Restoring partial flow of oxygenated blood is a fundamental goal of cardiopulmonary resuscitation. The ideal devices used for this purpose should have features such as low incidence of complications, high survival rate, rapid control of the airway, and adequate ventilation. Besides limiting the frequency and duration of interruptions in chest compressions, they can improve the survival and clinical outcomes of return of spontaneous circulation during cardiopulmonary resuscitation. The overall rates of survival from out-of-hospital cardiac arrest have improved dramatically in recent years. However, optimal airway management during out-of-hospital cardiac arrest is a controversial issue. The proposed standard of care, i.e. endotracheal intubation, may have paradoxical adverse effects on intended outcomes by interrupting cardiopulmonary resuscitation and by reduction of coronary and cerebral perfusion pressure during resuscitation. The aim of this narrative review is to provide health care providers with an overview of relevant studies in the area, with a focus on alternative advanced airway techniques.
Perioperative and oncologic outcomes of open radical nephrectomy and inferior vena cava thrombectomy with liver mobilization and Pringle maneuver for Mayo III level tumor thrombus: single institution experience
- Minerva urologica e nefrologica = The Italian journal of urology and nephrology
- Published 4 days ago
Scarce data are available regarding the technique and outcomes for patients with RCC and Mayo III caval thrombi. To report surgical and oncological outcomes of RCC patients with Mayo III thrombi treated with radical nephrectomy and thrombectomy after liver mobilization (LM) and Pringle Manoeuvre (PM).
Advancements in ophthalmologic procedures warrant exploration of alternative approaches to standard intravenous (IV) anesthesia sedation. One new approach, a sublingual troche containing midazolam, ketamine, and ondansetron, allows for IV catheter-free administration of sedation. This project compared the effectiveness and equivalency of sublingual troche during monitored anesthesia sedation with traditional IV sedation for maintaining comfort in patients undergoing cataract surgery. The study was conducted at a surgery center using an after-only nonequivalent control group design. Patients (N=107) were 55 to 85 years of age; 54 patients received IV sedation, and 53 received troche sedation. Four patients receiving IV sedation reported nausea during and after the procedure (n=1, 1.9%) or pain during the procedure (n=3, 5.6%), whereas 3 patients receiving troche sedation reported dizziness after the procedure (n=1, 1.9%), and pain during the procedure (n=2, 3.8%). Although the troche group (mean=6.25, SD=3.94) spent less time in recovery than the IV group (mean=6.48, SD=2.61), the difference was not significant (t[df=105]=0.677, P>.05). In conclusion, the results showed comparable experiences for both groups with equivalency and effectiveness in providing patient comfort during cataract surgery.
Vasa previa is a rare but serious medical condition characterized by a velamentous insertion of fetal blood vessels onto the placenta, which places those vessels at high risk of rupturing with rupturing of the membranes. Often vasa previa goes undetected until fetal compromise ensues following rupture of membranes. A recent case report of a 25-year-old pre-eclamptic female demonstrates the emergent and fatal nature of undiagnosed vasa previa.
In the ambulatory surgical setting, the anesthesia provider must implement safe and efficient airway management techniques for an increasingly obese population. The laryngeal mask airway (LMA) is the device most frequently selected by anesthesia providers in ambulatory surgery centers (ASCs) for airway management. The purpose of this study was to evaluate the safety of LMA use in ASCs for obese patients. This retrospective data analysis of 1,004 general anesthesia cases performed in a freestanding urology center investigated the incidence of aspiration, laryngospasm, and inadequate ventilation leading to intraoperative changes in airway management. There were no incidents of aspiration and 2 incidents of laryngospasm, with no difference found between obese and healthy-weight patients. Inadequate ventilation necessitating an intraoperative change in airway management occurred in 10 of the 1,004 patients (1%), 9 of 446 obese patients (2%), and 6 of 154 morbidly obese patients (3.9%). Conversion to endotracheal intubation occurred in 2 cases, both involving morbidly obese patients in the lithotomy position. No patient had clinical sequelae. Findings in this study support that when cases are managed by experienced providers with appropriate contingency plans, LMA use does not contribute to the morbidity of obese or healthy-weight patients in the ASC.
