Did you realize that 20% of Americans still smoke? That is an amazing number considering that cigarette smoke has some 6000 identifiable constituents! Some of the constituents include: ammonia, arsenic, benzene, formaldehyde, toluene, and vinyl chloride. I don’t know about you, but that sounds appetizing! But what does this mean for the anesthetist working in the clinical setting? For starters, smoking increases the likeliness of an irritable airway and a greater potential for hypoxia. There are a few steps you can take to try and mitigate the effects smoking can bring to the table. A thorough pulmonary examination is a great start. Listen to the lungs and ask if there is a history of wheezing, coughing, and expectoration. Observe their passive breathing and note if there is clubbing of the nails. Are they short of breath just sitting in the pre-op area? This can be an indication of pulmonary disease and prompt the need for further evaluation. As a side note, if they have pulmonary disease it is very likely that they cardio-vascular disease as well. While doing your H&P, don’t hesitate to focus on this area as well. Next, take a look at the medications they are on. If they use inhalers, ask them about the last time they used them and how frequently they use them. This is another good indicator for potential problems during the procedure. Have them use their inhaler before the procedure. It never hurts to have the airways as open as possible prior to a procedure. Chuck Biddle, CRNA, has a great list of considerations for the smoker that include, abstinence for 24 hours if possible, bronchodilators, nicotine patch if possible, pre-oxygenate, and there may be a need for increased analgesia during the procedure. Also be aware that their FRC (functional residual capacity) may be diminished. This may lead to a state of hypoxia sooner than normally expected in a non-smoker. Be prepared! And finally, as anesthesia providers we have a unique opportunity to educate our patients about the deleterious effects of smoking. For a brief period of time the patient is a captive audience, don’t hesitate to seize this opportunity for education.
A recent article brought about some very important and simple symptoms that patients can use to evaluate their susceptibility to sleep apnea. In an article by Dr. Orly Avitzur M.D., she describes the need for medical evaluation of loud snoring. She stated up to 1 in 10 women and 1 in 4 men might have undiagnosed sleep apnea and the first symptom to look at is loud snoring . She further states that less than 15% know they have sleep apnea and most physicians don’t routinely inquire about it during office visits. Other symptoms that warrant further professional evaluation include, but are not limited to: High blood pressure Frequent morning headaches Day time drowsiness Frequent wake-ups Frequent morning sore throats Wake-ups with choking or gasping for breath Wake-ups in a sweat Overweight Loud snoring Sleep apnea increases a persons chance of high blood pressure , stroke and type 2 diabetes, but the most terrifying statistic Dr. Avitzur stated is there is an increased risk of death that is associated with having sleep apnea. Anesthesia providers especially need to be aware of any of the symptoms listed above prior to administration of any anesthetic, so please inform them before any surgery. Additional protocols may be implemented in the pre and post-op areas and drug regimes may be modified if the symptoms are present in a patient. Avoid anesthesia complications with sleep apnea by speaking with your physician. Check out this article on sleep apnea and same-day surgery for more information. As sleep apnea affects such a high number of people, we would appreciate any personal experiences with sleep apnea you could share on this blog.
The adverse events rate is low when Propofol is administered by a trained professional such as a CRNA. In a recent article published in Clinical Gastroenterology and Hepatology, a study was performed with patients undergoing a variety of endoscopic procedures with sedative dosing administered by a CRNA. This article stated, “… this is the first paper to report the frequency of airway modification associated with the use of propofol in endoscopy.” The article continued to highlight the importance and need for trained personnel, such as CRNA’s, to monitor patients during sedation with propofol. The conclusion by Sreenivasa Jonnalagadda M.D., the lead author of the article, confirmed ” … Highest-risk patients should be managed by nurse anesthetists trained in advanced airway interventions…” . For further reference and information please see the April 2010 Clinical Gastroenterology and Hepatology Journal.
The upcoming annual meeting of the American Association of Nurse Anesthetists (AANA) scheduled for Sunday, August 8, 2010 will focus on healthcare reform and its impact on nurse anesthesia practice. Healthcare expert, Gail Wilensky, PhD as the Keynote Speaker, will address the meeting in Seattle speaking about “Comparative Effectiveness Research: The Key to Healthcare Reform”. The healthcare reforms package recently announced by the government is expected to expand coverage for 32 million uninsured Americans by 2019. Health insurance is expected to be more affordable and the number of elective surgeries will grow. In light of this, AANA President James Walker, CRNA, DNP, considers Dr. Wilensky’s topic very timely for the nurse anesthetist community. The AANA has recently published its own cost-effectiveness analysis of nurse anesthesia practice. This year’s annual meeting will encourage an informed and analytical discussion about the new healthcare reforms and what changes they are likely to augur for anesthesiologists and the nurse anesthesia practice. At Steel City Anesthesia we play an active role in educating, informing and working together with the community of anesthesiologists. If you’d like to know more about any of our anesthesia services, contact us online. Do you have comments, questions or observations about healthcare reforms and anesthesia? We’d love to hear from you on our blog. Leave us your thoughts below.
We’re very excited to announce the launch of our new website located at www.SteelCityAnesthesia.com. We’ve been working very hard for the past couple of months to develop an online strategy that will benefit our employees, facilities, patients and future partners. Our new website and online scheduling system are a big piece of this and there is a lot we plan to add as we ramp up. You can also keep track of us on Twitter, Facebook, LinkedIn and YouTube. At Steel City Anesthesia, we provide high quality clinical anesthesia services to inpatients and outpatients in a variety of settings. We offer anesthesia outsourcing to surgery centers, hospitals and healthcare provider offices in Pennsylvania, Ohio and West Virginia. Our website offers information unique to each one of these segments to help them understand why outsourcing is the best choice for their anesthesia needs. The website also provides a method for patients to schedule their procedure online and learn more about anesthesia. Our online scheduling system, linked into the new site, is an internal tool we use to ensure our facilities are staffed appropriately and our anaesthetists have complete control over their work schedule. CRNAs and anesthetists can input their work requests, we then review and approve them to a facility. Facility managers have access to the system to see who is working at their location and when. The system has been a benefit to our employees as well as our facilities – and freed up some of our personal time as a side benefit 🙂 Our blog will contain topics related to the speciality of anesthesia. We are looking to post on a frequent basis, so stop back often to see what’s new. Or better yet, subscribe to our RSS feed . We’d love to keep in touch. If you’re interested in a specific topic that you’d like us to write a post on, please email us at firstname.lastname@example.org.