anesthj: A Pathfinder

This is a computer-generated pathfinder created against the Distant Reader study called anesthj.

Each Distant Reader study carrel is composed of many individual items. Each item is bibliographically described with author, title, date, summary, and keyword values. Below is a list of the items' most signficant keywords as well as lists of the items themselves. Purpusing the content of this pathfinder provides the student, researcher, or scholar with one way to get their heads around the scope of the carrel. The keywords include:

Patient; Pain; Patients; Nurse; Surgery; Use; Studies; Dexmedetomidine; Glucose; Airway; Induction; Intubation; Syndrome; Pressure; Cesarean; Loss; Test; Magnesium; Sugammadex; Sevoflurane; Block; Carbon; Gas; Bleeding; Grifton; Echocardiography; Access

Depending on how this pathfinder was created, many of the bibliographic sections will include elaborations on the meaning(s) of the given keywords. These elaborations were generated by feeding the items' summaries to a large langauge model and asking the model to address the question, "What is X?", where "X" is the keyword. The result will be a few sentences of elaboration. Be forewarned. The elaborations are often plausible, but they should not be take as truth. Instead, they should be taken as points for consideration.

• Use of Clevidipine as an Alternative to Nitroglycerin in Cardiac Surgery by Harville, Kate; Jenschke, PhD, CRNA, Monica (2019) - 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
• Propofol and Ketamine for Targeted Muscle Reinnervation after Limb Amputation: A Case Report by Hupman, SRNA, Angela; Eshkevari, PhD, CRNA, Ladan (2013) - »» 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
• Intravenous Magnesium Sulfate for Multimodal Analgesia by Noland, Ashley (2019) - § 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
• Opioid Free Anesthesia: A Gender Reassignment Case Report by Barnett, Chelsea (2019) - • 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
• Verification of Ventilation before Neuromuscular Blocker Administration during Anesthetic Induction and Endotracheal Tube Insertion in the Non-Rapid Sequence Induction Setting by Murdock, Skyler (2019) - 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
• Patient Blood Management by Berman, Brianna (2021) - • 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
• Dexmedetomidine versus Propofol for Cardiopulmonary Bypass by Leazenby, Jinah (2020) - 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
• Intraoperative Dexmedetomidine for Analgesia during Burn Excision and Grafting by Ybarra, Amy L. (2020) - • 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
• Anesthesia for a Patient with Osteogenesis Imperfecta, Achondroplastic Dwarfism and History of Malignant Hyperthermia by Harvey, SRNA, Jaclyn (2024) - 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
• The Anesthetic Management of a Patient with Hereditary Coproporphyria by Fisher, Audrey (2021) - • 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
• Evidence is Inconclusive that Forcedair Warming Devices Increase Surgical Site Contamination or Infection by Bonner, SRNA, Ashley; Welliver, DNP, CRNA, ARNP, Mark (2014) - 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
• Preoperative Optimization of the Asthmatic Patient by Jordan, Ryan R (2022) - 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
• Protamine Reaction in Cardiovascular Surgery by Walker, Gage (2023) - 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
• Reducing Intravenous Narcotic Documentation Errors On the Electronic Anesthesia Record: A Quality Improvement Project by Borza, DNP, MBA, CRNA, John Michael; Kaufmann, Dr.PH, FNP-BC, Judith A.; Cline, PhD, MBA, Thomas W. (2015) - 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
• Anesthetic management of a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like symptoms (MELAS): a case study by Flanagan, DNP, CRNA, Annabelle Lea Hicks (2016) - 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
• The Effectiveness of an Anesthesia Handoff Tool: An Electronic Health Record Application to Enhance Patient Safety by Gillikin, MSN, MSNA DNP, CRNA, Karen Elizabeth; Apatov, MSN, MHS, PhD, CRNA, Nathaniel (2016) - 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
• Postoperative Residual Curarization: A Case Report by Freman, DNP, CRNA, Clay (2016) - 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
• Polypeptide Antibiotic Potentiation of Neuromuscular Blocking Agent Postoperatively: A Case Report by Reeve, DNP, CRNA, Jenna (2016) - 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
• How is Intraoperative Music Therapy Beneficial to Adult Patients Undergoing General Anesthesia? A Systematic Review by Flanagan, MSN, CRNA, DNPc, Donté A.; Kerin, MS, CRNA, Athena (2017) - 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
• The Use of Cognitive Task Analysis to Improve Anesthesia Skills Training for Postoperative Extubation by Embrey, Ed.D, CRNA, Karen; Yates, Ed.D, Kenneth (2013) - 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
• Prophylaxis and Treatment of Hereditary Angioedema with Fresh Frozen Plasma: A Synthesis and Narrative Review by Mosier, RN, BSN, RRNA, Meredith; Riddle, PhD, DNP, CRNA, J. Dru (2018) - 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
• A Case Report of Acute Pulmonary Edema and Sudden Death Following Heart Surgery by Thigpen, DNP, CRNA, Joshua M. (2019) - 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
• Student Registered Nurse Anesthetists: The Impact of Structured High Fidelity Simulation on Anesthesia Ready Time by Ballister, DNP, CRNA, APRN, Michele Marie (2018) - 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
• Opioid-Free Anesthesia for an Emergency Laparoscopic Cholecystectomy in a Patient Taking Buprenorphine-Naloxone for Opioid Addiction: A Case Report by Baribeault, MSN, CRNA, Thomas (2018) - 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
• Prevention of Opioid Induced Hyperalgesia Following Remifentanil Infusion: A Case Report by Gray, Lauren (2022) - 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

