AANA journal
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Examining transfer of care processes in nurse anesthesia practice: introducing the PATIENT protocol.
Human factors, such as inadequate situation awareness, have been associated with preventable accidents in anesthesia practice. Integral to developing situation awareness in the operating room environment is the safe and efficient exchange of essential information when the care of a patient is transferred from one anesthesia provider to another for circumstances such as breaks, meals, and the end of a scheduled work shift. ⋯ HumaThis article describes a 2-phase, nonexperimental exploratory study with a purpose to (1) examine current transfer of care practices of Certified Registered Nurse Anesthetists during the intraoperative period and (2) develop, implement, and evaluate a communication checklist tool designed to improve situation awareness. Findings from this study have the potential to contribute to the understanding of current transfer of care practices, promote situation awareness in a swift and organized manner, and minimize variation in transfer of care processes that exist in practice today.
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Review Case Reports
Methylene blue encephalopathy: a case report and review of published cases.
Methylene blue is a cationic thiazine dye useful in staining parathyroid glands during surgical resection. There have been a number of reports of altered neurologic status postoperatively in patients who are taking antidepressant medications when they received methylene blue for their surgery. ⋯ It has been suggested that in susceptible individuals an interaction occurs between methylene blue and serotonergic agents that precipitates serotonin syndrome. Because people with hyperparathyroidism commonly experience depression as part of their illness, anesthesia practitioners should exercise increased vigilance when administering methylene blue to these patients.
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Case Reports
Elective laparoscopic fetal laser photocoagulation in twin-twin transfusion syndrome: a case report.
Twin-twin transfusion syndrome (TTTS) is a complication of multiple gestation in which arteriovenous vascular communications occur in a shared placenta. Due to these communications, there is an imbalance of blood flow between the developing fetuses. This results in 1 twin becoming the donor and the other becoming the recipient. ⋯ Therapeutic options available include decompression amniocentesis, amniotic septostomy, interruption of the placental vessel communications, and selective fetal reduction. Selective fetoscopic laser photocoagulation of abnormal vascular communications has shown to result in increasing survival rates and has become a definitive treatment option for severe TTTS. The case report presented involves a 32-year-old, gravida 5, para 2 patient at 19 weeks' estimated gestational age with a monochorionic diamniotic twin gestation with TTS diagnosed using ultrasonography presenting for an elective laparoscopic fetal laser photocoagulation.
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A retrospective analysis of the National Practitioner Data Bank (NPDB) Public Use Data File was performed on anesthesia-related malpractice payments from 2004 to 2010. Anesthesia-related allegations, malpractice act or omission codes, severity of injury, and cost were assessed. ⋯ When reviewing specific allegations of malpractice act or omission among the total number of CRNA malpractice payments, the most common allegations were improper performance,, failure to monitor, and problem with intubation. Patients between the ages of 40 and 59 years, inpatients, and female gender were independently more prevalent among CRNA malpractice claims leading to payment than other patient demographics.