Anesthesia and Perioperative Considerations for Patients With Myasthenia Gravis.

Patients with neuromuscular diseases such as myasthenia gravis can present as complicated anesthetic cases. This article reviews anesthetic considerations for optimal perioperative care of patients with myasthenia gravis. The pathophysiology of myasthenia gravis, cholinergic and myasthenic crises, and perioperative management are discussed; this includes the pharmacology of acetylcholinesterase inhibitors vs sugammadex, extubation criteria, pain management, and risk factors for postoperative myasthenic crisis.

Comparing Forced-Air to Resistive-Polymer Warming for Perioperative Temperature Management: A Retrospective Study.

Purpose: Compare perioperative temperature management between forced-air warming (FAW) and resistive-polymer heating blankets (RHBs).

Design: A retrospective, quasi-experimental study.

Methods: Retrospective data analysis of nonspine orthopedic cases (N = 426) over a one-year period including FAW (n = 119) and RHBs (n = 307).

Nitrous Oxide for the Management of Labor Analgesia.

This article reviews nitrous oxide and explores current practice standards for use of nitrous oxide in managing labor analgesia. Inhaled nitrous oxide is used in the labor process for analgesia as well as for anxiolysis in many countries but is rarely offered in the United States. Because of its minimal invasiveness, highsafety index, effectiveness, and relatively low cost, it is reemerging as a consideration for use during labor and is worthy of further research.

Update on Guidelines for Perioperative Antibiotic Selection and Administration From the Surgical Care Improvement Project (SCIP) and American Society of Health-System Pharmacists.

Antibiotic prophylaxis plays an important role in the prevention of surgical site infections. For healthcare institutions to receive reimbursement, compliance with current measures introduced by the Surgical Care Improvement Project is required. Anesthesia providers commonly administer prophylactic antibiotics and are in the position to provide valuable input in the perioperative setting.

Perioperative Vision Loss: Considerations and Management.

Perioperative vision loss (POVL) associated with routine surgical procedures is a rare but catastrophic event. Although no clear direct cause of POVL has been determined, it is theorized that decreased ocular perfusion pressure of the optic nerve is responsible for POVL. This article will investigate theories as to why POVL occurs, risk factors associated with POVL, anatomy related to POVL, preventive measures that may help to reduce risk of POVL, and interventions that the anesthesia provider can implement.

Tranexamic Acid in Anesthetic Management of Surgical Procedures.

Blood loss during surgical procedures poses a grave risk to the patient, but transfusion is costly and associated with adverse outcomes. Antifibrinolytics, however, offer an economical and effective means of decreasing blood loss associated with surgical procedures. Tranexamic acid (TXA) is an antifibrinolytic that blocks lysine-binding sites of fibrinogen and fibrin, preventing the breakdown of existing clots.

Perianesthetic Considerations for the Breastfeeding Mother.

Breastfeeding has been shown to be beneficial in the development of infants, but sometimes, the breastfeeding mother may require anesthesia. It is important for perianesthesia caregivers to understand how the breastfed infant may be affected by the anesthetic medications received by the breastfeeding mother. This article reviews current literature on drug transfer into breast milk and specifically how anesthetic drugs may affect breastfed infants.

Thromboelastography: Clinical Application, Interpretation, and Transfusion Management.

The coagulation cascade is a dynamic process dependent on many factors. It involves interaction between primary hemostasis, platelet clot formation, secondary hemostasis, thrombin generation, and fibrinolysis. The assessment of this process is particularly important in the surgical patient to properly manage hemostatic issues.

Residual Neuromuscular Blockade.

This article provides an update on residual neuromuscular blockade for nurse anesthetists. The neuromuscular junction, pharmacology for producing and reversing neuromuscular blockade, monitoring sites and methods, and patient implications relating to incomplete reversal of neuromuscular blockade are reviewed. Overall recommendations include using multiple settings when employing a peripheral nerve stimulator for monitoring return of neuromuscular function and administering pharmacologic reversal when the train-of-four ratio is below 0.

Infection Associated With Single-Dose Dexamethasone for Prevention of Postoperative Nausea and Vomiting: A Literature Review.

Postoperative nausea and vomiting is one of the most common complications affecting surgical patients. The glucocorticoid dexamethasone is often used for the prevention of postoperative nausea and vomiting. This literature review seeks to summarize research related to the use of a single perioperative dose of dexamethasone for prophylactic treatment of postoperative nausea and vomiting and its impact on surgical healing.

Role of Esmolol in Perioperative Analgesia and Anesthesia: A Literature Review.

Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction.

Cost-effectiveness of quantitative pretest probability intended to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea.

Objectives: Quantitative pretest probability (qPTP) incorporated into a decision support tool with advice can reduce unnecessary diagnostic testing among patients with symptoms suggestive of acute coronary syndrome (ACS) and pulmonary embolism (PE), reducing 30-day costs without an increase in 90-day adverse outcomes. This study estimates long-term (beyond 90-day) costs and outcomes associated with qPTP. The authors hypothesized that qPTP reduces lifetime costs and improves outcomes in low-risk patients with symptoms suggestive of ACS and PE.

Anesthesia and critical care ventilator modes: past, present, and future.

Mechanical ventilators have evolved from basic machines to complicated, electronic, microprocessing engines. Over the last 2 decades, ventilator capabilities and options for critical care and anesthesia ventilators have rapidly advanced. These advances in ventilator modalities--in conjunction with a better understanding of patient physiology and the effects of positive pressure ventilation on the body--have revolutionized the mechanical ventilation process.

Cost of education and earning potential for non-physician anesthesia providers.

Potential non-physician anesthesia students gauge many different aspects of a graduate program prior to applying, but cost of education and earning potential are typically high priorities for students. Our analysis evaluated the cost of tuition for all certified registered nurse anesthetist (CRNA) and anesthesiologist assistant (AA) programs in the United States, as well as earning potential for both professions. We collected educational cost data from school websites and salary data from the Medical Group Management Association's Physician Compensation and Production Survey: 2012 Report in order to compare the two groups.

The impact of the Bologna process on nursing higher education in Europe: a review.

Background: Changes are occurring in global higher education. Nursing is not exempt from these changes, and must adapt in order to be competitive in a global market. The Bologna process has been integral in the last decade in modernizing European higher education.