Journal Club 2021
Introduction to COVID-19 Module
Greetings everyone and welcome to the MeANA Journal Club! I am Bev Henion, CRNA and I helped write the program. Many thanks to Andrea Farrar, CRNA, Mike Dunnington, CRNA, and Susan DeCarlo-Piccirillo, CRNA for their assistance with this idea of doing something we haven’t done before!
First, some housekeeping items. We have received approval from AANA for our Journal Club and with this introductory note, you will receive the article, the quiz, and the evaluation. You must successfully complete the quiz with a minimum score of 80% on the first attempt and complete the evaluation in order to receive credit. Credit will be reported directly to AANA on completion of the requirements. Each month is approved for two credits. We at MeANA are new to this and there may be some glitches to work out, but we will get there!
Now, this month’s offering. COVID-19 has in many ways taken over a significant portion of our lives, whether personally and professionally. While we had hoped that things would have returned to normal (whatever that will be!), that has, sadly, not been the truth of the matter. As such, an article written today may be outdated by next month.
The article attached was written prior to the onslaught of the Delta variant. I have already seen further research on when we can safely proceed with elective surgeries on COVID positive patients, but even much of that was done and published either before or early in to Delta. Due to Delta’s increased level of contagion, the answer to the all important question of when we can proceed has not yet been defined.
Please enjoy this article and the subsequent offerings in the program. If you have any questions about the particulars of the program, please don’t hesitate to contact me at beverly.henion@namecrna.com I am more than happy to help you. Thank you for participating.
Article One
Article Two
We all know that airway is the beginning and end of anesthesia, the alpha and the omega, as it were. We have sayings, such as ‘airway, airway, airway’ and ‘Ventilate and Graduate’. Closed claim studies list airway related problems as the number one reason for anesthesia providers in lawsuits, many of which could have been avoided. It’s all about the airway!!
This month’s article is a review of the things that can go wrong with an airway, some with very, scary pictures! It also reminds us of just how important careful positioning of patients can be. I suspect that you’ll learn a lot and hopefully not be afraid to ever approach an airway again!
Please feel free to share it with your students as well.
Article Three
A significant number of CRNAs in the state of Maine practice independently of anesthesiologists. While we all face numerous challenges, solo providers are at the forefront of some of these issues It’s impossible to cover them all in a two hour course, but we are touching on two key concerns.
The first is informed consent. Have any of us NOT been in a situation where the surgeon or proceduralist tried to include an anesthesia consent with the procedure consent? Have any of us not cringed at hearing a provider say to the patient “you’ll be fine, you won’t have any pain, and you won’t remember anything”? Have you ever said to yourself “that wasn’t exactly an informed consent!” and then tried to remedy the situation? You will see an article on how informed consent developed as well as the AANA’s current guidance on the matter. We must protect our patients, just as we have always done. After all, there may be such a thing as minor surgery, but there is no such thing as minor anesthesia!
The second issue concerns a patient’s ability to drive after sedation, specifically propofol. I remember working at a small hospital and learning after the fact that a patient operated his snowmobile to his home across Moosehead Lake after a colonoscopy. Another patient had a ride home and then returned to the hospital to pick up his daughter after work. There is a study that was done to measure the ability of individuals to drive after receiving propofol. I have again included the AANA’s current position statement on this topic. We hope that you are finding the journal club offerings useful. This is the third installment and we have three more to go.
Article Four
I hope that you have all had a wonderful fall! It seemed as though the leaves stuck around for a little longer than usual and I hope that you had time to enjoy their beauty. But on to darker subjects. One of the great epidemics of our time is the opioid crisis. There are few, if any, of us who have not seen the effects of this issue in our operating rooms. If you have the luxury of a scheduled patient on methadone or buprenorphine that also has a pain management plan, try to find the time to become familiar with it, so that you can adhere to it during the perioperative period. If, on the other hand, you are doing an urgent/emergent case, the issue remains “Do I continue it or stop it?”. There are no simple answers.
As a CRNA who often provides anesthesia for orthopaedic trauma, this is a difficult decision and not one to be undertaken lightly. This month’s journal club contains the history and some scary future as well as some recommendations on handling this situation.
Speaking of scary, new “drugs” are almost constantly emerging to deal with a host of personal issues. One that I have seen once is Kratom, although my nurse colleagues in the ER say that they are seeing it. It is being touted as producing sedation, pleasure and decreased pain when mixed with opioids, but can also serve as a stimulant. It is not currently illegal and is easily available online or in shops selling marijuana and other herbals. Sadly, the consequences can be devastating.
I hope that this month’s offerings are of help to you. If you are enjoying the journal club, please let me know at beverly.henion@namecrna.com. If you have any questions or comments, please let me know at the same address.
Article Five
Is there anyone among us who has not observed that the provision of anesthesia (and surgery) has moved from the realm of art to that of production? Consider that the top two money making departments in most hospitals are the operating room(s) and the cafeteria. I grant you that this was from before the pandemic, so I don’t know how the cafeterias are faring. This, of course, accounts for much of the devastating impacts on hospital balance sheets stemming from the pandemic. It is also why many of us did not see our operating rooms shut down during the Delta variant onslaught.
The need to seek ways to increase profits from operating rooms is probably not going to disappear after the pandemic. One of the outcomes of the pandemic was to see an increase in the use of regional anesthesia. While it MAY initially have increased in an attempt to avoid AGPs, the cost savings have been noted. It costs significantly less to use a spinal tray than to crack a vaporizer. With so many procedures demonstrating improved outcomes with regional (OB and total joints for example), with fewer negative side effects, regional is an area whose time has come. (That’s just me speaking.)
We have a couple of articles this month on this topic. The first one is a brief editorial on the rise of regional during the pandemic as one positive outcome of a very negative thing. The second examines the use of epidural versus TAP block for abdominal surgery. I hope that you enjoy. This is the fifth offering in our series. We have one more which will come to you just in time for the holidays. It considers the effects of marijuana on anesthesia. Oh, happy days!
As always, if you have any questions or comments, please don’t hesitate to contact me at Beverly.henion@namecrna.com Thank you and Happy Thanksgiving!
Article Six
Hello everyone and welcome to the last installment of the MeANA Journal Club! We’ve covered some interesting topics during this series and our final module is no different.
With the legalization of marijuana and the increased stress of the pandemic, it’s believed that the use of cannabis has increased up to 25% (or not at all!) based on what studies you read. Recreational use of marijuana is now legal in Maine and dispensaries have been started in numerous places throughout the state. A recent story in all of the state papers detailed an illegal trafficking program in the Farmington area that has implicated growers, accountants, and law enforcement officers, among others.
Marijuana has now been around long enough for some studies on its effects on anesthesia or in conjunction with anesthesia are now reliable. It’s a question we need to ask our patients.
Please enjoy this offering. Also, please continue to send me your comments, suggestions, and ideas for further programs. I have sincerely appreciated the support from the CRNAs of Maine.
My original intention was to be able to report your credits to AANA on a monthly basis. That, unfortunately, has not happened. We are releasing the December offering now so that anyone who needs the credits can complete them all (or however many you wish to) and I will report them all at once. You must, however, complete the program by December 31, 2021. Please drop me an email once you’ve finished and I will get things taken care of and let you know once I’ve reported your credits to AANA.
If you have any questions or concerns, as always, please don’t hesitate to contact me at beverly.henion@namecrna.com.
Finally, please enjoy the holidays. It’s not been an easy year. For those of taking call over the November and December holidays, thank you for your devotion to duty and to our patients. May you find all the blessings you wish for in the coming year!