AANA journal course. Update for nurse anesthetists. Parkinson disease

In this Journal course, the manifestations, etiologic and pathophysiologic factors, and incidence of Parkinson disease are reviewed along with current medical management. Medications and other factors that have an impact on the course of Parkinson disease are discussed. Suggested preanesthetic, intraoperative, and postoperative interventions are provided.     

AANA journal course. Update for nurse anesthetists. Neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a potentially fatal condition composed of hyperthermia, extrapyramidal symptoms, autonomic nervous system disturbances, and altered levels of consciousness. Although uncertainty exists about its cause, most studies suggest it is the result of dopaminergic deficiency in the central nervous system, most commonly caused by neuroleptic medications. Excessive dopaminergic blockade occurs most commonly in psychiatric patients receiving neuroleptic medications, but many antiemetic medications used in anesthesia also have been implicated. Promethazine (Phenergan), prochlorperazine (Compazine), droperidol (Inapsine), and metoclopramide (Reglan) are most problematic. Reversal of dopaminergic blockade in the central nervous system is believed to be the treatment of choice for an acute episode of NMS. Once identified, withdrawal of causative medications, administration of dantrolene or dopamine agonists (bromocriptine and amantadine), and supportive measures will result in a 90% to 94% survival rate from the acute episode. Anesthetists must be aware of the pathophysiology, diagnosis, and treatment of this syndrome. Avoidance of neuroleptic medications, prompt diagnosis, and appropriate treatment will make the difference between success and failure when treating a patient during the acute phase of NMS.     

AANA journal course. Update for nurse anesthetists. Gender and pain

A major responsibility of nurse anesthetists caring for patients is the provision of adequate pain relief. A growing body of evidence in the literature suggests that gender of the provider and gender of the patient may affect the clinical management of pain. The different socialization processes of children has been theorized to influence how, as adults, individuals perceive and express pain. The willingness of females to express their discomfort has led to the perception that females are more emotional and expressive than males; this perception has led investigators to note that females may be at a disadvantage in the treatment of pain. Recently recognized disparities between the sexes in their response to antidepressants, certain opioids, and inhalation agents, as well as the identification of gender distributions for certain diseases, has heightened awareness among the scientific community of gender influences and gender differences that were not evident in the past. Awareness among nurse anesthetists of these differences, as well as the possible influence of gender, is critical to individualize anesthetic management and to minimize the potential for gender bias in providing pain management.     

AANA journal course: new technologies in anesthesia: update for nurse anesthetists--lasers

The common use of the laser in many specialty areas has challenged the anesthetist to possess more than a cursory knowledge of laser function and safety. The unique property of laser light and its effect on tissues presents unique safety considerations for patients and personnel. The protection of flammable materials, selection of the least flammable gas mixture and determination of the most appropriate anesthetic technique all work in concert to provide a beneficial outcome for everyone. This course will discuss principles of laser technology, safety for patients and personnel and precautions in anesthetic management.     

AANA journal course: update for nurse anesthetists--refrigerated anesthesia-related medications

Medications have strength, expiration date, and storage conditions printed on the medication bottle or package. Some anesthesia medications require refrigeration to maintain the stated strength and safety until the expiration date. These medications may expire in days rather than years when left at room temperature in anesthesia carts or emergency boxes. The following AANA Journal course discusses anesthesia-related medications that require refrigeration and how long potency and safety is maintained out of the refrigerator and provides a chart for future referral.     

AANA journal course. Update for nurse anesthetists. A common sense approach to hypothermia

Hypothermia frequently is considered inadvertent in the perioperative setting. The preservation of vital body heat has been an issue since the 1800s. This article provides a select review of the causes of hypothermia and the methods for prevention of hypothermia during the perioperative period. Providing patients with an environment designed to foster normothermia can preclude the costs of longer hospital stays, prevent morbid conditions associated with hypothermia, and provide patients with a more comfortable perioperative experience. Our goal as perioperative healthcare providers is a normothermic perioperative experience for all patients.     

AANA journal course: update for nurse anesthetists--current concepts in cardiopulmonary resuscitation.

Developmental strides in cardiopulmonary resuscitation were paralleled by acquired knowledge of pulmonary and cardiac physiology. The evolution of the current recommendations for cardiopulmonary resuscitation have evolved over the past 40 years as a result of human trial and error and have been authenticated through laboratory research and clinical experience. Current research efforts in cardiopulmonary resuscitation are examining the mechanisms of blood flow during external cardiac massage and techniques to optimize myocardial and cerebral perfusion during the resuscitative period. The restoration of circulation with preservation of myocardial and neurological function is the essential goal during the resuscitative effort. Prior to the 1950s, the occurrence of cardiac arrest was associated with the conduct of anesthesia and surgery. Although infrequent today by comparison, cardiac arrest continues to occur with the conduct of regional and general anesthesia. This course will review the etiology of cardiac arrest during anesthesia, detail the mechanisms of blood flow during resuscitation, and review the pharmacological importance of epinephrine for the preservation of myocardial and neurologic function.     

AANA journal course: new technologies in anesthesia: update for nurse anesthetists--intraoperative blood salvage

The transfusion of blood and blood products is often a lifesaving measure in a variety of medical and surgical conditions. The benefits of transfusion are increasingly contrasted with associated risks. Today, various alternatives exist that attempt to minimize or eliminate the known transmission of infection or reactions attributed to transfusion. The intraoperative salvage and reinfusion of red blood cells is one of the alternatives and is the focus of this lesson.     

AANA journal course: update for nurse anesthetists--blood-brain barrier function alteration during anesthesia.

