Cliff Blaylock, CRNA, MS, prepares to administer a retrobulbar block for an ophthalmic procedure at Rayner Surgery Center, Oxford, Miss. Blaylock is one of many nurse anesthetists that practice in an autonomous office-based setting. Ophthalmology is the primary practice area for 1.3% of the CRNAs who responded to AANA's 2005 Practice Profile and Demographic Surveys. (Photo taken by W. Farmer, MD, ophthalmologist, Rayner Eye Clinic, Oxford, Miss.)
Keywords: Aromatherapy, isopropyl alcohol, ondansetron, postoperative nausea and vomiting.
Version: 2005;75:21-26.Authors: LCDR Jonathan W. Cotton, CRNA, MS, NC, USN
LCDR Lana R. Rowell, CRNA, MS, NC, USN
CDR Raymond R. Hood, CRNA, MS, NC, USN (ret)
CAPT Joseph E. Pellegrini, CRNA, DNSc, DNP, NC, USN
Meclizine in combination with ondansetron for prevention of postoperative nausea and vomiting in a high-risk populationPostoperative nausea and vomiting (PONV) is prevalent in surgical patients with known risk factors: general anesthesia, female, nonsmoker, motion sickness history, and PONV history. Common treatment involves ondansetron; however, the effects are short-lived, and supplemental medication may be required. Meclizine, a long-acting drug with a low side-effect profile, may be ideal in combination with ondansetron for at-risk patients. Prophylactic meclizine resulted in lower incidence and severity of PONV in a high-risk population, especially after rescue treatment.
Keywords: Meclizine, motion sickness, postoperative nausea and vomiting (PONV).
Version: 2007;75:27-33.Authors: LT Carrie M. Forrester, CRNA, MS, NC, USN
LT Dennis A. Benfield, Jr., CRNA, MS, NC, USN
LT Christina E. Matern, CRNA, MS, NC, USN
CDR Joseph A. Kelly, CRNA, MS, NC, USN
CAPT Joseph E. Pellegrini, CRNA, DNSc, DNP, NC, USN
Myocardial ischemia in the postanesthesia care unit: A case reportCardiac complications can occur in 1% to 5% of patients who have major noncardiac surgery. Indications of myocardial ischemia should be treated quickly and effectively to avoid permanent myocardial damage. This article describes a case of myocardial ischemia detected in the postanesthesia care unit following an excision of a facial/neck hematoma in an 83-year-old male. Marked ST-elevation in lead II and T-wave inversion in lead V5 were noted and the patient was treated promptly.
The Washington State nurse anesthetist workforce: A case studyThe purposes of this study were to describe the Washington State Certified Registered Nurse Anesthetist (CRNA) workforce and analyze selected dimensions of their clinical practice. The authors developed a 31-item CRNA Practice Questionnaire that was mailed to CRNAs licensed in Washington with an address in Washington, Oregon and Idaho. Workforce data may assist CRNAs when negotiating with employers and institutions and in resolving interprofessional conflicts and can have implications for scope of practice, policy, and legislative issues.
Evidence-based management assessment of return on investment from anesthesia information management systemsIn this article, the authors describe the evaluation of the proven role of anesthesia information management systems (AIMS) in reducing the costs of providing anesthesia services. For AIMS to be a good financial investment, they should produce a positive return on investment for the hospital. This article adopts a broader societal perspective because AIMS may be more beneficial for society than for the corporations purchasing them. Thus, the authors ask the question: Do AIMS produce net reductions in costs for the healthcare system?
Keywords: Anesthesia billing data, anesthesia information management system, automated anesthesia record, electronic medical record anesthesia billing data.
Version: 2007;75:43-48.Authors: Cormac T. O'Sullivan, CRNA, MSN
Franklin Dexter, MD, PhD
David A. Lubarsky, MD, MBA
Michael M. Vigoda, MD, MBA
Anesthetic care of the trauma patient: Development of a web-based resourceAdequate preparation by anesthesia providers promotes quality care and decreases the likelihood of morbidity and mortality. Unfortunately, many trauma cases occur after hours when support resources are less readily available. In this article, the authors said that a web-based resource seemed a logical choice in their busy Level I trauma center because it provided a readily accessible, user-friendly, cost-effective medium to promote improved patient care. They outline the process used to develop a web-based resource specifically focusing on anesthetic care of trauma patients in a large academic institution, but it also was their intent that this process could be replicated to develop a variety of projects at institutions of varying size.
Version: 2007;75:49-56.Authors: Nicole K. Anderson, CRNA, MNA
Andrew D. Jones, CRNA, MNA
Erin E. Martin, CRNA, MNA
Renee F. Thies, CRNA, MNA
Mary E. Shirk Marienau, CRNA, MS
Beth A. Elliott, MD
Current literature questions the routine use of low-dose dopamineDopamine use in acute renal failure (ARF) patients has been considered standard practice for many years; however, the authors of this review article state that low-dose dopamine has been linked to several harmful side effects, has extreme variability even at steady-state infusion rates, and is not well supported in the literature. The use of low-dose dopamine on the basis that it will be beneficial while causing no harm is no longer advisable. With research related to specific dopamine-1 agonists, such as fenoldopam, there may be no need to subject patients to the harmful effects of dopamine. Research on fenoldopam is still in its infancy, but, when given intrarenally, it shows a promising future in the prevention and treatment of ARF.
AANA Journal Course 6, Update for nurse anesthetists Perioperative care of patients with cerebral palsyCerebral palsy (CP) is characterized by a nonprogressive motor impairment that develops from an antenatal, perinatal, or postnatal insult to the developing encephalon. Contemporary care of patients with CP is multidisciplinary and oriented to improve the quality of life. The challenge for anesthetists in the care of patients with CP is to understand the clinical manifestations, accompanying pathophysiology, and current medical therapy to facilitate a peroperative plan of care. In this Journal course, the authors describe epidemiology and pathyphysiology, classification and clinical manifestations, medical and surgical treatment, orthopedic surgery, and preoperative and intraoperative anesthesia ssessment.
Keywords: Baclofen, cerebral palsy, dorsal rhizotomy, general anesthesia, static encephalopathy.
Version: 2007;75:65-73.Authors: John Aker, CRNA, MS
David J. Anderson, MD