FacebookTwitter

New Things You Want to Learn but Fall Asleep Reading About …

By on Sep 24, 2013 in Board Updates | 1 comment

New Things You Want to Learn but Fall Asleep Reading About … (aka Update! New Advances in Clinical Anesthesia Practice) Let’s face it, we’re all interested in learning about the “latest and greatest” in clinical anesthesia, but after the long working day, afternoon errands, and family obligations, WE’RE EXHAUSTED!  Just as you find that quiet moment to sit down and read, your eyelids simply Refuse. To. Stay. Open…zzzzz So I’ll give you a brief rundown on what’s happening now with links to explore more details whenever your eyelids can cooperate! Intraoperative Acceleromyography The pure technical nature and number of syllables in these words immediately invoked in me the feeling of “you’re really going to have to focus for this one…”  However, once my inner techie discovered that this involves a cool gadget for quantitative monitoring of neuromuscular blockade to more accurately determine residual neuromuscular weakness, I was sold on learning more! The acceleromyograph is a device that measures muscle acceleration across a joint in response to nerve stimulation.  That acceleration correlates with the force of muscle contraction therefore providing a quantitative, objective measure of residual muscle weakness beyond the traditional qualitative, subjective measures typically used. This concept is not really new, but has been in the works for quite some time. Clinicians have been seeking more accurate ways of measuring residual neuromuscular blockade in an attempt to decrease adverse postoperative events that occur as a result.  As with any new technology, it takes time for studies to prove its worthiness, describe its strengths and weaknesses, and produce a device that is affordable and safe for clinical use.  For that reason, this device is just beginning to surface in many ORs.  My experience with the acceleromyograph is a result of its integration into the newest anesthesia machine our department purchased, the GE Aisys.  Other manufacturers are following suit as well. To embrace your inner techie, you can read more here: Brull, S. J. & Murphy, G. S. (2010). Residual neuromuscular block: Lessons unlearned. Part I: Definitions, incidence, & adverse physiologic effects of residual neuromuscular block. Anesthesia & Analgesia, 111(1), 120-128. doi: 10.1213/ANE.0b013e3181da832d The above article is free & available online at http://www.anesthesia-analgesia.org/content/111/1/120.long Brull, S. J. & Murphy, G. S. (2010). Residual neuromuscular block: Lessons unlearned. Part II: Methods to reduce the risk of residual weakness. Anesthesia & Analgesia, 111(1), 129-140. doi: 10.1213/​ANE.0b013e3181da8312 This above article is free & available online at http://www.anesthesia-analgesia.org/content/111/1/129.long Sandberg, W. S., Urman, R. D., & Ehrenfeld, J.M.  (2011). The MGH textbook of anesthetic equipment. Philadelphia: Elsevier Saunders. IV Ibuprofen – Caldolor I recently received a visit from our area’s Cumberland Pharmaceuticals rep to hear his plug for IV ibuprofen (trade name Caldolor).  I’m always a little skeptical about sales pitches in general but try to be open-minded about the potential of any new drug.  Caldolor actually received FDA approval in 2009, but until recently I hadn’t really heard any buzz about it.  This leaves me wondering if there is a new wave of sales promotions designed to ride the coat tails of IV acetaminophen’s (Ofirmev) success.  Regardless, it seems rational to consider the possibilities.  Here are the basics: • Indicated for pain and fever in adults • Administered pre-op, intra-op, or post-op • Dosing:  400mg q 4-6 hours or 800mg q 6 hours • Infuse over 30 minutes • Added anti-inflammatory benefits of other NSAIDs like ketorolac, but with fewer side effects related to bleeding, gastric upset, and renal issues Unfortunately, this drug is not on my hospital’s formulary, so I don’t have any personal experience to comment upon. I would love to hear opinions from those who have! Get the full details and prescribing information at www.caldolor.com. Hyperthermic Intraperitoneal Chemotherapy (HIPEC) In healthcare, we all love the mystery of a new abbreviation.  This time my curiosity was peaked when one of my students told me about a new “hi-tech” procedure she was involved in (but only briefly involved in because it was potentially dangerous for her, at a childbearing age, to be in the room…..THAT got my attention!). HIPEC (not “hi-tech” as I thought I heard) is a procedure available to treat advanced abdominal cancers such as peritoneal mesothelioma, pseudomyxoma peritonei, colorectal cancer, and ovarian cancer. This procedure is new to my facility, but has been performed successfully at other leading medical centers across the country. HIPEC involves surgical exploration, tumor debulking, and application of heated chemotherapy to the peritoneal cavity. The chemotherapy solution is left in the abdomen for 1.5 to 2 hours. This phase of the procedure is referred to as “shake and bake” where the surgeon ensures the chemotherapy solution is evenly distributed throughout the peritoneal space. Confining the chemotherapy to the peritoneal cavity allows for usage of higher concentrations of agents while minimizing systemic toxicity and side effects. Patient and healthcare provider safety is of utmost concern during this procedure due to the potential exposure to cytotoxic agents.  Routes of exposure include: inhalation, contact, ingestion and injection. Essential equipment that should be utilized and/or readily available includes: unpowdered latex gloves, impervious sterile gowns, protective eye wear, respirator mask (if a spill occurs), a spill kit, an impenetrable hazardous waste container, specially marked linen bags and appropriate cytotoxic agent labels. With regard to providers’ repeated involvement with these cases, Stephens et al (2010) state, “Because the toxicities of low level cumulative exposure are not well defined, personnel who have specific medical concerns should...

