<![CDATA[WWW.NURSE-ANESTHESIA.ORG - Anesthesia Clinical Cases, Questions & Pearls]]> http://www.nurse-anesthesia.org/ Where CRNAs and SRNAs present clinical cases, questions and helpful ideas learned through experience! en Sat, 25 May 2013 16:03:08 GMT vBulletin 60 http://www.nurse-anesthesia.org/images/styles/BlueDemon/misc/rss.png <![CDATA[WWW.NURSE-ANESTHESIA.ORG - Anesthesia Clinical Cases, Questions & Pearls]]> http://www.nurse-anesthesia.org/ Foley placement for elective C-Section http://www.nurse-anesthesia.org/showthread.php/16732-Foley-placement-for-elective-C-Section?goto=newpost Thu, 23 May 2013 22:06:21 GMT So I am curious for those doing obstetric anesthesia. When do you have the foley placed on your patients, before or after the spinal is placed. In my... So I am curious for those doing obstetric anesthesia. When do you have the foley placed on your patients, before or after the spinal is placed. In my practice I like to do it after the spinal has been placed, and has been the way have had it done for years..... Full disclosure today had a nurse tell me that we shouldn't do that, because she had a patient develop a total spinal while having a foley placed and had to be put off to sleep. This was attributed by the anesthesia provider due to frog legging the patient for foley placement making the spinal go high. I have not heard of this phenomenon, wondering if anyone else could give me some input/thoughts. I not having been there think of a couple of other mechanisms that may predispose to high/total spinal ie an epidural that was bolused with enough volume to decrease the volume of the subarachoid space.... possibly a hypobaric spinal? ]]> chansoncrna http://www.nurse-anesthesia.org/showthread.php/16732-Foley-placement-for-elective-C-Section Ventilation Mode http://www.nurse-anesthesia.org/showthread.php/16723-Ventilation-Mode?goto=newpost Wed, 22 May 2013 00:28:20 GMT I was just wondering what mode of ventilation people are using on a daily basis and why are you using this mode. I know many facilities have... I was just wondering what mode of ventilation people are using on a daily basis and why are you using this mode. I know many facilities have different ventilators with PRVC (pressure regulated volume control) and others but was interested to see how many use pressure control vs. volume control. I may be the minority here. ]]> BrianCRNA http://www.nurse-anesthesia.org/showthread.php/16723-Ventilation-Mode Henderson Hasselbach in 5 minutes! http://www.nurse-anesthesia.org/showthread.php/16716-Henderson-Hasselbach-in-5-minutes!?goto=newpost Sun, 19 May 2013 02:48:04 GMT Hope you find it useful! Attachment 4005 (http://www.nurse-anesthesia.org/attachment.php?attachmentid=4005) Sent from my GT-N8013 using... Hope you find it useful!

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]]> armygas http://www.nurse-anesthesia.org/showthread.php/16716-Henderson-Hasselbach-in-5-minutes! Allergy to Fentanyl? http://www.nurse-anesthesia.org/showthread.php/16685-Allergy-to-Fentanyl?goto=newpost Fri, 10 May 2013 23:09:33 GMT Had a case the other day and 30 something female having a cystoscopy with hydrodistention. Patient states she had an allergic reaction to fentanyl... Had a case the other day and 30 something female having a cystoscopy with hydrodistention. Patient states she had an allergic reaction to fentanyl in the past during a GI procedure. Old records confirmed that Fentanyl (not really sure why she was given this, but...) was given and patient subsequently had SOB with swelling of lips/tongue. Patient improved with Benadryl and Naloxone only? Has anyone ever seen this before. She did not receive any other medications (or contrast) during previous case (ultrasound for GB issues). ]]> painter50 http://www.nurse-anesthesia.org/showthread.php/16685-Allergy-to-Fentanyl Tidbits from the AVANA conference (VA Nurse Anesthetists) http://www.nurse-anesthesia.org/showthread.php/16676-Tidbits-from-the-AVANA-conference-(VA-Nurse-Anesthetists)?goto=newpost Thu, 09 May 2013 02:41:48 GMT So I just got back from the AVANA conference in Portland. Here are a few things I picked up... Presentation on Sleep Apnea: suggestion to instruct... So I just got back from the AVANA conference in Portland. Here are a few things I picked up...

