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Issue 5 - 15 Feb 2012


1. Are Pigs the Right Model for Lipid Resuscitation?
By Zider, Brian et al. AANA Journal, Dec 2011, Vol. 79 Issue 6: p453-454
To the Editor
: We read, with interest, the study by Bushey et al1 that analyzed the efficacy of lipid emulsion treatment following cardiovascular collapse caused by the combination of bupivacaine plus hypoxia. The authors showed thatlipid emulsion provided no benefit in return of spontaneous circulation or in survival rates compared with saline control. While these results would seem to suggest that lipid emulsion may not be as clinically effective as commonly supposed, it is important to consider the effect of the experimental design on the authors’ findings.

2. Syringe Size Effect on Delivered Versus Calculated Dosages of Propofol: A Bench Experiment Using the Baxter InfusOR Syringe Pump.
By Klapperich, Mark A.& Klotz, Randall W. AANA Journal, Dec 2011, Vol. 79 Issue 6: p454-455
To the Editor:
In response to the excellent article by Randall Klotz, CRNA, MEd, MSN,1 I would like to add the following suggestion.We in the profession of administering anesthesia during monitored anesthesia care/sedation cases frequently omit the documentation of the drugs’ effects on our patients, such as the patient’s level of consciousness, any pain experienced, perceived anxiety, airway management needed, etc.

3. Ira P. Gunn: Educator, Advocate, Legend
By McAuliffe, Maura S.& Koch, Kathy J. AANA Journal, Dec 2011, Vol. 79 Issue 6: p459-463
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. [ABSTRACT FROM AUTHOR].

4. Management of a Traumatic Tracheal Tear: A Case Report
By Barrett, Eric. AANA Journal, Dec 2011, Vol. 79 Issue 6: p468-470
: This case report describes a posterior tracheal tear in a healthy 8-year-old girl. The child sustained the injury while riding her scooter, when the handlebars of the scooter dislodged after running into the curb, causing the shaft to strike her in the manubrium of the sternum. The child presented with subcutaneous emphysema of the neck and the supraclavicular region bilaterally. Before the patient's arrival, the surgical and anesthesia team had extensive discussion regarding the child's perioperative management, which included the need to maintain spontaneous ventilation to avoid opening the tracheal tear and producing a further increase in the size of the pneumomediastinum. The anesthesia machine was prepared for a general anesthetic along with a wide array of appropriately sized endotracheal tubes. In addition to appropriately sized laryngoscope blades, a fiberoptic scope and video laryngoscope were immediately available. Spontaneous respirations were maintained throughout the procedure, and the case proceeded uneventfully. This case represents the need for proper preparation and communication between providers to manage all possible scenarios of a traumatic tracheal tear. [ABSTRACT FROM AUTHOR].

5. Diabetic Cardiac Autonomic Neuropathy and Anesthetic Management: Review of the Literature
By Oakley, Ingrid; Emond, Lyne. AANA Journal, Dec 2011, Vol. 79 Issue 6: p473-479
Cardiac autonomic neuropathy is a serious complication among diabetic patients. It occurs in both type 1 and type 2 diabetes, and its progression results in poor prognosis and increased mortality. During its course, parasympathetic and sympathetic nerve fibers of the cardiovascular system are damaged, resulting in potentially serious cardiac complications and even death. Poor glycemic control is believed to play a pivotal role in the pathogenesis of cardiac autonomic neuropathy. Its underlying etiology is not well understood; however, several potential pathologic mechanisms have been identified. Several clinical manifestations of cardiac autonomic neuropathy have been reported, including resting tachycardia, exercise intolerance, loss of heart rate variability, orthostatic hypotension, prolonged QT interval, silent ischemia, and sudden death. Diabetic patients exhibiting these signs and symptoms are at greater risk of anesthesia-related complications. A series of noninvasive autonomic tests were developed for the diagnosis of cardiac autonomic neuropathy, improving the management of diabetic patients requiring general anesthesia. These patients often experience cardiovascular events that may increase perioperative morbidity and mortality. The presence of cardiac autonomic neuropathy alters the hemodynamic response to induction and tracheal intubation during general anesthesia, resulting in intraoperative hypotension. A thorough preoperative assessment and vigilant monitoring perioperatively ensure successful anesthesia management. [ABSTRACT FROM AUTHOR].

6. Bronchial Thermoplasty: A Novel Treatment for Severe Asthma Requiring Monitored Anesthesia Care
By Lee, Jamille al. AANA Journal, Dec 2011, Vol. 79 Issue 6: p480-483
: 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 ß-2 agonists. [ABSTRACT FROM AUTHOR].

7. Predictors of Situation Awareness in Student Registered Nurse Anesthetists
By Wright, Suzanne M. & Fallacaro, Michael D. AANA Journal, Dec 2011, Vol. 79 Issue 6: p484-490
: Situation awareness (SA) is defined as one's perception of the elements of the environment, the comprehension of their meaning, and the projection of their status in the near future. The concept of SA is well known in the aviation industry, which is characterized by complexity and dynamism. The discipline of anesthesia shares these same environmental characteristics, yet the study of SA in this setting is in its infancy. Guided by Endsley's theory of SA, the purpose of this study was to provide educators with a best-evidence predictor model of SA in student registered nurse anesthetists (SRNAs). Seventy-one SRNAs were randomly selected from 3 US universities. A nonexperimental, correlational design and multiple regression analysis were used to measure the relationship between memory, cognition, and automaticity and SA. Findings from this study reveal cognition as the best predictor of SA in graduate SRNAs, with the addition of memory and automaticity contributing no additional predictive value to the model. The results of this study have the potential to make a positive impact on the admission, education, and training of SRNAs. This study contributes evidence for further research examining the use of highfidelity simulation in promoting SA in SRNAs. [ABSTRACT FROM AUTHOR].

