AANA journal
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The pathophysiologic mechanisms for complex regional pain syndrome (CRPS) are complex and elusive. The proposed etiologic mechanisms for CRPS include inflammatory responses, peripheral or central sensitization, and sympathetic dysfunction. Anesthesia care of patients with CRPS is challenging. Treatments including physiotherapy, peripheral vasodilators, sympathetic blockade, analgesics, and other systemic medications can help optimize mobility, perfusion, and pain relief for affected patients.
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Case Reports
Anesthetic management of a patient undergoing an ex utero intrapartum treatment (EXIT) procedure: a case report.
The ex utero intrapartum treatment (EXIT) procedure involves partial delivery of the fetus with the fetal-placental circulation maintained. This allows for management of the obstructed fetal airway via direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. These complex and often challenging procedures have been performed about 100 times in the United States to date. ⋯ Various considerations must be managed by the anesthesia provider during the EXIT procedure to ensure positive maternal and fetal outcomes. Careful attention to achieving adequate uterine relaxation, maintaining maternal blood pressure, avoiding placental abruption, prioritizing fetal airway establishment, and providing return of uterine tone when indicated are examples of these considerations. In this case report, a parturient presented for an EXIT procedure secondary to fetal cystic hygroma.
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Case Reports
Bronchial thermoplasty: a novel treatment for severe asthma requiring monitored anesthesia care.
Dexmedetomidine used in monitored anesthesia care produces a safe and effective technique well documented in research. We report the successful use of dexmedetomidine for sedation during bronchial thermoplasty, a new treatment for patients with severe persistent asthma refractory to inhaled corticosteroids and long-term beta-2 agonists.
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This column examines the contributions of nurse anesthetist Ira P. Gunn, CRNA, MLN, FAAN (1927-2011), widely recognized as a visionary and tireless advocate for the profession of nurse anesthesia. Her contributions to nurse anesthesia practice, research, education, publication, consultation, credentialing, and government relations have significantly contributed to the preservation and advancement of nursing and nurse anesthesia.
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There are no set standards for nurse anesthesia education in developing countries, yet one of the keys to the standards in global professional practice is competency assurance for individuals. Nurse anesthetists in developing countries have difficulty obtaining educational materials. These difficulties include, but are not limited to, financial constraints, lack of anesthesia textbooks, and distance from educational sites. ⋯ Sustainability of development can come only through anesthetists who are both well trained and able to pass on their training to others. The international nurse anesthesia continuing education project was developed in response to the difficulty that nurse anesthetists in developing countries face in accessing continuing education. The purpose of this project was to develop a nonprofit, volunteer-based model for providing nurse anesthesia continuing education that can be reproduced and used in any developing country.