AANA journal
-
Case Reports
Multidisciplinary management of peripartum cardiomyopathy during repeat cesarean delivery: a case report.
Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 29-year-old African American woman, gravida 3, para 2, at 36 weeks' gestation had a history of cardiomyopathy, morbid obesity (body mass index > 70 kg/m2), uncontrolled hypertension, obstructive sleep apnea, and required a repeat cesarean delivery. ⋯ This case report illustrates the recognition of peripartum cardiomyopathy and the risks early in pregnancy. It also describes the appropriate medical management, including transesophageal echocardiography and the need for collaboration of multiple medical specialists before and during delivery to provide the best possible outcome for both mother and infant.
-
This case report details the onset of masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis following a sevoflurane mask induction and succinylcholine administration in a 12-year-old boy. The patient had no family or personal history of neuromuscular disease or malignant hyperthermia. ⋯ Subsequent to this event, it was recommended that the patient undergo a workup for neuromuscular disease and malignant hyperthermia with muscle biopsy. Until this workup is completed, the family should advise anesthesia providers that the patient is "malignant hyperthermia susceptible." Masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis will be thoroughly discussed in this article.
-
Dexmedetomidine is a relatively selective alpha2 agonist with sympatholytic, sedative, amnestic, and analgesic properties. It is indicated for the short-term sedation of patients needing mechanical ventilation in the intensive care unit. ⋯ This article will provide the reader with a comprehensive review of the pharmacology, pharmacokinetics, and adverse effects of dexmedetomidine. A thorough understanding of this drug will enable the anesthesia provider to determine situations in which dexmedetomidine may be a useful drug to consider, whether as an adjunct or as a sole agent.
-
An educational curriculum using adult learning principles in an active learning format was developed for Certified Registered Nurse Anesthetist clinical educators (CRNACEs) to help improve the quality of the clinical learning experiences for student nurse anesthetists (SNAs). This exploratory study sought to determine the extent to which an 8-hour educational course modified the behavioral perceptions and the knowledge of CRNACEs. The effects of the CRNACE course were measured using a questionnaire that consisted of 22 Likert scale items and 8 open-ended questions. ⋯ Additional findings included that information provided during the CRNACE course did not change the perceptions of CRNACEs related to their ability to communicate with students or their willingness to modify their teaching practices. Providing instruction incorporating principles of adult learning using an active learning format for CRNACEs may improve the clinical learning experiences for SNAs. As a result, SNAs would be better prepared to make the transition to clinical expert.