information items were identified as essential components of patient care handoff. These findings provide information regarding the incidence of patient information inaccuracies and omissions during patient care transfer before and after implementation of an electronic patient care transfer tool. keywords: anesthesia; care; electronic; handoff; information; omissions; patient; status; tool; transfer; years cache: anesthj-45.pdf plain text: anesthj-45.txt item: #53 of 77 id: anesthj-46 author: Hudson, DNP, MSNA, CRNA, APRN, Melissa Dawn; Crogan, Ph.D, ARNP, GNP-BC, FNGNA, FAAN, Neva L; Bilsky, PhD, Edward J title: Efficacy of Ondansetron as a Prophylactic Anti-Hypotensive Pharmacologic Intervention Among Obese Parturients Undergoing Spinal Anesthesia for Cesarean Delivery date: 2016 words: 4444 flesch: 44 summary: The primary objective of this study was to assess the efficacy of the novel application of ondansetron as a prophylactic anti-hypotensive pharmacologic intervention among obese parturients to facilitate practice recommendations for reducing maternal-fetal risk associated with the administration of spinal anesthesia for cesarean delivery. Conclusions: Obese parturients undergoing spinal anesthesia for cesarean delivery demonstrated improvements in hemodynamic stability when prophylactically treated with ondansetron. keywords: administration; anesthesia; cesarean; delivery; obese; ondansetron; parturients; spinal; vasopressor cache: anesthj-46.pdf plain text: anesthj-46.txt item: #54 of 77 id: anesthj-49 author: Pickering-Luttrell, MS, CRNA, Hazel Marie; Gayden, MS, CRNA, Johnny; Pellegrini, PhD, DNP, CRNA, Joseph title: EFFECTIVENESS OF INTRAVENOUS ACETAMINOPHEN ADMINISTRATION IN THE POSTOPERATIVE PAIN MANAGEMENT OF THE CESAREAN SECTION PATIENT date: 2016 words: 4558 flesch: 38 summary: The maximum blood concentration (Cmax) of acetaminophen given intravenously is 29 mcg/mL, that for the oral formulation is 14.2 mcg/mL, and that for the rectal formulation is 10.3 mcg/ mL.13 Pharmacokinetic information indicates that dosing of IV acetaminophen does not reach the hepatotoxic levels of 150 mcg/ mL, even with repeat dosing.14 Kulo et al15 collected plasma or urine samples from 39 women scheduled for elective cesarean delivery to evaluate the pharmacokinetics of IV paracetamol. 1 g IV paracetamol in 100 mL normal saline over 15 min and placebo group with normal saline alone, 20 min prior to the end of the procedure. keywords: acetaminophen; analgesic; anesthesia; cesarean; delivery; morphine; opioid; pain; paracetamol; patients; study cache: anesthj-49.pdf plain text: anesthj-49.txt item: #55 of 77 id: anesthj-5 author: Kline, CRNA, MSN, Jonathan P title: The Evolution of the Adductor Canal Block: The Emerging Technique for Motor-Sparing Analgesia to the Knee date: 2014 words: 3398 flesch: 58 summary: Also in 2013, a head- to-head, retrospective study comparing the analgesic/ambulatory effects of the adductor canal block to femoral nerve block was published by Perlas et al 14 Adductor canal block versus femoral nerve block and quadriceps strength: a randomized, double-blind, placebo-controlled, crossover study in healthy volunteers. keywords: adductor; adductor canal; block; canal; knee; nerve; pain; technique cache: anesthj-5.pdf plain text: anesthj-5.txt item: #56 of 77 id: anesthj-50 author: Freman, DNP, CRNA, Clay title: Postoperative Residual Curarization: A Case Report date: 2016 words: 2809 flesch: 47 summary: The corrugator supercilii muscle demonstrates a recovery time comparable with that of the diaphragm.5,7,8 The adductor pollicis has a more delayed recovery time than that of the corrugator supercilii muscle.2,5,6 The adductor pollicis is in fact one of the muscles that is part of the last group of muscles to recover from NMB.5,7 Interpretation of TOF is also a crucial aspect in evaluating the degree of neuromuscular recovery. Additionally, dosing NMB antagonism on the basis of the degree of neuromuscular recovery is