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

ACCREDITATION

American Society of PeriAnesthesia Nurses, (ASPAN) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

Additional provider numbers: Alabama ABNP0074

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

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

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

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

Authors: Christopher H. Stucky, PhD, RN, CNOR, CSSM, CNAMB, NEA-BC, FAAN, J. Michael Hartmann, DNP, RN, CNOR, CSSM, CNAMB, RNFA, Young J. Yauger, PhD, RN, CRNA, Kenneth J. Romito, DNP, RN, APRN, AGCNS-BC, CNOR, CSSM, David F. Bradley, DNP, RN, APRN, AGCNS-BC, CNOR, Gaston Baza, DNP, RN, CNOR, Megan E. Lorenz, DNP, RN, APRN, ACCNS-AG, AGACNP-BC, RN-BC, Sherita L. House, PhD, RN, CCRN, Rebeccah A. Dindinger, DNP, RN, RNC-OB, IBCLC, Joshua A. Wymer, DNP, RN, CNOR, RN-BC, NEA-BC, CHCIO, CDH-E, FACHE, FAAN, Melissa J. Miller, PhD, RN, CNOR, Albert R. Knight, DNP, RN, CNS-CP, CNOR
Adverse surgical events cause negative patient health outcomes and harm that can often overshadow the safe and effective patient care provided daily by nurses as members of interprofessional healthcare teams. Near misses occur far more frequently than adverse events and are less visible to nurse leaders because patient harm is avoided due to chance, prevention, or mitigation. However, near misses have comparable root causes to adverse events and exhibit the same underlying patterns of failure. Reviewing near misses provides nurses with learning opportunities to identify patient care weaknesses and build appropriate solutions to enhance care. As the operating room is one of the most complex work settings in healthcare, identifying potential weaknesses or sources for errors is vital to reduce healthcare-associated risks for patients and staff. The purpose of this manuscript is to educate, inform, and stimulate critical thinking by discussing perioperative near miss case studies and the underlying factors that lead to errors. Our authors discuss 15 near miss case studies occurring across the perioperative patient experience of care and discuss barriers to near miss reporting. Nurse leaders can use our case studies to stimulate discussion among perioperative and perianesthesia nurses in their hospitals to inform comprehensive risk reduction programs.

Authors: Geeta kamal, MDa, Swetha Rudravarama, Shilpa Agarwal, MDa, Anju Gupta, MD, DNB, IDRA, EDRA
Multisystem inflammatory syndrome in children (MIS-C) is an immune response inciting multiorgan dysfunction and a shock-like state which is typically seen in children 2 to 6 weeks after either a coronavirus disease-19 infection or exposure. When such a child comes for any surgery, perioperative anesthetic management demands multidisciplinary involvement and individualized case-based decision-making. Due to the novelty of the condition, there are limited data on anesthetic implications in these patients. Anesthetic management in the affected children is dynamic depending on the organ systems involved and the progression of the disease state. Though the long-term effects of the syndrome are largely unknown, we hope that awareness of the MIS-C-associated complications may help anesthesiologists involved in childcare. Herein, we put forward challenges and clinical dilemmas we faced during the anesthetic management of three children with MIS-C presenting for emergency and elective surgery.

Authors: Azucena Becerra, DNP, CRNA, Michael Liu, DNP, CRNA, Molly Ronan, DNP, CRNA, Sarah E. Giron, PhD, CRNA, FAANA, Rui Yan, MS, Sadeeka Al-Majid, PhD, RN, FAAN

Purpose: Perioperative vision loss (POVL) is a rare and devastating complication following prone spine surgery. Due to the rare nature of this complication, there is limited research available about patient and surgical risk factors that increase the risk of POVL. The objective of this study was to investigate associated risk factors for POVL with use of the National Surgical Quality Improvement Program (NSQIP) database.
Design: This study used a case-control secondary data analysis methodology that included five cases of POVL and 250 controls from the American College of Surgeons National Surgical Quality Improvement Program database who all underwent prone spine surgery between 2010 and 2020.
Methods: Each POVL case was matched to 50 randomly selected controls (n = 250) based on type and year of surgery. Demographics and variables of interest were compared among the POVL cases, among POVL cases and the aggregate control group (n = 250), and POVL cases against their matched control group. Univariate and multivariate conditional logistic regression were then used to estimate the odds of developing POVL in relation to potential patient and surgical risk factors.
Findings: When POVL cases were compared to the 250 control cases using univariate analysis, patients who developed POVL were more likely to have received a blood transfusion within 72 hours of surgery (P < .0001). and have longer operative times (odds ratio = 1.01, 95% CI [1.003, 1.017], P = .003).
Conclusions: Two surgical risk factors were determined to be statistically significant, including the need for perioperative blood transfusion and prolonged operative time. These findings support previous research on POVL which often identified blood loss and prolonged operative times as surgical risk factors. The narrow patient population used in this project may have limited the ability to perform a more robust study on POVL. Therefore, further research on POVL using the National Surgical Quality Improvement Program database is strongly encouraged.

Authors: Suki Ismet, MD, MMED, Muhamad Rafiqi Hehsan, MBBCh, MMED

Argininemia is a rare autosomal recessive metabolic disorder characterized by a deficiency of arginase, a vital enzyme in the urea cycle. This metabolic defect results in the accumulation of arginine and its metabolites, leading to hyperammonemia and associated neurological symptoms. We present a case detailing the perioperative management of an 11-year-old male child diagnosed with argininemia undergoing circumcision. The perioperative management of patients with argininemia presents unique challenges due to the risk of hyperammonemia and neurological decompensation triggered by physiological stress, fasting, and the catabolic state associated with surgery. This case report highlights the importance of individualized anesthetic strategies for patients with rare metabolic disorders like argininemia. A multidisciplinary approach involving collaboration among anesthesiologists, endocrinologists, dietitians, and surgeons is essential to ensuring a safe perioperative experience for these patients. Further research is essential to refine perioperative protocols and optimal anesthetic interventions for individuals with argininemia undergoing surgical procedures.

Authors: Shelby L. Wallen, BS, BSN, RN, Tony V. Paul, MS, BSN, RN, Tito D. Tubog, PhD, DNAP, CRNA

Purpose: Examine the effectiveness of using intracuff lidocaine to minimize postoperative complications.
Design: Systematic review.
Methods: This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines. PubMed, CINAHL, Cochrane, Google Scholar, and gray literature databases were searched to obtain eligible studies and minimize selection bias. The Johns Hopkins Nursing Evidence-Based Practice Model was used to appraise the level of evidence for the varying studies. Only randomized controlled trials (RCT) and systematic reviews with meta-analyses of RCTs were included in the review.
Findings: Three RCTs and three systematic reviews with meta-analyses incorporating a total of 2,337 patients were included in this review. Intracuff lidocaine (alkalinized and nonalkalinized) had the lowest incidence of postoperative sore throat in the early and late postoperative periods compared to intracuff air or intracuff saline. Furthermore, the evidence suggested that the use of intracuff lidocaine reduced postextubation cough and the incidence of hoarseness but had little or no effect on dysphagia. All studies were Level 1 and Grade A, indicating clinically solid evidence in analyzing intracuff lidocaine’s effect on all outcomes measured.
Conclusions: The current literature suggests the feasibility of using intracuff lidocaine as an effective method to reduce the incidence of postoperative sore throat, postextubation cough, and hoarseness. The implications to practice include improving the norm of postoperative throat mucosal injuries by implementing an evidence-based practice intervention of intracuff lidocaine.