Improving CRNAs' Confidence and Perceived Knowledge of Endosurgical Patients Who Use Marijuana: A Quality Improvement Project.

Although some researchers have reported health-related benefits of marijuana, others have reported adverse side effects in nearly every organ system. Patterns of marijuana use are evolving, as is researchers' understanding of marijuana use for healthcare. Despite these findings and developments, nurse anesthetists are inadequately educated about marijuana's perioperative effects on endosurgical patients. As a result, many nurse anesthetists lack confidence in and knowledge of the perioperative care of endosurgical patients under the influence of marijuana. This lack of confidence and knowledge limits the ability of nurse anesthetists to provide optimal care, threatens patient safety, and potentially impairs surgical outcomes. To improve the confidence and perceived knowledge of certified registered nurse anesthetists (CRNAs) regarding perioperative care of endosurgical patients who use marijuana, a quality improvement project was conducted in a metropolitan endosurgical center in California. After the project, participating CRNAs (N = 15) reported increased confidence (z = -0.982; P = .325, > .05) and significantly improved perceived knowledge (z = -3.04; P = .002, < .05) regarding care of patients who use marijuana. For endosurgical patients who used marijuana prior to their procedure, knowledgeable and confident anesthesia care for the side effects of marijuana substantially improved the quality of care, communication, and reduced cancellations.

Canine Cesarean Section: Emergency and Elective.

Canine Cesarean Section (CS) is primarily performed to increase survival of newborns and less commonly to save the life or reproductive future of the dam. Conducting proper ovulation timing to accurately predict the due date will allow a planned, elective CS as an excellent alternative to a high-risk natural whelping, and possible dystocia, for certain breeds and situations. Techniques for ovulation timing, anesthesia, and surgery tips are provided.

Multidisciplinary management of peripartum cardiomyopathy during repeat cesarean delivery: a case report.

Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 29-year-old African American woman, gravida 3, para 2, at 36 weeks' gestation had a history of cardiomyopathy, morbid obesity (body mass index > 70 kg/m2), uncontrolled hypertension, obstructive sleep apnea, and required a repeat cesarean delivery. The patient was admitted to the hospital several times throughout her pregnancy for congestive heart failure, pulmonary edema, and headaches. Two years previously the patient received a diagnosis of peripartum cardiomyopathy 3 weeks after the delivery of her second child. This case report illustrates the recognition of peripartum cardiomyopathy and the risks early in pregnancy. It also describes the appropriate medical management, including transesophageal echocardiography and the need for collaboration of multiple medical specialists before and during delivery to provide the best possible outcome for both mother and infant.

Prevalence of and reasons for preoperative tobacco use.

Smoking cigarettes has an impact on all aspects of the perioperative anesthetic. It is not known whether patients are typically educated regarding these effects. Eighty-one patients completed a questionnaire concerning smoking behavior in the 24 hours before surgery. Variables measured were smoking history, tobacco addiction, and preoperative education. Chi-square analysis was used. Of 81 participants, 66 (81%) smoked tobacco within 24 hours of surgery. Thirty-seven patients received no instructions to stop smoking, and only 2 patients abstained on their own. Of the 44 patients counseled not to smoke, 12 abstained from tobacco before operation. Thus, with counseling, the cessation rate was approximately 5 times greater (chi 2 = 7.0, P = .008). A second correlation was seen when the patients were informed about tobacco's risks related to anesthesia. The smoking rate decreased from 15% to 4%, a 4-fold decrease (chi 2 = 15.3, P = .0001). The results indicate patients who smoke are not routinely informed of the risks of tobacco use or the benefits of abstinence before surgery. Counseling has a positive impact on the patient's smoking behavior in the 24 hours preceding surgery. Anesthesia providers and surgeons have a renewed obligation to instruct patients not to smoke before surgery.