AANA journal
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A 37-year-old morbidly obese man with a history of obstructive sleep apnea underwent elective tonsillectomy. The patient was successfully intubated with an 8.0-mm regular cuffed endotracheal tube. A large video laryngoscope (GlideScope, Verathon Inc, Bothell, Washington) was used for intubation, as airway assessment indicated a potentially difficult airway. ⋯ Resuctioning and reinsertion of the GlideScope probe did not provide an adequate visual field. After 2 failed attempts, the use of the GlideScope was abandoned. Subsequently, the patient's trachea was successfully intubated with a size 4 Macintosh blade.
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The benefits of collaboration in healthcare have been linked positively with higher patient satisfaction, improved patient outcomes, enhanced nursing staff satisfaction, and decreased hospital costs. A sample of nurse anesthetists and anesthesiologists affiliated with postgraduate training programs in the state of Texas responded to a survey designed to gather attitudes toward physician-nurse collaboration using an adaptation of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. Two-hundred seventy surveys were completed by 62 anesthesiologists and 208 nurse anesthetists. ⋯ No significant differences in attitudes were found between men and women for the total sample. However, the health discipline showed a statistically significant difference. These findings suggest that Certified Registered Nurse Anesthetists who deal with role conflict or unclear expectations as well as limited scope of practice may have increased job stress and dissatisfaction.
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Review Case Reports
Myocardial infarction and subsequent death in a patient undergoing robotic prostatectomy.
A 52-year-old patient, ASA physical status IV, undergoing a radical prostatectomy for cancer with a robotic system had a cardiac arrest 3 hours into the case. All attempts to resuscitate were unsuccessful, and several hours later he was pronounced dead. Underlying patient comorbidity and procedural issues contributed to the patient's death. ⋯ The needed positioning, combined with the problems associated with insufflation, presents a unique challenge in anesthetic management. This course reviews the current literature on the surgical implications for patients with drug-eluting stents and the physiologic factors related to position and pneumoperitoneum and their associated stressors. By using a review of the contemporary literature, a best-evidence approach to anesthetic management is reviewed.