AANA journal
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Diastrophic dwarfism is an autosomal recessive disease that predominantly occurs in the Finnish population (1 in 33,000) but has been known to occur worldwide. Affected patients present with multiple cartilaginous anomalies and early degeneration of weight-bearing joints. Once past infancy, life expectancy is favorable and patients may undergo multiple surgical procedures throughout their lifetime to repair .or replace affected joints. The characteristic short trunk of these patients in addition to scoliosis, cervical kyphosis, and involvement of articular cartilages can create unique ventilation and airway challenges for anesthesia providers involved in their care.
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Local anesthetic toxicity remains a clinical concern when performing regional anesthesia. Because signs and symptoms of toxicity may not appear for 20 to 30 minutes after administration of local anesthetic, vigilance is crucial. ⋯ The number of case reports demonstrating successful use of lipid emulsions is growing. Continued research remains pivotal to improve understanding of the theory of lipid emulsion pharmacology and application to clinical practice.
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The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace. The U. S. ⋯ Human tissue is also an important factor in ultrasound imaging. The different densities of soft tissues, bone, fluid, and air all interact with sound, creating distinctive images that can aid and potentially hinder accuracy. Comprehension of basic ultrasound principles and how it is affected by tissue will enable anesthetists to better understand what is being seen and reduce the potential for errors.
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Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. ⋯ No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs.
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The American Association of Nurse Anesthetists (AANA) is committed to advancing evidence-based nurse anesthesia practice. This determination is evident across multiple activities within the Association. This editorial describes the AANA's evidence-based policy and process for the development of those practice-related documents that require approval from the AANA Board of Directors. Additionally, several of the Association's initiatives geared toward fostering the advancement of evidence-based nurse anesthesia practice are described.