of critical importance to avoid PORC. keywords: anesthesia; neuromuscular; nmb; patient; porc; recovery; reversal cache: anesthj-50.pdf plain text: anesthj-50.txt item: #57 of 77 id: anesthj-53 author: Reeve, DNP, CRNA, Jenna title: Polypeptide Antibiotic Potentiation of Neuromuscular Blocking Agent Postoperatively: A Case Report date: 2016 words: 3340 flesch: 40 summary: Furthermore, it is important to recognize that polymyxin can not only potentiate the neuromuscular blockade produced by an NMBA but also cause some degree of neuromuscular blockade when administered alone.1-2,5-7,9-10,12 Lindesmith et al9 in 1968 discussed cases in which patients experienced symptoms of neuromuscular toxicity due to polypeptide antibiotics without being given any NMBA or other potentially neurotoxic antibiotics. The polypeptide antibiotics were administered intramuscularly to most of the patients.9 Also, to prevent possible complications, polypeptide antibiotics and certain NMBAs should be used cautiously in patients with altered renal function or myasthenia gravis.8 These patient populations are at higher risk for neurotoxicity and nephrotoxicity after polypeptide antibiotic administration.8 Reversal of neuromuscular blockade caused by antibiotics is difficult, and attempts to reverse with calcium chloride and cholinesterases have not proven effective.1,3-4,6-12 Although neostigmine is an acetylcholinesterase inhibitor, it can actually augment the neuromuscular blockade enhanced by polypeptide antibiotics.6 Subclinical doses of acetylcholinesterase inhibitors may inadequately antagonize neuromuscular blockade and actually enhance the blockade at standard reversal dosages.1,3,6,7 keywords: antibiotics; blockade; muscle; neuromuscular; nmbas; patient; reversal cache: anesthj-53.pdf plain text: anesthj-53.txt item: #58 of 77 id: anesthj-55 author: Bozimowski, DNP, CRNA, Greg; Skellenger, MS, CRNA, Peter title: Anesthesia Related Outcomes in Patients Receiving Regional Anesthesia for Shoulder Surgery in a CRNA-Only Practice In the Rural Setting date: 2017 words: 4398 flesch: 57 summary: Sample: 50 patients Result: * 76% of ISB patients and 16%of GA patients bypassed PACU * 0 ISB patients and16% of GA patients were admitted * 0 (0 %) ISB patients and 20 (80 %) Strengths: Randomized, blinded study Aldrete scoring used on all patients initially to assess ability to bypass PACU Follow-up was through 2 week period Weaknesses: Small sample size GA patients received PONV prophylaxis, ISB patients did not GA patients received nitrous oxide 50%, an agent known to produce PONV Authors/Study Design, Purpose and Sample Results and Conclusions Critique of Strengths and Weakness Lehmann L, Loosen G, Weiss C, Schmittner M. Interscalene plexus block versus general anaesthesia for shoulder surgery: A randomized controlled study. keywords: anesthesia; group; isb; patients; shoulder; surgery; time cache: anesthj-55.pdf plain text: anesthj-55.txt item: #59 of 77 id: anesthj-58 author: Margulies, MSN, CRNA, Jake; Bahoravitch, MSN, CRNA, Dirk; Collins, PhD, DNP, CRNA, Shawn; Hewer, MSN, CRNA, Ian title: Environment impact of inhaled anesthetics: A literature review date: 2017 words: 2961 flesch: 43 summary: Through the use of the GASman computer tool (Med Man Sim- ulations, Chestnut Hill, MA), Feldman15 was able to simulate the various phases of anesthesia, including induction, maintenance, and emergence, and the amount of volatile anesthetic used during each phase under certain FGFs and volatile anesthetics. Current research demonstrates that increasing air pollution causes significant increases in cardiac disease, pulmonary disease, and even death—including 16% of lung cancer, 11% of chronic obstructive pulmonary disease, and 20% of ischemic heart disease and stroke deaths.5 An estimated 150,000 deaths per year (0.3% of all annual deaths) are said to be related to climate by the World Health Organization (WHO), and this number is expected to increase.6 The climate-associated