• Perioperative Management Considerations for Patients on Methadone and Buprenorphine by Coleman, Emily (2020) - 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
• Perioperative Management of a Patient Receiving Suboxone by Hipps, Hugh Hayden (2021) - 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
• An Anesthesia Quality Improvement Plan to Improve Postoperative Pain Outcomes after Hysterectomy by 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. (2016) - 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
• EFFECTIVENESS OF INTRAVENOUS ACETAMINOPHEN ADMINISTRATION IN THE POSTOPERATIVE PAIN MANAGEMENT OF THE CESAREAN SECTION PATIENT by Pickering-Luttrell, MS, CRNA, Hazel Marie; Gayden, MS, CRNA, Johnny; Pellegrini, PhD, DNP, CRNA, Joseph (2016) - 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
• The Evolution of the Adductor Canal Block: The Emerging Technique for Motor-Sparing Analgesia to the Knee by Kline, CRNA, MSN, Jonathan P (2014) - 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
• 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 by Kline, MSNA, CRNA, Jonathan P (2018) - 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
• Procedural Ultrasound Location of Pectoral Nerve Neuroma Prior to Breast Reconstruction Surgery by Kline, MSNA, CRNA, Jonathan P (2018) - 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

• Improving Anesthetic Depth Assessment During Electroconvulsive Therapy with Bispectral Index Monitoring: A Pilot Quality Improvement Project by Titch, CRNA, DNP, Frank J.; Holsinger, MD, Tracey; Vacchiano, CRNA, Phd, Charles; Blood-Siefried, CPNP, DNSc, Jane (2015) - 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
• Rocuronium vs Succinylcholine: Emergency Airway Management of the COVID-19 Patient by Shores, Ryan; Fowler, Katherine; McDonough, John; Suralis, Amy; Scindele, Denise; Müller-Wolff, Tilman (2021) - 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
• Congenital Long QT Syndrome:: A cardiac ion channelopathy with important anesthetic considerations by Harris, David E (2024) - 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
• 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? by Flowers, BSN, RRNA, Becky (2015) - 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
• An Institutional Peri-operative Intravenous Insulin Infusion Algorithm: Evaluation and Recommendations by Dukatz, MSN, CRNA, Tamra; Hurst, MSN, CRNA, Emma; Golinski, PhD, CRNA, Mary; Rosenblatt, MD, Solomon; Sakharova, MD, Alla; Van Loon, MS, James (2016) - 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
• Anesthesia Related Outcomes in Patients Receiving Regional Anesthesia for Shoulder Surgery in a CRNA-Only Practice In the Rural Setting by Bozimowski, DNP, CRNA, Greg; Skellenger, MS, CRNA, Peter (2017) - 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
• Regional Anesthesia for Bilateral Carpal Tunnel Release by Varela, DNP, CRNA, Debra S.; Newman, DNAP, CRNA, Johanna; Valdes, DNP, CRNA, Jorge A. (2018) - 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
