AANA journal
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Review Case Reports
Methylene blue for refractory hypotension: a case report.
Methylene blue has multiple indications for use, but recently it has been shown to be useful in treating refractory hypotension. Anaphylaxis results in widespread vasodilation and hypotension. Epinephrine has been described as the drug of choice in the treatment of hypotension for anaphylaxis, but the increased heart rate may be poorly tolerated by some patients. ⋯ Furthermore, the patient required a decreased amount of vasoactive agents in the postoperative course. The suspected mechanism of action of methylene blue is inhibition of the enzyme nitric oxide synthase, which ultimately prevents the smooth muscle dilation that accompanies anaphylaxis. Methylene blue may be a valuable adjunct in the treatment of anaphylaxis and other causes of refractory hypotension.
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The use of a cuffed endotracheal tube (ET) has been discouraged in children up to 8 years of age. Recent literature suggests that this age-old argument is empirical rather than scientifically based. This AANA Journal course will examine the history of pediatric endotracheal intubation, suggested methods for choosing the appropriately sized ET emerging literature describing the advantages and disadvantages of the use of the cuffed ET in young children, and potential clinical problems that develop with the use of the currently available, manufactured, cuffed pediatric ETs.
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An educational curriculum using adult learning principles in an active learning format was developed for Certified Registered Nurse Anesthetist clinical educators (CRNACEs) to help improve the quality of the clinical learning experiences for student nurse anesthetists (SNAs). This exploratory study sought to determine the extent to which an 8-hour educational course modified the behavioral perceptions and the knowledge of CRNACEs. The effects of the CRNACE course were measured using a questionnaire that consisted of 22 Likert scale items and 8 open-ended questions. ⋯ Additional findings included that information provided during the CRNACE course did not change the perceptions of CRNACEs related to their ability to communicate with students or their willingness to modify their teaching practices. Providing instruction incorporating principles of adult learning using an active learning format for CRNACEs may improve the clinical learning experiences for SNAs. As a result, SNAs would be better prepared to make the transition to clinical expert.
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Case Reports
Subcutaneous carbon dioxide emphysema following laparoscopic salpingo-oophorectomy: a case report.
Multiple patient and economic benefits have contributed to the widespread popularity of laparoscopic surgery. Although the laparoscopic approach is safe, it is not without potential complications. ⋯ Hyperventilation, close monitoring, and mechanical ventilation for 4 hours postoperatively resulted in a positive patient outcome. The mechanisms of carbon dioxide absorption, as well as risk factors, complications, treatment, and prevention of subcutaneous emphysema will be described.
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Use of the Bullard laryngoscope has been fraught with difficulties, especially for inexperienced users who often end up placing the instrument on the back shelf of the airway cart without further use. A recent hypothesis suggests that the use of a flexible tip tube on the Bullard stylet might facilitate intubation. ⋯ Intubations on 6 patients assessed as difficult to intubate were performed on the first attempt without any difficulty. In fact, the effortlessness of these potentially difficult intubations led to the conclusion that the preliminary finding should be reported immediately.