With some exceptions, the entire central nervous system (CNS) is encircled by the blood-brain barrier (BBB). The function of the BBB is to sustain the CNS in a homeostatic environment. A variety of occurrences during an anesthetic have been shown to disrupt the BBB. Alterations of electrolytes or drugs in the systemic circulation at the time of a disruption in the BBB could result in an abnormal concentration of these molecules in the CNS leading to abnormal CNS neuronal transmissions which may manifest as both intraoperative or postoperative problems.     

AANA journal course. Update for nurse anesthetists. 2. Anticoagulation and spinal and epidural anesthesia

An increasing number of surgical patients preoperatively are taking anticoagulant medications. These patients are at an increased risk for development of epidural hematoma with spinal or epidural anesthesia. It is the responsibility of the anesthesia provider to understand and anticipate this risk and to alter the anesthetic plan accordingly. The purpose of this AANA Journal course is to update anesthesia providers regarding the common anticoagulants used for surgical patients, the risks associated with epidural and spinal anesthesia in conjunction with anticoagulation, and recommendations for the use of epidural and spinal anesthesia in anticoagulated patients. Antiplatelet drugs, oral anticoagulants, heparin, low-molecular-weight heparin, other new anticoagulants, and herbal medications are reviewed. When spinal or epidural anesthesia is considered for a patient who has been taking anticoagulant medications, the risk of epidural hematoma vs the benefits of regional anesthesia must be weighed carefully. Appropriate management of the patient extends well into the postoperative period and should include anesthesia providers, attending physicians, and nurses.     

AANA Journal Course: update for nurse anesthetists. Arrhythmia management devices and electromagnetic interference

The technological complexity of implantable arrhythmia management devices, specifically pacemakers and defibrillators, has increased dramatically since their introduction only a few decades ago. Patients with such devices are encountered much more frequently in hospitals and surgery centers, yet anesthesia provider knowledge of safe and proper management is often incomplete. Anesthesia textbooks and references may provide only short paragraphs on arrhythmia management devices that do not address important perioperative management strategies for this ever-growing patient population. It is no longer satisfactory to simply place a magnet over an implanted device during surgery and assume that this action protects the patient from harm due to electromagnetic interference from inappropriate device function. This AANA Journal course serves as a concise review of basic device function, the sources and effects of electromagnetic interference in the operative setting, and patient management recommendations from current literature.     

AANA Journal course: update for nurse anesthetists--magnesium homeostasis and deficiency.

Magnesium is the second most abundant intracellular cation in the human body and serves as an obligate cofactor in approximately 300 essential enzymatic cellular reactions. Magnesium is crucial for the generation and use of adenosine triphosphate and is required for oxidative phosphorylation. A wide variety of internal and external stresses have been found to increase a person's requirement for dietary magnesium. Magnesium deficiency may develop during a variety of pathological states, or it may have an iatrogenic basis. Magnesium deficiency complicates the management of hypertension and cardiac arrhythmias, affects the clinical behavior of neuromuscular blocking drugs, and may impair immune function.     

AANA journal course: update for nurse anesthetists--anesthetic considerations for minimally invasive direct vision coronary artery bypass grafting.

A recently developed procedure known as MIDCAB (minimally invasive direct vision coronary artery bypass) offers a select group of patients with coronary artery disease an alternative to coronary artery bypass grafting with cardiopulmonary bypass. Compared with customary coronary artery bypass graft surgery, the MIDCAB procedure has a smaller modified incision, requires less operative time, eliminates the risk of cardiopulmonary bypass, and is, as the name implies, far less invasive. Single or multiple vessels are revascularized while the heart remains warm and beating. Movement of the beating heart is dampened in the area of the targeted bypass vessel with the use of mechanical stabilizers by the surgeon. The heart rate may be pharmacologically slowed by the anesthetist. The combination of slowed heart rate and mechanical tamponade by the stabilizers may lead to profound hemodynamic and ischemic changes that may be poorly tolerated in a patient with multiple vessel disease and concurrent disease processes. Extubation and recovery times are far shorter for MIDCAB procedures, leading to earlier discharge and substantial cost savings. The surgical techniques for cardiac bypass surgery have evolved dramatically during the past few years. It is the unique combination of anesthetic monitoring, quick response to hemodynamic changes, and manipulation of physiologic parameters that makes providing anesthesia for minimally invasive cardiac bypass surgery exceptionally challenging.     

AANA Journal course. 10. AANA Journal course: new technologies in anesthesia: update for nurse anesthetists--integrating computer capabilities into the clinical setting

Clinicians routinely use computer-integrated anesthesia equipment. Clinical application of computers is widespread and, with rapidly advancing computer technology, the availability of computer-integrated equipment is likely to expand. By being able to identify the general functional components of the computer and understanding some of the basics about how a computer functions, the clinician will be better prepared to decide which types of monitors and computer-integrated technologies will most appropriately fit individual needs.     

AANA Journal course: new technologies in anesthesia: update for nurse anesthetists--high frequency ventilation

The introduction of high frequency ventilation (HFV) to the clinical arena has offered patients with severe respiratory disease a method for adequate ventilation and oxygenation with improved hemodynamics and diminished lung barotrauma. The scientific community has been investigating for a number of years the mechanism of gas transport in the airways using high frequencies with tidal volumes approaching or less than anatomical dead space. Clinicians have been attempting to identify the clinical circumstances for which this new technology can be applied. This course will discuss some of these theoretical mechanisms responsible for gas transport during three types of HFV, and also present the high frequency ventilators which have been recently approved by the U.S. Food and Drug Administration and the clinical indications for use for each of them.