AANA journal
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This article examines successful management of an anesthesia machine failure with the Draeger (or Dräger) Apollo (Draeger Inc) anesthesia workstation. Approximately 45 minutes into the case, while the patient was under general anesthesia and mechanical ventilation, the anesthesia machine failed to achieve positive pressurization following a high-pressure alarm. Despite multiple maneuvers, the issue did not resolve until the machine was manually powered off and on at the main power switch. This case report emphasizes the importance of always having a backup means of patient ventilation and anesthesia administration.
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A "cannot ventilate, cannot intubate" scenario is a rare, high-risk anesthesia event. Cricothyrotomy is the final step, but anesthesia training and maintenance of surgical airway skills is variable. The ability to "cut to air" when one performs a cricothyrotomy may be all that prevents a patient from experiencing anoxic brain injury or death. ⋯ The confidence of CRNAs in performing a successful cricothyrotomy in less than 2 minutes was significantly increased (P ≤ .001). Simulating airway skills improved performance, speed, and confidence. Because not all CRNAs have had extensive education in performing surgical airways and practicing these skills, simulation may have additional value in developing and maintaining skills and confidence.
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Comparative Study
Review of Anesthesia Versus Intensive Care Unit Ventilators and Ventilatory Strategies: COVID-19 Patient Management Implications.
The coronavirus disease 2019 (COVID-19) respiratory illness has increased the amount of people needing airway rescue and the support of mechanical ventilators. In doing so, the pandemic has increased the demand of healthcare professionals to manage these critically ill individuals. Certified Registered Nurse Anesthetists (CRNAs), who are trained experts in airway management and mechanical ventilation with experience in intensive care units (ICUs), rise to this challenge. ⋯ The most common ventilator modes found in anesthesia machine ventilators and ICU ventilators are reviewed, as are the lung-protective ventilation strategies, including positive end-expiratory pressure, used to manage patients with COVID-19-induced acute respiratory distress syndrome. Adjuncts to mechanical ventilation, recruitment maneuvers, prone positioning, and extracorporeal membrane oxygenation are also reviewed. More research is needed concerning the management of COVID-19-infected patients, and CRNAs must become familiar with their ICU units' individual ventilator machine, but this brief review provides a good place to start for those returning to the ICU.
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Postoperative nausea and vomiting (PONV) degrades patient experience and increases healthcare costs. Estimates of PONV range from 10% to 80%. The Apfel Simplified Score is an evidence-based instrument for determining individual risk of PONV. ⋯ While ondansetron was unavailable, providers began using 3 other antiemetics, a practice that persisted once intravenous ondansetron returned. The Apfel score is an evidence-based tool that providers can use to reduce the risk of PONV. This electronic tool and the reminder cards have been shared across the US Military Health System, fostering an organizational culture that values targeted prophylaxis for PONV.