AANA journal
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Case Reports
Anesthetic management for lobectomy in a patient with coccidioidomycosis: a case report.
Coccidioidomycosis is a fungal disease with a wide variety of manifestations. The systemic infection is a product of airborne spore inhalation released from the soil. This once-endemic disease is steadily increasing in incidence, geographic location, and severity. ⋯ This case report describes a 45-year-old woman with no relevant medical history admitted for lobec-occidi tomy with decortication because of aggressive coccidioidomycosis. Anesthetic considerations included attention to fungal sepsis, acute tubular necrosis related to amphotericin B therapy, and airway challenges. Careful attention to perioperative fungal therapies, invasive monitoring, and electrolyte stabilization remain pivotal concerns offering the best outcomes for patients with coccidioidomycosis.
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The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace. The U. S. ⋯ Human tissue is also an important factor in ultrasound imaging. The different densities of soft tissues, bone, fluid, and air all interact with sound, creating distinctive images that can aid and potentially hinder accuracy. Comprehension of basic ultrasound principles and how it is affected by tissue will enable anesthetists to better understand what is being seen and reduce the potential for errors.
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Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. ⋯ No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs.
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Patients who are Jehovah's Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. 'Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. Several blood conservation techniques are available for consideration, including acute normovolemic hemodilution. ⋯ Leaving the procured blood continuously attached to the patient through the collection tubing makes the procedure acceptable to most Jehovah's Witness patients. Current literature is unclear when this technique should be used. In this particular case, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah's Witness who was undergoing major surgery.
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The American Association of Nurse Anesthetists (AANA) is committed to advancing evidence-based nurse anesthesia practice. This determination is evident across multiple activities within the Association. This editorial describes the AANA's evidence-based policy and process for the development of those practice-related documents that require approval from the AANA Board of Directors. Additionally, several of the Association's initiatives geared toward fostering the advancement of evidence-based nurse anesthesia practice are described.