• Preoperative Interventions for Prevention of Hypothermia by Haley, MS-N, CRNA, Trish; Min, MSN, CRNA, Yejin; Collins, Shawn; Hooper, PhD, RN, CPAN, FAAN, Vallire (2017) - 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
• Perioperative Management to Prevent Allogeneic Blood Transfusion in Liver Surgery by Rabbani, CRNA, MS, Robbin; Gold, CRNA, PhD, Michele E. (2014) - 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

• Barriers and Determinants that Influence Membership in the American Association of Nurse Anesthetists by Samons, David a; Samons, Jissel; Tolosa, Manuel (2022) - 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
• Job Satisfaction Among Certified Registered Nurse Anesthetist: A Multigenerational Analysis by Mileto, CRNA, DNP, Lisa; Penprase RN, PhD, CNOR, Barbara (2014) - 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
• Turnover Factors for Certified Registered Nurse Anesthetists: A Scoping Review by Lambert, Michael C; Ward, Robyn C; Riddle, J Dru (2024) - 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
• Student Nurse Anesthetists’ Views on CRNA Role Transition by Tracey, MSN, CRNA, Andy (2015) - 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
• Using Video Assisted Technology and Simulation to Transform a Nurse Anesthesia Machine and Equipment Course by Smith-Steinert, DNP, CRNA, Rachel Marie; Stec, DNP, CNM, APRN, FACNM, FAAN, Melissa (2018) - 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
• Contributions of South Korean Registered Nurses in Anesthesia Practice by Rayborn, DNP, CRNA, Michong Kong; Jeong, PhD,CRNA, Gyeseon; Choi, PhD, Hwanseok; Hayden, PhD, MSN, RN, SatAnanda (2018) - 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

• The Effectiveness of Total Intravenous Anesthesia (TIVA) in Functional Endoscopic Sinus Surgery (FESS) by Busalacchi, Anna (2022) - • 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
• Effect of Dexmedetomidine on Incidence of Emergence Delirium in Adult Nasal Surgery by Steinkampf, Christopher (2023) - 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

• Mobile Anesthesia Applications as Point-of-Care Tools for CRNAs in Clinical Practice by Strickland, Bevin Rene; Strickland, Daniel M (2020) - 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
• Environment impact of inhaled anesthetics: A literature review by Margulies, MSN, CRNA, Jake; Bahoravitch, MSN, CRNA, Dirk; Collins, PhD, DNP, CRNA, Shawn; Hewer, MSN, CRNA, Ian (2017) - 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
• Use of a High-Fidelity Patient Simulator to Introduce an Evidence-Based Emergency Manual into Certified Registered Nurse Anesthetist Practice by Hacker, James B; Johnson, Paul M; Bruner, Sandra; Parrott, Justice; Alguire, Katherine; Uranga, Tiffany; Yauger, Sunny J; Nayback-Beebe, Ann (2022) - 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

• 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 by Grelson, SRNA, Megan (2013) - 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
• Efficacy of Intranasal Dexmedetomidine as a Preoperative Anxiolytic in Children: A Systematic Review by Wood, MSNA, CRNA, Eric R. (2017) - 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