health risks identi- fied by the WHO include food and water insecurity, increased transmission of infection, heat stress, more frequent and extreme weather events, threats to shelter and security, and population migration.7 Because of the medical necessity of volatile anesthetic gases, no prior regulations on emissions have been sought.8 However, with the increased number of individuals undergoing surgery and anesthesia and the development of newer anesthetic agents, the environmental impacts of these anesthetics should be evaluated. keywords: anesthesia; anesthetics; desflurane; environmental; gases; health; impact; ozone; use cache: anesthj-58.pdf plain text: anesthj-58.txt item: #60 of 77 id: anesthj-6 author: Varkey, John; Welliver, CRNA, DNP, Mark title: Debunking Volatile Anesthetic Cost Myths Between Sevoflurane and Desflurane date: 2013 words: 4497 flesch: 51 summary: Actual VAA cost is determined by actual consumption and the CRNA iVAC quickly determines actual VAA cost. The authors opposed the use of a static formula to determine VAA cost because FGF rates are often adjusted throughout a case. keywords: anesthesia; cost; desflurane; fgf; mac; min; sevoflurane; vaa cache: anesthj-6.pdf plain text: anesthj-6.txt item: #61 of 77 id: anesthj-62 author: Flanagan, MSN, CRNA, DNPc, Donté A.; Kerin, MS, CRNA, Athena title: How is Intraoperative Music Therapy Beneficial to Adult Patients Undergoing General Anesthesia? A Systematic Review date: 2017 words: 6152 flesch: 46 summary: In the late 1940s, Pickrell and his research team spent 6 years studying the effects of music therapy on preoperative, intraoperative, and postoperative surgical patients.2 Music therapy has been accepted as a beneficial tool used for the treatment of anxiety and pain relief for the conscious patient. keywords: anesthesia; control; general; group; headphones; intervention; music; music therapy; pain; patient; postop; studies; study; therapy; volume cache: anesthj-62.pdf plain text: anesthj-62.txt item: #62 of 77 id: anesthj-66 author: Erlinger, PhD, CRNA, Lisa; Monk, MD, MS, Terri; McAfee, MD, Steven title: The Safety of Glucagon use during ERCP in Diabetic Patients with Renal Insufficiency: A Case Discussion and Review of Literature date: 2018 words: 2535 flesch: 48 summary: L-Hyoscyamine is associated with peri- procedural adverse effects including nausea and vomiting and has not been shown to decrease the amount of glucagon patients receive.11,16 Each counterbalances blood glucose levels to keep the body within the normal therapeutic range. keywords: bile; duct; ercp; glucagon; glucose; hyperkalemia; insulin; potassium cache: anesthj-66.pdf plain text: anesthj-66.txt item: #63 of 77 id: anesthj-7 author: Embrey, Ed.D, CRNA, Karen; Yates, Ed.D, Kenneth title: The Use of Cognitive Task Analysis to Improve Anesthesia Skills Training for Postoperative Extubation date: 2013 words: 4274 flesch: 39 summary: Keywords: Cognitive task analysis, extubation training, expertise and anesthesiology AbstrAct This study examines knowledge gains in 25 nurse anesthesia trainees, following the implementation of a novel instructional design, which incorporated cognitive task analysis (CTA) to teach an adult postoperative extubation procedure. Cognitive task analyses are methods used to elicit the full spectrum of expertise necessary for complex skill execution in order to improve instructional design for the teaching of these skills. keywords: cta; experts; extubation; instruction; knowledge; patient; students; task cache: anesthj-7.pdf plain text: anesthj-7.txt item: #64 of 77 id: anesthj-70 author: Wood, MSNA, CRNA, Eric R. title: Efficacy of Intranasal Dexmedetomidine as a Preoperative Anxiolytic in Children: A Systematic Review date: 2017 words: 3347 flesch: 47 summary: The most common negative behavior responses include separation anxiety, eating problems, nightmares, aggression toward authority, and temper tantrums.1,2 Problems with eating and sleeping may be