It’s a PINTERESTing Thursday!

By on Sep 19, 2013 in PINTERESTing Thursday | 0 comments

Are you following us on Pinterest yet? Source: keepcalm-o-matic.co.uk via Tennessee Association of Nurse Anesthetists on...

Live Streaming: To Be or Not to Be …

By on Sep 17, 2013 in AANA, Notes from the President | 9 comments

AANA Business Meeting, Live Streaming: To Be or Not to Be … A question has recently been raised in AANA. The question is whether the Annual Business Meeting should be streamed online, and should CRNAs at home be allowed to vote. At first you may say, that is a no brainer, “YES.” I want each of you to read this article, and please comment and vote on this. This is your state president-elect trying to represent the membership of Tennessee, but I need you to be informed about all that is involved. Where did this topic arise? Leaders within the AANA have discussed the poor attendance at the business meeting for years. Although, this year was the largest turnout in 20 years with 538 members present. Looking at the numbers, it is still apathetic since there are 45,000 eligible CRNA voters (1.2%). So, how do we involve more CRNAs and convey the importance of using your voice? Online streaming of the business meeting has been discussed, but there are concerns. What about security of the feed as reports, financials, and future initiatives to advance nurse anesthesia are discussed during these meetings. It is essential that the feed, should on-line streaming be implemented, be secure. Questions arise about how to allow CRNAs not in the business meeting participate in the discussion of issues that will be voted on. (i.e. Pro, Con, Point of Information Microphones). There are then the issues with the cost to place this system. The importance of member input and discussion is ESSENTIAL to the AANA Business Meeting. You also have to ask if involving more CRNAs is worth the risk, but is involving CRNAs the priority. Would CRNAs participate? Would more or less CRNAs travel to attend the meeting? Would the business meeting be disorganized. I believe that we must ask, “How many CRNAs would participate if the AANA invested significant amounts of money in a secure live-streaming business meeting.” With CRNA apathy at an all time high, it is crucial that the voice of CRNAs are heard, but at what cost?  I look forward to hearing your comment and what Tennessee CRNAs want. I will ensure that your voice will be heard. As the AANA continues to look at this issue, it is critical that state associations poll their members and that the voice of CRNAs are heard. So, please respond with Yes or No to Live-Streaming for the AANA Business Meeting, and Yes or No to whether you would participate from home if not at the...

Want to be the next TASNA Liaison to the TANA Board?

By on Sep 13, 2013 in Announcements, Student Success | 0 comments

Hey Students! It’s time to apply to be the next TASNA Liaison to the TANA Board!  This is a fun way to get involved in the association. All you have to do is submit your name to be the next TASNA Representative. You can find the candidate packet with instructions here. All nominations are due by October 4!  The vote will take place at TANA’s Annual Meeting on Saturday, October 12, at 9:15 a.m. in a meeting held just for TASNA members by secret ballot. If you have questions about what it is like to serve in this position, and the time it takes, the benefits or downside of being in the role, you can email current TASNA Representative Meredith Goldman Holtz at mggoldman11@gmail.com. Your questions will be confidential.  You can also call the TANA office at...

It’s a PINTERESTing Thursday

By on Sep 5, 2013 in PINTERESTing Thursday | 0 comments

Hi TANA friends! It’s another PINTERESTing Thursday, and we’re excited to announce that this one includes a photo contest! We’ve been looking for OR fashion ideas to pin on our boards, but we’re having a hard time finding good ideas. So, we’ve decided to fill our board with OR fashion statements from our very own TANA members! Send pictures of you or your friends wearing fun scrubs, cool hats, or your favorite shoes to marketing@tncrna.com by Wednesday, September 11, and we’ll pin them on our OR Fashion Pinterest board. The first one to get to 20 likes or 20 re-pins wins a FREE Tana t-shirt! Contest begins will begin next week in our PINTERESTing Thursday post! So, go lay out your cutest outfit for tomorrow, and get your cameras ready! In the meantime, here’s a little inspiration …   Source: hospitalgowns.com via Tennessee Association of Nurse Anesthetists on Pinterest Source: Uploaded by user via Tennessee Association of Nurse Anesthetists on Pinterest Source: etsy.com via Tennessee Association of Nurse Anesthetists on...