Presentation on Sleep Apnea: suggestion to instruct patients to use CPAP for 3 days following surgery because the REM sleep deficit resets around three days after anesthesia.

Apneic Oxygenation: 4 studies showing greater time to desaturation when nasal O2 provided at 5 liters/ minute during apneic period. In obese or patients with difficult airways, the suggestion to have nasal O2 going during time of intubation ( when patient is apneic) and during RSI with maintenance of patent airway.

Obese patients: saw slides of a patient that was ramped for intubation using inflated pressure bags under the shoulders that could be deflated after intubation.

Patients with ventricular assist devices: non-pulsatile devices will require an arterial line placed with ultrasound or Doppler as they will have no palpable pulses. Patients with these devices will require a preop CT prior to laparoscopic procedures to identify location of drive lines. No chest compressions during a code, as it can cause tearing of the pump line from the heart.

P6 meridian block for prevention of nausea: CRNA observed this block during a mission trip and has started using in her practice. I will try to post reference and pictures... But basically it is 1ml of 1% lidocaine injected lateral to tendons in the forearm ( bilateral)

Just a quick share :) ]]> nurserebecca http://www.nurse-anesthesia.org/showthread.php/16676-Tidbits-from-the-AVANA-conference-(VA-Nurse-Anesthetists) Antibiotics - infuse or push? http://www.nurse-anesthesia.org/showthread.php/16643-Antibiotics-infuse-or-push?goto=newpost Wed, 01 May 2013 20:13:54 GMT In our facility we are now being required to document start and end times for all antibiotics.

As RN's we learned to infuse all IV antibiotics over a time frame of typically an hour or so. As CRNA's we learned that many may be "infused" over a much shorter time frame...

There does seem to be some emerging data supporting increased efficacy when antibiotics are infused rather than bolused.

Is there a list of recommended minimum infusion times for all antibiotics out there somewhere?
Do you see infusion of all antibiotics at your facility? ]]> FORANE http://www.nurse-anesthesia.org/showthread.php/16643-Antibiotics-infuse-or-push Differences in opioid usage http://www.nurse-anesthesia.org/showthread.php/16633-Differences-in-opioid-usage?goto=newpost Mon, 29 Apr 2013 00:50:44 GMT My personal anesthetic techniques tend to use a good bit of opioids and part of that stems from how smooth a well narcotized wake up is. I also aim... My personal anesthetic techniques tend to use a good bit of opioids and part of that stems from how smooth a well narcotized wake up is. I also aim to give enough narcotics that the PACU nurses don't have to give much if any to my patients, I just want the patient to wake up and be transferred. One of the MDAs I work with has relieved me on cases twice and commented about my narcotics. Both times it was a older (80+) patient whom I had given a milligram of dilaudid. I don't remember the first case but the other one happened last week.

Sharp 89 y.o. who had taken her plavix the day before for an ORIF of a hip. She had some CAD and a cardiac history but nothing acute and otherwise very healthy and mentally sharp. I induced with 250 mcg of fent, some propofol and Sux and placed an ETT without issue. As they were beginning to prep I gave a mg of dilaudid. They were finishing up and getting ready to start to close when the MDA relieved me. I had her breathing 6-7 mL/kg tidal volumes rate = 8-10 on pressure support of 6 cm H2O and when I told the MDA what had been given the answer I got was "so you weren't planning on waking her up?". That is almost the same answer I had gotten before when I had given another patient a mg of dilaudid and that one while I don't remember the case was spontaneously breathing on an LMA when I was relieved.

My patients wake up very smoothly and comfortably and I rarely have to give narcotics after they wake up because they are in pain. Is there something in this picture I am missing? ]]> BuckeyeRN http://www.nurse-anesthesia.org/showthread.php/16633-Differences-in-opioid-usage