8. Model for a Reproducible Curriculum Infrastructure to Provide International Nurse Anesthesia Continuing Education
By Collins, Shawn Bryant. AANA Journal, Dec 2011, Vol. 79 Issue 6: p491-496
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. There is increasing evidence that the application of knowledge in developing countries is failing. One reason is that many anesthetists in developing countries are trained for considerably less than acceptable time periods and are often supervised by poorly trained practitioners, who then pass on less-than-desirable practice skills, thus exacerbating difficulties. 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. [ABSTRACT FROM AUTHOR].

9. Anesthetic Management of a Patient Undergoing an Ex Utero Intrapartum Treatment (EXIT) Procedure: A Case Report
By Choleva, Abbie J. AANA Journal, Dec 2011, Vol. 79 Issue 6: p497-503
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. Recent advances in prenatal diagnosis of fetal congenital malformations, in particular, abnormalities involving the fetal airway, have allowed for the development of the EXIT strategy to convert potentially catastrophic situations during fetal delivery to a controlled environment. Indications for the EXIT procedure have expanded to a variety of congenital abnormalities, including fetal neck masses, lung or mediastinal tumors, congenital high airway obstruction syndrome, conjoined twin separation, and acute respiratory distress syndrome requiring transitioning from EXIT to extracorporeal membrane oxygen transitioning. 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. [ABSTRACT FROM AUTHOR].

10. Complex Regional Pain Syndrome: A Review of Diagnostics, Pathophysiologic Mechanisms, and Treatment Implications for Certified Registered Nurse Anesthetists
By Watts, Daniel & Kremer, Michael J. AANA Journal, Dec 2011, Vol. 79 Issue 6: p505-510
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. [ABSTRACT FROM AUTHOR].

Journals - Table of Contents

11. From New Zealand College of Midwives Midwifery News, Issue 63, December 2011
From the CEO
. Autonomy is a multifaceted concept
. Shared Maternity Record of Care
MERAS Report
. New Zealand Maternity Standards
MMPO Report
. Farewell to Lisa Wisdom
Rural Midwifery Recruitment and Retention Update - Rural Evaluation Report
. Legal and Professional Aspects of Child and Family - Protection Issues
Power to Them - Autonomy and the Core Midwife
11H. Asian Indian Ethnicity Third Degree Tears and Improving Outcomes
11I. Pioneering Midwifery Regular Celebrates "Fantastic Experience" [Sally Pairman]
11J. How we can learn from clinical audits
11K. Why you should care for yourself as you care for others
11L. Dangers of heat therapy for post epidural women
11M. What maternity care in the United States can learn from New Zealand
. Midwifery at Kalene Mission Hospital, Zambia, Africa
. What is the impact of the internet on decision-making in pregnancy? A global study

12. From Journal of Infection Prevention, Volume 13, Issue 1, January 2012
12A. Editorial:
Translating evidence into practice – mission impossible?
12B. Disney, engagement, action: the Infection Prevention Society’s strategy from development to launch
12C. A fresh look at preoperative body washing
12D. Pros, cons and potential risks of on-site decontamination methods used on neonatal units for articles indirectly associated with infant feeding, including breast pump collection kits and neonatal dummies
12E. Saving Lives audits: do they improve infection prevention and control practice?
12F. Nursing knowledge of hepatitis – 25 years later


13. Human factors in Developing a Safety Culture
Auckland -
13 April 2012
Wellington - 23 April 2012
More information:

14. Turning Safe Actions into Subconscious Habits
One Day Workshop
- 2 May 2012
Wellington - 24 April 2012

News - National

15. 'Google Government' risks alienating people - expert
TVNZ - 15 Feb 2012

The Government is being warned it risks alienating people if it relies too heavily on internet based services to cut costs in the public sector. Prime Minister John Key said this week he had been talking with global search engine giant Google about providing software services to cut the cost and improve the efficiency of public services.

16. Press Release – Alcohol Healthwatch
A new online resource has been launched to assist the many New Zealand healthcare professionals who say they don’t feel adequately trained to discuss alcohol use with their pregnant patients. Studies show up to 30 percent of New Zealand women drink during pregnancy and 50 percent still believe drinking some alcohol during pregnancy is safe – but that healthcare workers are often unsure how to speak with them.

News - International

17. Sinus infection? Antibiotics won't help
CNN - 14 Feb 2012

( -- Roughly 20% of the antibiotic prescriptions written in the United States for adults each year are for sinus infections. That's an impressive statistic, given that doctors and public health officials have long doubted that antibiotics can successfully treat the condition.

18. Health aides in trial felt overwhelmed Julia Medew, Health Editor
February 15, 2012

TEENAGERS employed as health assistants in a Victorian hospital say they were overwhelmed by the work at times and needed more training related to death, dying and other traumatic events, a state government report says.

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