AANA journal
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Obstructive sleep apnea (OSA) is a chronic disease that is underdiagnosed. It is characterized by repetitive pauses in breathing during sleep that can last for several seconds and can subsequently cause hypoxia-related complications. This apnea can lead to significant medical problems, daytime somnolence, cognitive impairment, decreased work productivity, and an increased risk of motor vehicle crashes. ⋯ If patients who have OSA or who are at risk for having OSA are identified before surgery, anesthesia providers can take action to prevent perioperative complications. Guidelines published by the American Society of Anesthesiologists provide helpful anesthetic considerations for patients with OSA undergoing surgery in an effort to decrease morbidity and mortality. While research into the effects of surgery and anesthesia in patients affected by OSA is ongoing, compliance with these recommendations, along with vigilance, will help ensure that many patients with OSA can be managed safely during their surgical experiences.
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Case Reports
Awake video laryngoscope intubation: case report of a patient with a nasopharyngeal mass.
Difficult airway management remains central to anesthesia practice. Video laryngoscopes have been an adjunct to airway management since the early 2000s. ⋯ The purpose of this article is to summarize the use of a video laryngoscope for an awake intubation and to suggest alternative uses of these devices in other awake intubation scenarios. The case report presented offers a description of successful awake intubation using a video laryngoscope in a patient with a large pedunculated mass arising from the nasopharynx and extending down into the oropharynx.
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Dexmedetomidine was used as an adjunct anesthetic for an infant with tetralogy of Fallot (TOF). who underwent complete surgical repair during a mission trip in Jamaica. Anesthetic maintenance was achieved with the concomitant use of dexmedetomidine and remifentanil infusions, as well as inhalational sevoflurane. The dexmedetomidine infusion ranged from 0.3 to 0.5 µg/kg/h and the remifentanil infusion ranged from 0.5 to 2 µg/kg/min, with end-tidal sevoflurane ranging from 0.8% to 6%. ⋯ This report includes a review of the anatomy and pathophysiology of tetralogy of Fallot, medical and surgical treatments, anesthetic management, as well as global health issues involved in caring for complex cardiac patients in this underserved population. The expertise and dedication of medical mission professionals ensures that children in developing Caribbean countries receive life-saving heart surgery that would otherwise not be available. Collaboration between pediatric cardiac surgery programs in the United States and developing programs in the Caribbean is vital to the future of a self-sustaining cardiac program that will provide the knowledge and resources to care for these complex cardiac patients.
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The purpose of this study was to determine and compare the maximum concentration (C(max)) and time to maximum concentration (T(max)) of epinephrine administered via tibial intraosseous (IO), sternal IO, and intravenous (i.v.) routes in a porcine model of cardiac arrest during cardiopulmonary resuscitation. Five pigs each were randomly assigned to 3 groups: tibial IO, sternal IO, and i.v. Cardiac arrest was induced with i.v. potassium chloride. ⋯ There were significant differences in Cmax between the sternal IO and i.v. (P = .009) and tibial IO and i.v. (P = .03) groups but no significant difference between tibial and sternal IO groups (P = .75). Significant differences existed in Tmax between the tibial IO and i.v. (P = .04) and between tibial IO and sternal IO (P = .02) groups but no difference between the sternal IO and i.v. groups (P = .56). Intravenous administration of 1 mg of epinephrine resulted in a serum concentration 5.87 and 2.86 times greater than for the tibial and sternal routes, respectively.