• Dexmedetomidine as an Anesthetic Adjunct in Off-Pump Coronary Artery Bypass Grafting: A Case Report by Vanek, Dean Allen (2021) - 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

• Carnitine Palmitoyl Transferase, Type 1A (CPT1A): The Arctic Variant by Patson, Amber Lee Madrid (2019) - 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
• The Safety of Glucagon use during ERCP in Diabetic Patients with Renal Insufficiency: A Case Discussion and Review of Literature by Erlinger, PhD, CRNA, Lisa; Monk, MD, MS, Terri; McAfee, MD, Steven (2018) - 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

• The Laryngeal Mask Airway: Is It Safe for Pediatric Adenotonsillectomy? by Reid, CRNA, MSNA, Jo; Austin,CRNA, PhD, Paul N.; Rodriguez, PhD, Ricardo E. (2015) - 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

• Open-Globe Eye Injuries and Choice of Muscle Relaxant: A Review of the Evidence by Benoit, BSN, RRNA, Joelle; Welliver, DNP, CRNA, ARNP, Mark (2014) - 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

• Submental Intubation for LeFort Type III Fracture by Bumatay, Ashley Jane (2021) - 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

• Off-label Rescue Agents for Vasoplegic Syndrome after Cardiopulmonary Bypass by Gatehouse, Jessica (2022) - 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

• Negative Pressure Pulmonary Edema (NPPE) by Nagel, Christine (2023) - “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

• Ondansetron Prior to Spinal Anesthesia to Prevent Hypotension During Cesarean Delivery by Jordan, Haley Marie; Diehl, Roseann (2022) - 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
• Efficacy of Ondansetron as a Prophylactic Anti-Hypotensive Pharmacologic Intervention Among Obese Parturients Undergoing Spinal Anesthesia for Cesarean Delivery by Hudson, DNP, MSNA, CRNA, APRN, Melissa Dawn; Crogan, Ph.D, ARNP, GNP-BC, FNGNA, FAAN, Neva L; Bilsky, PhD, Edward J (2016) - 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

• 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. by Kline, CRNA, MSNA, Jonathan (2015) - 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

• Noise Pollution in the Operating Room: Student Registered Nurse Anesthetist Education including Reduction Strategies and Tools by Davis-Sandfoss, Tyler A.C.; Smith-Steinert, Rachel (2020) - 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

• Magnesium Sulfate: A Multi-Modal Adjunct for Post-Operative Analgesia by Justice, Cody Ryan (2021) - 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

• Hypotension and Bradycardia with Sugammadex Administration by Nicholson, Samantha (2021) - 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

• Debunking Volatile Anesthetic Cost Myths Between Sevoflurane and Desflurane by Varkey, John; Welliver, CRNA, DNP, Mark (2013) - 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

• Comparison of Quadratus Lumborum Block and Transversus Abdominis Plane Block for Postoperative Pain Management by Whiteley, Kristina Alexis (2023) - 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

• Reducing the Carbon Footprint of the Anesthesia Provider by McGowan, Levi Scott (2021) - 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

• Anesthesia Management of Venous Gas Embolism with Hepatectomy by Kunisawa, Yoshiya (2021) - 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

• Anesthetic Management of a Patient with Von Willebrand Disease by Juch, Elaine (2021) - 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

• Decreased Pulse Oximetry Readings in Asymptomatic Patient with Hemoglobin Grifton by Serrano, Anne Marie (2021) - 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

• Transesophageal Echocardiography Use for Orthotopic Liver Transplant by Sedberry, Colton (2023) - • 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

• A Review Evaluating Intravascular Access for High Volume Resuscitation: Can You Keep Up? by Mishra, Puneet; Wanderer, Jonathan P; Edwards, David A; Eagle, Susan S; Bruehl, Stephen P; Semler, Matthew W; Mishra, Kelly L (2023) - 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

Epilogue

For more detail, about this study carrel, see the computed home page. For more detail about study carrels in general, see the read me file.

Created: 2025-12-23