A Novel Mechanistic Model for Future Research in the Elements of the ERAS Program in Patients With Sickle Cell Disease.

Enhanced recovery after surgery (ERAS) is a patient-centered, evidence-based, multidisciplinary team-developed approach to a surgical stress response that is implemented to optimize physiological function and facilitate recovery for the best possible outcomes from surgery. Although there are currently well-known published guidelines for the perioperative management of patients with sickle cell disease, there are currently no specific and evidencebased ERAS protocols that address the needs of these patients. A novel mechanistic model has recently been found that could change ERAS protocols for patients with sickle cell disease with regard to a current preoperative carbohydrate loading drink recommendation, nutrition and intravenous fluid management. ERAS has great benefits for most patient populations, but emerging research suggests that patients with sickle cell disease may process and respond differently to varying concentrations of serum glucose and serum cations (hyperglycemia and hypertonic states). This adverse response involves actin, a cytoskeletal protein, in the red blood cell and how increased hemoglobin glycosylation may lead to a malfunction in this protein and a transition to vaso-occlusive crises in patients with sickle cell disease. Further research is warranted with this new mechanistic model to develop more meticulous and customized perioperative management plans to address risk mitigation in patients with sickle cell disease.

Perioperative Pain Management Strategies in the Age of an Opioid Epidemic.

According to the US Department of Health and Human Services 2016 and 2017 data, an estimated 130 people per day died from opioid-related drug overdoses; 42,249 people died from overdosing on opioids; and 2.1 million people had opioid-use disorder. Health care organizations such as the American Association of Nurse Anesthetists, the Association of periOperative Registered Nurses, the American Society of PeriAnesthesia Nurses, the American Society of Anesthesiologists, the American College of Surgeons, and the American Medical Association have information related to pain management and/or the opioid epidemic on their Web sites. It is imperative for health care providers to be cognizant of, and use low-dose opioid/opioid-free pain management therapies. This article reviews the pain process and outlines low-dose opioid/opioid-free pain management modalities.

Novel hydration and nutritional strategies for sickle cell disease.

Introduction: Sickle cell disease and sickle cell trait affect over 300 million people worldwide. Vaso-occlusive crises (VOCs) are the most common reason that these patients seek medical care. Objectives: Recently, a newly identified "trigger" (involving glucose and electrolytes) for a mechanism of abnormal actin polymerization may offer further understanding with regard to the sequence of events that cascade to complications such as VOCs in those with sickle cell disease (SCD) and as well as those with sickle cell trait. Methods: A literature review to identify the current standard of care guidelines for hydration and nutritional strategies during VOCs in patients with SCD and sickle cell trait was conducted in PubMed, OVID, and Google Scholar. Results: This review suggested that current rationales for hydration and nutritional strategies for these patients during periods of crisis are generally based on consensus and have remained largely undefined to date. Conclusion: This new trigger, along with this literature review, suggests investigations related to serum glucose and cation (electrolyte) levels may help define novel strategies for the development of protocols/standard of care with regard to intravenous and oral hydration/nutritional guidelines in these patients during both clinical and perioperative management periods.

How One Nurse Changed a Country: The Faithful Journey of Sister Margaret Kollmer.

How can one nurse change the world? This descriptive case study examines the remarkable career of Margaret Kollmer, a nurse and Mary-knoll Sister who developed Korea's first Certified Registered Nurse Anesthetist training program and organized the Korean Association of Nurse Anesthetists. Later, she joined a team serving displaced Korean families and helped establish the first hospice program in Korea, as well as a resident hospice program for homeless AIDS patients in New York. Her 59 years of service shows what faithful reliance on God can accomplish.

Cost effectiveness of preoperative screening for healthy patients undergoing robotic hysterectomy.

The objective of this study was to determine whether routine preoperative type and screen blood testing is cost effective and medically warranted for benign diagnosis in healthy patients undergoing robotic hysterectomy. The study was designed as a cross sectional retrospective descriptive study. Four hundred and twenty two medical records of American Society of Anesthesiologists (ASA) Classifications I and II patients undergoing robotically-assisted laparoscopic hysterectomy between 1 June 2011 and 31 May 2014 at a 211 bed regional medical center were analysed. The results from this study paralleled the findings of other published research. Preoperative type and screen testing was performed on 249 (59%) of the patients in the study. Ten patients (2.4% of the group) converted to open laparotomy. Mean estimated blood loss was 59.59ml. No perioperative transfusions were required. The results indicate that preoperative type and screen testing is not warranted for patients meeting the inclusion criteria.

The Future of Certified Registered Nurse Anesthetist Practice in South Korea: Fading Into the Sunset or Breaking of a New Dawn?

The purpose of this study is to describe the practice of nurse anesthesia in the Republic of Korea and to identify trends, policy, and other factors that affect Certified Registered Nurse Anesthetists (CRNAs) as a profession. The authors conducted a descriptive study using a cross-sectional online survey of members of the Korean Association of Nurse Anesthetists. The data were collected between July 1 and September 15, 2015. A total of 267 surveys were analyzed. Descriptive and nonparametric analysis of data was used to determine differences in practice and job satisfaction related to level of preparation. There were statistically significant differences in work satisfaction between CRNAs and anesthesia registered nurses (ARNs) and statistically significant differences in components of practice between CRNA and ARN respondents. The practices of CRNAs and ARNs in South Korea demonstrate important differences that are likely the result of different levels of education, clinical training, and autonomy. The authors also note that the current CRNA workforce is aging, and many CRNAs plan to retire within the next 10 years. Because only one university produces 10 or fewer CRNAs annually, the profession will experience major attrition in the future.