Heidi Shields, CRNA, MSN, intubates a patient at Lakeview Medical Center Ambulatory Surgery Center, Suffolk, Virginia, in preparation for a tonsillectomy. At the time the photo was taken, Shields was a student at Old Dominion University, Nurse Anesthesia Program, Norfolk, Virginia. She is now a nurse anesthetist at Bon Secours Maryview Medical Center, Portsmouth, Virginia. (Photo taken by Aimee M. Joseph, CRNA, MSN.)
Bilateral Transversus Abdominis Plane Nerve Blocks for Analgesia Following Cesarean Delivery: Report of 2 Cases The author describes 2 case reports that use transversus abdominis plane (TAP) nerve blocks for analgesia following emergency cesarean delivery. Bilateral single shot TAP blocks provided prolonged and extremely effective analgesia. Patients displayed early oral intake, early ambulation, and low pain scores. No postoperative narcotics were used by either patient throughout the hospital stay. A technique for TAP blocks is described with discussion of risks and suggested uses.
α2-Adrenergic Agonists and Their Role in the Prevention of Perioperative Adverse Cardiac Events In today’s climate of rising healthcare costs with more patients seeking surgical services, the need for medical therapies to prevent crippling cardiac events has never been greater. The purpose of this review article is to summarize the current data pertaining to α2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. The author points out that, to date, no other pharmacological agent on the market has a more diverse therapeutic profile than α2 agonists.
Preoperative Fluid Bolus and Reduction of Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Gynecologic Surgery A randomized clinical trial of patients undergoing laparoscopic gynecologic surgery was conducted to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). The exact mechanism of how preoperative hydration decreases the incidence of PONV is uncertain; however, the occurrence of PONV decreased during this study. The authors conclude that preoperative intravenous fluid administration is a simple, non–time-consuming, cost-effective means to reduce the occurrence of PONV, and it warrants consideration as routine therapy.
Version: 2009;77(2):110-114.Authors: A randomized clinical trial of patients undergoing laparoscopic gynecologic surgery was conducted to determine the effect of a calculated preoperative fluid bolus on postoperative nausea and vomiting (PONV). The exact mechanism of how preoperative hydration decreases the incidence of PONV is uncertain; however, the occurrence of PONV decreased during this study. The authors conclude that preoperative intravenous fluid administration is a simple, non–time-consuming, cost-effective means to reduce the occurrence of PONV, and it warrants consideration as routine therapy.
Anesthetic Considerations for the Patient with Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu Syndrome) Hereditary hemorrhagic telangiectasia (HHT), Osler-Weber-Rendu syndrome, is an uncommon disease but may be present in many people who remain undiagnosed. It is an autosomal dominant disorder characterized by multiple arteriovenous malformations and telangiectases that affect multiple organ systems. In this case report, the authors state that anesthetic care of patients with HHT involves very specific interventions with regard to control of bleeding, maintaining adequate oxygenation, and balancing hemodynamic values to optimize perfusion without compromising anesthetic depth.
New Estimates for CRNA VacanciesA national survey to estimate vacancy rates of Certified Registered Nurse Anesthetists (CRNAs) in hospitals and ambulatory surgical centers was conducted in 2007. Poisson regression methods were used to improve the precision of the estimates. Results from this study found the vacancy rate was higher in rural hospitals than in nonrural hospitals, and it was lower in ambulatory surgical centers. The remarkable factor since the last survey was the unusually large rate of new CRNAs entering the market, yet the vacancy rates remain relatively high.
Effect of Timing of Fluid Bolus on Reduction of Spinal-Induced Hypotension in Patients Undergoing Elective Cesarean Delivery Spinal-induced hypotension (SIH) remains the most common complication associated with subarachnoid block (SAB) for cesarean delivery. Recent evidence indicates that a 20-mL/kg bolus via pressurized infusion system administered at the time of SAB (coload) may provide better prophylaxis than the traditional administration of a 20-mL/kg crystalloid infusion (preload) about 20 minutes before SAB; however, this method raises some concerns. Based on the results of this study, the authors believe that a combination preload and coload of fluid is a beneficial method of minimizing SIH.
AANA Journal Course: Update for Nurse Anesthetists—Part 1—The Cerebral Oximeter: What is the Efficacy?Patients having surgical procedures are at risk for anoxia that may cause cognitive impairment. Continuous monitoring of cerebral oxgenation and perfusion with an instrument such as a cerebral oximeter is needed to give insight into the cause of cerebral insults and cerebral response to specific interventions, all of which could help prevent damage to the brain. This critical review of the literature on the efficacy, mechanics, and usefulness of the cerebral oximeter will be helpful to anesthesia providers in evaluating the controversy surrounding its use.