Simulation is an effective tool to learn or refresh skills and knowledge, but numerous barriers prevent the routine use of simulation. The purpose of this project was to assess the feasibility and acceptability of the use of a low-tech simulation kit by the hospital’s personnel for overcoming those barriers. A phenomenological qualitative approach using semistructured interviews was conducted with a convenience sample of 5 Certified Registered Nurse Anesthetists (CRNAs) and a student registered nurse anesthetist at a rural community hospital. Additionally, a CRNA served as the facilitator and was interviewed. After the data were independently analyzed by 2 individuals, 6 themes emerged. A low-tech simulation was acceptable, although the sense of stress was difficult to replicate. The facilitator found that simulation preparation and execution were easier and less work than expected. A low-tech simulation kit is a viable option for increasing the frequency of simulating anesthesia emergencies and overcoming the barriers that prevent the frequent use of simulation in the clinical setting. Psychological fidelity can be enhanced through innovative methods (flip book containing screenshots of an electrocardiographic monitor, video) to overcome the limitations of a low-tech simulation.
Japan is challenged with unique social problems because of its declining birthrate and rapidly aging population. By the year 2025, all of Japan’s baby boomers will be 75 years or older, making Japan a “superaging” society. Japanese healthcare expenditures are rapidly climbing because of the need for increasingly complex medical-surgical treatments for this aging population. In addition, a major shortage of anesthesiologists has produced serious threats to patient safety, as well as to quality and timeliness of surgical care. In an attempt to meet the demand for anesthesia services and to ensure access and quality care, the Japanese Ministry of Health, Labor and Welfare has identified a potential role for nurses as anesthesia practitioners, as an innovative solution. Nurse and physician educators in Japan have begun educating and training nurses in the practice of anesthesia; however, nationally recognized licensure or certification does not yet exist for graduates of these programs. The purpose of this article is to review the unique challenges facing Japan’s anesthesia practice and to make recommendations about the potential introduction of nurse anesthetists in Japan.
This case report describes a right arytenoid dislocation after emergency fiberoptic nasotracheal intubation in a patient with angioedema. The patient returned to the emergency department multiple times with classic symptoms of arytenoid dislocation, complicated by resultant postinjury laryngeal edema and poorly controlled laryngopharyngeal reflux. The arytenoid injury was not initially recognized, which delayed treatment. Several months later, intraoperative assessment was done because of continued symptoms suspicious for laryngeal injury, resulting in a diagnosis of right cricoarytenoid joint fixation resulting from prior intubation trauma. Because of delayed diagnosis and treatment, severe cricoarytenoid joint scarring and fixation prevented repositioning of the arytenoid and improvement in laryngeal function. Discussion of this case includes a review of the anatomy and function of the arytenoid and cricoarytenoid joint, along with factors that increase and decrease joint stability and risk of injury. The etiology of arytenoid dislocation is described, along with suspected mechanisms of injury in anterior vs posterior and right vs left dislocations. Classic symptoms, the importance of early identification, and treatment options are also discussed.
Pulmonary aspiration is a potentially fatal anesthetic complication occurring when gastric contents enter the respiratory system. Fasting guidelines aim to decrease the risk of pulmonary aspiration by recommending a timeframe in which patients abstain from food and drink before surgery. Fasting guidelines recommended for healthy individuals fail to account for patients with type 2 diabetes mellitus (T2DM). Gastroparesis, a common condition associated with T2DM, is exacerbated during stress such as an impending surgery. This study sought to determine whether a relationship exists between stress levels and gastric contents in fasting patients with T2DM presenting for an elective surgical or diagnostic procedure. The quality and quantity of gastric contents and preoperative stress were evaluated using gastric ultrasonography and salivary α-amylase levels. No relationship existed between preoperative stress and gastric contents; however, glycated hemoglobin levels of 7% or greater were associated with increased gastric fluid, which was the most significant finding in this study. In addition, there was a significant difference between the mean gastric volume in healthy individuals and patients with T2DM. Performance of gastric ultrasonography preoperatively provides objective data that could influence the anesthetic plan and decrease the risk of pulmonary aspiration in patients with T2DM.
The North Carolina Association of Nurse Anesthetists recognized concerns surrounding decreased member engagement and communication. Member engagement and communication is the lifeblood of an organization and is directly related to the success of an organization’s outcomes and goals. Revamping of social media is a cost-effective method to help increase membership engagement and communication. The purpose of this project was to identify Certified Registered Nurse Anesthestist membership preferences for social media-based communication and engagement through the measurement of activity levels based on Facebook posting content, feature, and time. Therefore, a literature review and retrospective analysis was conducted. Results revealed that posting content of public relations/advocacy, the feature of tagging, and the time of week was influential on audience engagement on the association’s Facebook account. The aims of the project were met. Social media allows organizations to employ various features and techniques to increase member engagement and communication. To successfully use social media to engage and communicate with members, organizations will need to continuously analyze and adjust their social media posts.