attributable to the fact that children with increased preoperative anxiety often experience a more painful and slower recovery than those with low anxiety levels.2 Predictors of preoperative anxiety include increased parental anxiety, a low activity level, a less sociable temperament, and a history of poor-quality medical In an older study by Yuen et al, the participants were given premedication 60 min before the induction of general anesthesia; the authors measured anxiety by evaluating behavior at parental separation by using a 4-point Likert-type behavior scale (a score of 1 indicated “calm and cooperative” and a score of 4 indicated “crying or resisting”).19 By contrast, both Ghali et al and Linares Segovia et al utilized the validated modified Yale Preoperative Anxiety Scale (mYPAS) to evaluate anxiety at the time of transfer to the operating room.20-22 The mYPAS, which can be performed by an observer in less than 1 min,20 contains 22 items within 5 categories.20,21 The categories include activity, emotional expressivity, state of arousal, vocalization, and use of adults.20,21 Scores range from 23 to 100, with an increased score indicating an increased anxiety state.20 Primary conclusions At the time of parental separation, Yuen et al found no significant difference in behavior scores between the oral midazolam group and the 2 IN DEX dose groups (P = 0.771).19 keywords: anesthesia; anxiety; children; dex; induction; midazolam; min; premedication; studies cache: anesthj-70.pdf plain text: anesthj-70.txt item: #65 of 77 id: anesthj-71 author: Mosier, RN, BSN, RRNA, Meredith; Riddle, PhD, DNP, CRNA, J. Dru title: Prophylaxis and Treatment of Hereditary Angioedema with Fresh Frozen Plasma: A Synthesis and Narrative Review date: 2018 words: 2928 flesch: 48 summary: Surgical patients with hereditary angioedema should undergo prophylactic treatment before surgical procedures to decrease the risk of an exacerbation. Hereditary angioedema (HAE), acquired angioedema (AAE), and angiotensin-converting enzyme (ACE) inhibitor-induced angioedema are 3 types of bradykinin-mediated angioedema.1 Patients susceptible to bradykinin-mediated angioedema may experience a precipitating event before an acute episode occurs.1 Airway instrumentation, upper airway trauma resulting from airway instrumentation, surgery, and psychologic or physiologic stress experienced by the patient may precipitate an exacerbation of angioedema.1 keywords: angioedema; exacerbation; ffp; hae; patient; prophylaxis; treatment cache: anesthj-71.pdf plain text: anesthj-71.txt item: #66 of 77 id: anesthj-74 author: Varela, DNP, CRNA, Debra S.; Newman, DNAP, CRNA, Johanna; Valdes, DNP, CRNA, Jorge A. title: Regional Anesthesia for Bilateral Carpal Tunnel Release date: 2018 words: 3906 flesch: 38 summary: A preponderance of available literature supporting the use of a local anesthesia only technique termed “wide awake local anesthesia no tourniquet” (WALANT) has been published by Lalonde et al.10-12,15 Comparison studies conducted by Lalonde’s group evaluating patient satisfaction between nonsedation and sedation techniques showed no significant differences in satisfaction; however, surgical conditions and local anesthesia techniques were not standardized between the groups.15 In the study conducted by Rozanski et al14 to specifically evaluate pain perception on injection and during the procedure between sedation and nonsedation groups, significantly higher pain on injection and during the surgery was reported in the local anesthesia only groups. The words and phrases searched included the following: bilateral carpal tunnel syndrome/release, bilateral versus staged unilateral carpal tunnel release, median nerve block, regional anesthesia for bilateral hand procedures, local anesthesia with epinephrine and hand surgery, buffering of local anesthetics, general anesthesia versus regional anesthesia: cost and safety, anxiety and anesthesia, sedation, and monitored anesthesia care. keywords: anesthesia; bctr; carpal; hand; local; median; nerve; patients; procedures; surgery; technique; tunnel cache: anesthj-74.pdf plain text: anesthj-74.txt item: #67 of 77 id: anesthj-75 author: Haley, MS-N, CRNA, Trish; Min, MSN, CRNA, Yejin; Collins, Shawn; Hooper, PhD, RN, CPAN, FAAN, Vallire title: Preoperative Interventions for Prevention of Hypothermia date: 2017 words: 4877 flesch: 29 summary: The PICO question used to guide this review was as follows: “In adults undergoing general anesthesia, does the addition of preoperative warming devices for a specific length of time compared to no preoperative warming methods result in a decreased incidence of perioperative hypothermia?” AORN Journal Experimental Randomized Con- trolled Trial Strength: Level 1 Quality: Moderate Small sample size Both groups received warmed cotton blankets preoperatively Lack of patients with hypothermia in both groups throughout the study Intraoperative temperature measurements were not evaluated Imprecise time intervals for temperature measurements Hooven (2011) Journal of Peri-Anes- thesia Nursing Quasi-experimental Nonrandomized Trial Strength: Level 2 Quality: Moderate Temperature measurements only obtained for preoperative and postoperative periods Mean surgical duration time differed significantly between the 2 groups (P=0.048) Significant difference in preoperative temperatures in both groups (P=0.008) keywords: air; anesthesia; group; hypothermia; minutes; patients; preoperative; prewarming; temperature; trial; warming cache: anesthj-75.pdf plain text: anesthj-75.txt item: #68 of 77 id: anesthj-77 author: Thigpen, DNP, CRNA, Joshua M. title: A Case Report of Acute Pulmonary Edema and Sudden Death Following Heart Surgery date: 2019 words: 2577 flesch: 48 summary: Both of these conditions can produce hypoxia, pulmonary edema, and hypoten- sion. Several signs may be observed as this process occurs, such as dyspnea, hypoxia, hypotension, pulmonary hypertension, pulmonary edema, pulmonary infiltrates on chest x-ray, and decreased lung compliance.2 keywords: anesthesia; blood; cpb; edema; patient; protamine; pulmonary cache: anesthj-77.pdf plain text: anesthj-77.txt item: #69 of 77 id: anesthj-79 author: Smith-Steinert, DNP, CRNA, Rachel Marie; Stec, DNP, CNM, APRN, FACNM, FAAN, Melissa title: Using Video Assisted Technology and Simulation to Transform a Nurse Anesthesia Machine and Equipment Course date: 2018 words: 4584 flesch: 45 summary: Threats to external validity were minimal because cohorts of nurse anesthesia students nationwide are required to meet similar standards for admission into programs. Therefore, they did not have other nurse anesthesia machine courses with which to compare this experience. keywords: anesthesia; anesthesia machine; course; equipment; exam; learning; machine; nurse; review; simulation; students; use cache: anesthj-79.pdf plain text: anesthj-79.txt item: #70 of 77 id: anesthj-8 author: Rabbani, CRNA, MS, Robbin; Gold, CRNA, PhD, Michele E. title: Perioperative Management to Prevent Allogeneic Blood Transfusion in Liver Surgery date: 2014 words: 3715 flesch: 51 summary: This study also identified a significant decrease in blood transfusion in the ANH group by more than 100 mL RBC. Although fibrinogen was decreased and PT/PTT were prolonged after ANH, these values were within normal limits and improved to values similar to the control group after transfusion of homologous blood.7 ANH facilitated a reduction in the concentration of RBCs lost, and allogeneic blood transfusion was not necessary, possibly due to ANH therapy. keywords: anh; blood; cvp; group; loss; low; patients; pressure; resection; transfusion cache: anesthj-8.pdf plain text: anesthj-8.txt item: #71 of 77 id: anesthj-80 author: Ballister, DNP, CRNA, APRN, Michele Marie title: Student Registered Nurse Anesthetists: The Impact of Structured High Fidelity Simulation on Anesthesia Ready Time date: 2018 words: 3616 flesch: 41 summary: The clinical performance