This module includes the mechanism of nociception and multimodal therapy as well as opioids and adjuvants used in multimodal therapy.

This module includes patient care priorities for the Parkinson’s patient.

This module includes the etiology, rick factors, incidence, signs & symptoms, and treatment for PTSD/PTSS.

This module includes preprocedural assessment, intraoperative positioning, possible complications & interventions and patient teaching.

This module includes strategies for to handle crucial conversations in stressful situations.

This module includes anesthesia techniques and commonly used anesthetic agents.

This module includes special anatomical and physiological considerations unique to the pediatric, geriatric and pregnant patient.

Authors: Edwin N. Aroke, PhD, CRNA, Alexis N. Robinson, MSN, APRN, CRNA, Bryan A. Wilbanks, PhD, DNP, CRNA
In the United States, approximately 15% of adults suffer from major depressive disorder (MDD), which results in an annual cost of over $200 billion per year. In the perioperative setting, MDD is associated with increased morbidity and mortality. The exact causes of the increase in adverse outcomes are unknown. Major depression affects virtually all major systems in the human body, and most antidepressants affect dopamine, norepinephrine, and serotonin levels or alter their target receptors. Unfortunately, anesthesia and medications used in the perioperative period affect the same neurotransmitters. As a result, patients with MDD are at an increased risk for cardiovascular effects, altered thermoregulation, and postoperative cognitive dysfunction. To determine when to continue or hold antidepressants preoperatively and avoid potential drug interactions, perioperative providers must understand the pharmacological action of antidepressants. This article reviews the pathophysiology of MDD, mechanism of action of antidepressants, and perioperative considerations for patients on antidepressant medications.

Authors: Edwin N. Aroke, PhD, CRNA, Rolland Z. Nkemazeh, MD
Prolongation of the QT interval can predispose patients to fatal arrhythmias such as torsade de pointes. While arrhythmias can occur spontaneously in patients with a genetic predisposition, drugs such as ondansetron and droperidol, which are frequently used in the perioperative period, have been implicated in the prolongation of the QT interval. As the list of medications that cause QT prolongation grows, anesthesia providers and perioperative nurses must be informed regarding the importance of the QT interval. This article reviews the physiology and measurement of the QT interval, the risk factors of QT prolongation, the mechanism of drug-induced QT prolongation, and perioperative considerations for patient care.

Authors: Matthew D. Muller, PhD, CAA, Angela M. Capp, CAA, James Hill, MD, MBA, Alan Hoffer, MD, James R. Otworth, MD, Patrick M. McQuillan, MD, Anthony S. Bonavia, MD
In 1930, the life expectancy of patients with Down syndrome was about 10 years; today, their life expectancy is more than 60 years. With aging, there is an increased need for anesthesia and surgery. There is, however, no published information regarding the anesthetic management of older adults with Down syndrome. In this report, we described the anesthetic management of a 50-year-old woman with Down syndrome undergoing major cervical spine surgery. Components of the anesthetic that we thought would be difficult such as intravenous line placement and endotracheal intubation were accomplished without difficulty. Despite our best efforts, our patient nevertheless experienced both emergence delirium and postoperative vomiting. We advocate that physicians, advanced practice providers, and registered nurses be aware of the unique perianesthesia needs of older patients with Down syndrome.