AANA journal最新文献

People with alternating hemiplegia of childhood undergoing general anesthesia are at risk for severe complications including critical bradycardia and hemiplegic incidents. We performed a 10-year historical cohort study and completed a subgroup analysis of patients who specifically underwent general anesthesia. Patients with ATP1A3 positive variants were compared with those without such variants. The 14 patients reviewed underwent general anesthesia a combined total of 39 times. Two patients had a short QTc documented prior to anesthesia and presented with bradycardia in the recovery room. Two other patients experienced a suspected seizure and hemiplegic incident; one of those patients received no facility-administered medications prior to experiencing a hemiplegic incident, and the other experienced a hemiplegic incident on emergence from anesthesia with subsequent cardiac arrest and successful resuscitation. No apparent association was identified between type of anesthesia and the development of bradycardia or hemiplegic incidences. Of the four patients experiencing critical events, three had the ATP1A3-D801N variant. Although additional research is necessary to confirm such associations, patients with alternating hemiplegia of childhood, specifically the ATP1A3-D801N variant, appear to be at elevated risk for complications associated with general anesthesia, suggesting the need for an increased anticipation of complications for this population.

Fetomaternal outcomes and anesthetic management of pregnancy have rarely been described in a prospective cohort of women with Ebstein's anomaly. Therefore, due to the scarcity of data, diagnostic approaches and obstetric and anesthetic management plans are still evolving. In this prospective observational study, we describe the anesthetic management and fetomaternal outcomes of seven women with different grades of unrepaired Ebstein's anomaly. All women were in NYHA (New York Heart Association) Class II, none had cyanosis or cardiac decompensation at the time of admission during pregnancy. Pregnancy was uneventful except in one woman who developed pulmonary oedema. Two women developed supraventricular arrhythmia in the postpartum period. Six women underwent vaginal or assisted vaginal delivery, while one woman underwent cesarean delivery due to the transverse lie of the fetus. All mothers returned to NYHA Class I at 6 weeks follow up. In conclusion, pregnancy increases the risk of maternal complications in asymptomatic women with Ebstein's anomaly. Therefore, preoperative functional and echocardiographic risk stratification is crucial for prepregnancy counseling. Intrapartum and postpartum surveillance, prompt diagnosis of complications, and appropriate management in multidisciplinary hospital settings are associated with favorable fetomaternal outcomes.

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by the accumulation of surfactant/lipoprotein material in the alveoli and subsequent hypoxemic respiratory failure. Whole lung lavage (WLL), a procedure used to physically remove the lipoprotein material from the alveoli, is the first-line treatment for this disease process. Anesthesia providers may infrequently encounter the management of the WLL procedure due to the rarity of the underlying disease process. Pertinent anesthesia considerations for WLL are covered in the following case report. A review of the literature examines the pathophysiology of PAP, the various approaches to WLL, and the physiologic implications of WLL.

Workforce shortages influence all areas of healthcare including healthcare education. While recruitment and retention are known barriers within academia, the factors associated with the nurse anesthetist's transition from clinician to academics are unknown. The purpose of this scoping review was to identify factors that affect the transition from nurse anesthesia clinical practice to academia. A scoping review was conducted using the framework of Arksey and O'Malley. The search was performed using MEDLINE and CINAHL databases. Review selection was performed by two teams of two independent reviewers and summary of findings input into a comprehensive table. The search identified 733 articles published from 2014 to May 2023. Reviews were limited in nurse anesthesia and mainly consisted of alternate nursing specialties. Seven themes were extrapolated from the findings including mentorship (82%), orientation (47%), work-life balance (41%), early identification and empowerment (18%), formal pedagogical training (41%), faculty compensation (29%), and alternative faculty positions (23%). The review overwhelmingly revealed educator strategies available for undergraduate nursing, nurse practitioners, and midwifery, but not for nurse anesthetists. To gain a more robust knowledge of this current issue, additional research is required to educate, support, inform, and evaluate the current nurse anesthesia transition to academia process.

Obstetric difficult airway management has emerged as a critical safety issue, and unsuccessful intubation can lead to morbidity and mortality. A literature review of difficult and failed obstetric intubations from the 1970s to 2015 shows that the incidence of failed intubation is unchanged, remaining at one per 390 anesthetics. Our obstetric case report highlights an obstetric difficult airway secondary to limited mouth opening; rescue of the airway with an i-gel®; and establishment of a definitive airway with the aid of an Aintree intubation catheter and flexible fiberoptic scope-guided intubation through the i-gel®, a second-generation supraglottic airway.

There has been a notable movement in performing procedures in the office setting. With this new shift, the utilization of proven safety measures would be beneficial to mirror. The utilization of a surgical safety checklist (SSC) has become an essential part of safety measures instituted to mitigate preventable errors in the operating room (OR). This measure is equally important to institute for non-OR procedures. The purpose of this project was to implement a SSC protocol as a standard of care at a clinic that newly adopted in-office surgical procedures with anesthesia. The project focused on developing and disseminating a SSC educational program for the procedural staff that included: three surgeons, three medical assistants, and one anesthesia provider. The staff were assessed on their ability to successfully implement the SSC over a 3-month period with a goal of 90% compliance. The result of the project was that the staff exceeded the compliance goal by successfully completing the SSC on 28 of the 29 procedures performed with anesthesia, meeting a 96% compliance. Overall, the implementation was embraced and effectively incorporated into the workflow. Comments received revealed that three staff have now adopted using the SSC beyond the project and utilize it for all procedures and injections they perform, making this implementation successful.

Acute promyelocytic leukemia (APML), a rare disease encountered during pregnancy, is associated with high mortality secondary to consumptive coagulopathy and fatal bleeding diathesis. It usually presents as a medical emergency and warrants prompt diagnosis and treatment to improve maternal survival. This case report details a 19-year-old female with new onset APML who presented for emergency cesarean section because of respiratory distress and suspected placental abruption. Antifibrinolytics, which are commonly utilized to treat postpartum hemorrhage, were contraindicated because the patient was receiving all transretinoic acid (ATRA) therapy for APML. This case adds insight into the disease and its management along with anesthesia considerations for patients undergoing emergent caesarean delivery in the setting of acute disseminated intravascular coagulation and ATRA therapy. It also highlights the importance of a multidisciplinary team approach to plan for treatment and timing of delivery that balances the risk of disease progression and fetal well-being. Such multidisciplinary care and proper planning helped in attaining the best possible outcomes for both mother and baby.

Aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted neurosurgical emergency with cardiopulmonary complications. Concurrent atrial fibrillation seen commonly in the geriatric population further challenges perioperative management. Osmotherapeutic agents such as mannitol are routinely used in SAH to decrease intracranial pressure by withdrawing water from the brain parenchyma into the intravascular space. However, mannitol also has the potential to cause myocardial dysfunction and exacerbation of arrhythmias like atrial fibrillation in geriatric patients with decreased cardiovascular reserve. The literature on goal-directed fluid therapy and transesophageal echocardiography (TEE)-guided intraoperative management of a case of atrial fibrillation is sparse. This case report highlights the role of mannitol in the potentiation of arrhythmias like atrial fibrillation which was then successfully managed using goal-directed fluid therapy and TEE leading to a favorable outcome.