of both groups of nurse anesthesia students, those with and without structured HFS before the onset of clinical training fell within the scheduled 30-minute time frame. The importance of debriefing in clinical simulations. Clin Simul Nurs. 2008;4(2):e19-e23. keywords: anesthesia; hfs; nurse; patient; performance; simulation; skills; srnas; time; training cache: anesthj-80.pdf plain text: anesthj-80.txt item: #72 of 77 id: anesthj-87 author: Kline, MSNA, CRNA, Jonathan P title: Ultrasound-Guided INTRAPEC Injection for Breast Surgery: A Novel Solution for Surgical Field Improvement During Electrocautery and Implantation and for Postoperative Pain and Muscle Spasm Reduction for Breast Surgery date: 2018 words: 2939 flesch: 41 summary: Finally, Trignano et al reported on the use of an injection of the pectoral muscle, using botulinum toxin type A (Botox-A), for relief of pectoral muscle spasms in 2011.5 Although the team reported favorable results of the intervention, the pectoral muscle was used as a flap for head and neck surgery, which is not exactly in league with this topic. Pectoral muscle spasms after mastectomy successfully treated with botulinum toxin injections. keywords: injection; intrapec; muscle; pain; pecs; spasm; technique; ultrasound cache: anesthj-87.pdf plain text: anesthj-87.txt item: #73 of 77 id: anesthj-88 author: Hacker, James B; Johnson, Paul M; Bruner, Sandra; Parrott, Justice; Alguire, Katherine; Uranga, Tiffany; Yauger, Sunny J; Nayback-Beebe, Ann title: Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice date: 2022 words: 3800 flesch: 48 summary: The overall incidence of perioperative critical events has been estimated at 145 events per year for a hospital that performs 10,000 operations.2,3 Thus, critical events may be so rare that individual anesthesia providers never experience them in practice, preventing opportunities to form pattern recognition, which is a key characteristic of expert clinical decision-making.4 CRNAs are expected to rely on memory alone to recall key actions and seamlessly manage a wide array of critical events, therefore, mismanagement or deviation from accepted practice due to human error, may account for a substantive portion of anesthesia- related risk.5 Utilization of an emergency manual (EM) can increase the number of key actions completed by anesthesia providers during low-frequency, high-risk perioperative critical events.6-10 In 1924, Babcock expressed if a critical event during surgery required a response that was not instantly obtained by simple measures, a fixed emergency routine should be posted on the walls of every operating room, drilled into every staff member, and strictly enforced.11 Over 90 years later, there remains a cultural reluctance among anesthesia providers towards use of emergency checklists during perioperative critical events, with one study reporting 60% of anesthesia residents believing they should be able to manage a critical event from memory alone.6 Substantial evidence indicates anesthesia providers routinely do not remember all actions involved in managing emergent events from memory alone.12 Indeed, three recent editorials make the same plea as Babcock did in 1924, concluding it is time to adopt the use of emergency routines during the perioperative period.11 Several studies demonstrate healthcare providers perform poorly when relying solely on memory to manage simulated critical events.8,13-16 For instance, Smith et al found a rapid decline in Advanced Cardiac Life Support (ACLS) skills among nurses after 3 and 12 months post-training, (30% and 14% of nurses, respectively).13 Regardless of these issues, the drastic change in key task performance proved invaluable when demonstrating the importance of using an EM for the management of critical anesthesia events. keywords: anesthesia; crnas; emergency; events; scenario; simulation; tasks; training; use cache: anesthj-88.pdf plain text: anesthj-88.txt item: #74 of 77 id: anesthj-89 author: Baribeault, MSN, CRNA, Thomas title: Opioid-Free Anesthesia for an Emergency Laparoscopic Cholecystectomy in a Patient Taking Buprenorphine-Naloxone for Opioid Addiction: A Case Report date: 2018 words: 2130 flesch: 43 summary: As the number of prescriptions written for opioid pain medication rises, so too does the number of patients presenting for surgery and anesthesia who may be opioid-dependent or undergoing medication-assisted treatment for opioid use disorder. In addition to reducing postoperative opioid use, multimodal therapies can significantly reduce the incidence of PONV.8 Patients undergoing bariatric surgery are also at high risk for PONV. keywords: anesthesia; buprenorphine; case; naloxone; opioid; pain; patient cache: anesthj-89.pdf plain text: anesthj-89.txt item: #75 of 77 id: anesthj-91 author: Rayborn, DNP, CRNA, Michong Kong; Jeong, PhD,CRNA, Gyeseon; Choi, PhD, Hwanseok; Hayden, PhD, MSN, RN, SatAnanda title: Contributions of South Korean Registered Nurses in Anesthesia Practice date: 2018 words: 6257 flesch: 52 summary: At that time there was a critical need for anesthesia services due to the many military and civilian war injuries, as well as from refugees flooding the country from the north.2-4 There were only a limited number of anesthesiologists in the country, and the Korean military trained the first nurse anesthetists in 1961 to help meet the shortfall.2-5 One of the most influential advocates for nurse anesthesia in the country at that time was an American woman named Sister Margaret Kollmer. For the next 29 years Sister Margaret was the most ardent pro- moter of nurse anesthesia in Korea.2 But the journey has not al- ways been smooth and there are still many bumps along the road. keywords: anesthesia; anesthetists; crnas; hospital; korea; nurse; practice; providers; specialty; study; test; years cache: anesthj-91.pdf plain text: anesthj-91.txt item: #76 of 77 id: anesthj-92 author: Gray, Lauren title: Prevention of Opioid Induced Hyperalgesia Following Remifentanil Infusion: A Case Report date: 2022 words: 2389 flesch: 46 summary: It is postulated that OIH is due to central sensitization through activation of NMDA receptors.3 In support of this hypothesis, the NMDA receptor antagonist ketamine has been shown to decrease postoperative pain intensity and morphine requirements in patients receiving remifentanil infusion during general anesthesia.4,5 Hong and colleagues used a 0.3-mg/kg intravenous bolus of ketamine during induction followed by a 3-mcg/kg/min ketamine infusion during surgery to effectively prevent OIH and decrease the total amount of opioids required in those undergoing general anesthesia utilizing sevoflurane and remifentanil.4 A separate study set out to determine the effective dose of ketamine to prevent OIH. These techniques include intravenous ketamine, inhaled nitrous oxide, oral pregabalin, and gradual cessation of remifentanil infusion. keywords: anesthesia; hyperalgesia; infusion; oih; opioid; pain; patient; remifentanil cache: anesthj-92.pdf plain text: anesthj-92.txt item: #77 of 77 id: anesthj-94 author: Kline, MSNA, CRNA, Jonathan P title: Procedural Ultrasound Location of Pectoral Nerve Neuroma Prior to Breast Reconstruction Surgery date: 2018 words: 2106 flesch: 42 summary: One complication from breast implant placement of nearly any kind is the development of chronic pain, defined as prolonged pain for more than 30 days after surgery. Ivica and colleagues reported the incidence of chronic pain after simple breast augmentation at 15%.2 Brummett reports that the prevalence of chronic pain after noncosmetic breast surgery is between 29% and 47%, with up to 13% of those patients experiencing severe pain.3 Ultrasound is being used in novel ways across the anesthesia community for needle-guided techniques, and increasingly, for bedside diagnosis and treatment. keywords: anesthesia; breast; chronic; neuroma; pain; surgery; ultrasound cache: anesthj-94.pdf plain text: anesthj-94.txt