Table of Contents
Use of Lipid Emulsions for Treatment of Local Anesthetic Toxicity: A Case Report
Hector Varela, CRNA, MSNShari M. Burns, CRNA, EdD
In this case report, the authors explain that intravenous administration of lipid emulsions may offer a viable adjunctive treatment of local anesthetic toxicity, and the growing list of case reports demonstrating successful resuscitation for patients with local anesthetic toxicity offers further support for the use of lipid emulsions. They conclude that continued research regarding the use of lipid emulsions and efficacy, optimal dosing regimens, and when to start lipid emulsion therapy merit further study.Print version:
Lipids, local anesthetic overdose, local anesthetic toxicity.
Total Knee Arthroplasty in a Patient With Diastrophic Dwarfism
Robin L. Crowley, CRNA, MS Richard E. Haas, CRNA, PhD
Diastrophic dwarfism is an autosomal recessive disease that predominantly occurs in the Finnish population but has been known to occur worldwide. The characteristic short trunk of these patients in addition to scoliosis, cervical kyphosis, and involvement of articular cartilages can create unique ventilation and airway challenges for anesthesia providers. This case report features a 50-year-old woman with known diastrophic dwarfism who presented for total knee arthroplasty.Print version:
Anesthesia, diastrophic dwarfism, dysplasia, total knee arthroplasty.
Postoperative Patient-Controlled Analgesia in the Pediatric Population: A Literature Review
Holly E. Franson, CRNA, MSN
In this review article, the author says the literature shows that patient-controlled analgesia (PCA) provides adequate pain control and high levels of satisfaction for the pediatric postsurgical population and their families. Safety issues, indications, contraindications, complications, and dosing regimens related to PCA are addressed. Recommendations for continuous pulse oximetry and sedation monitoring and individualized dosage requirements are presented to decrease the incidence of complications.Print version:
Epidural PCA, patient-controlled anesthesia (PCA), PCA-by-proxy, pediatric pain management.
Case Report: Management of Elective Cesarean Delivery in the Presence of Placenta Previa and Placenta Accreta
Sarah A. Bergakker, CRNA, MSN
The purpose of this case report is to discuss the obstetric disorder of placenta previa with the concurrent occurrence of placenta accreta. The author includes a review of the management and course of a patient undergoing elective cesarean delivery with the aforementioned disorders, followed by a discussion related to the management of an obstetric patient undergoing elective cesarean delivery with known placenta previa and placenta accreta.Print version:
Anesthesia, cesarean delivery, hemorrhage, placenta accrete, placenta previa.
Xenon as an Anesthetic Agent
Bryan D. Jordan, CRNA, MNA Elizabeth Laura Wright, CRNA, MNA
The search for the ideal anesthetic agent has been ongoing since the inception of anesthesia. Currently, xenon is being used primarily throughout Europe, but the high price of manufacturing and scavenging the noble gas has discouraged more widespread use. As technology in anesthetic delivery improves, xenon is being investigated further as a possible replacement for nitrous oxide as an inhalational agent. This article reviews the anesthetic properties of xenon and current and potential research about the gas.Print version:
General anesthesia, inhalational agent, nitrous oxide, noble gas, xenon.
Implications of Pharmacogenomics for Anesthesia Providers
Tori Ama, CRNA, MNA Sou Bounmythavong, CRNA, MNA Jodee Blaze, CRNA, MNA Melissa Weismann, CRNA, MNA Mary Shirk Marienau, CRNA, MS Wayne T. Nicholson, MD, PharmD
Pharmacogenomics has the potential to individualize drug therapy, help avoid adverse drug reactions and toxic effects, and improve therapeutic drug efficacy and outcomes by adjusting drug therapy to the patient’s genotype. This review article provides clinicians with basic knowledge related to pharmacogenomics and its implications in anesthesia. With an improved understanding of the clinical implications of pharmacogenomics, anesthesia providers may have an increased potential to individualize therapy.Print version:
Anesthesia, drug variability, pharmacogenetics, pharmacogenomics, polymorphisms.
Thoracotomy for Tracheal Disruption After Traumatic Intubation: A Case Report
Ryan D. Austin, CRNA, MSNA
Performing tracheal intubation is associated with risks, including upper and lower airway trauma. In this case report, the author details the airway management strategies employed during an emergent thoracotomy for a patient who suffered tracheal perforation during endotracheal intubation. A discussion of airway anatomy, airway considerations, intubation complications, and one-lung ventilation techniques is provided.Print version:
Endotracheal intubation complication, lower airway trauma, one-lung ventilation, tracheal tear.
Stress-Related Cardiomyopathy in a 31-Year-Old Woman
Shirley Pfister, RN, MS, ANP, GNP Phyllis Wagar, RN, MS, FNP-C Ivan P. Casserly, MD
Stress-related cardiomyopathy, initially referred to as Tako-Tsubo cardiomyopathy and later as apical ballooning syndrome, has been largely observed in postmenopausal women and is characterized by acute left ventricular failure in the absence of obstructive coronary disease. It is frequently precipitated by a stressful event. This case report describes a 31-year-old woman who experienced stress-related cardiomyopathy immediately after a bilateral mastectomy. Print version:
Apical ballooning syndrome, “broken heart syndrome,” stress-related cardiomyopathy, Tako-Tsubo cardiomyopathy.
AANA Journal Course: Update for Nurse Anesthetists – Part 4 – Treatment of Tracheal and Bronchial Tumors and Tracheal and Bronchial Stent Placement Kenneth M. Kirsner, CRNA, JD Mona Sarkiss, MD, PhD Garry J. Brydges, CRNA, MSN, ACNP-BC
Tumors of and trauma to the trachea and bronchi can result in loss of integrity of the airway and death. Once treated primarily with thoracic surgery, these conditions are increasingly being managed with interventional pulmonary procedures outside the operating room but requiring the assistance of anesthetists. Anesthetists must also be prepared to anesthetize patients with airway stents in place who are admitted for nonpulmonary surgical procedures. A discussion on the preferred methods for caring for patients in these situations is included.Print version:
Bronchial tumors, stent, trachea, tumors.