Dexmedetomidine as a sole sedating agent with local anesthesia in a high risk patient for axillofemoral bypass graft.
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Anesthetics, Local↗
Biomedical subjects
Michael J Kremer
Publications and source records attributed to Michael J Kremer.
AANA journal course. Update for nurse anesthetists. Parkinson disease.
In this Journal course, the manifestations, etiologic and pathophysiologic factors, and incidence of Parkinson disease are reviewed along with current medical management. Medications and other factors that have an impact on the course of Parkinson disease are discussed. Suggested preanesthetic, intraoperative, and postoperative interventions are provided.
Anesthesia↗
Collaborative practice in advanced practice nursing in acute care.
APN in the United States encompasses a variety of collaborative models of care. Collaborative relationships with other disciplines such as medicine, pharmacy, social service, and physical, respiratory, and occupational therapy are an important component of the APN role. The collaborative relationship of the APN and physician is a unique one for providing optimal patient and family care. As changes in healthcare in acute care settings continue to occur, additional collaborative models for APN and physician care will only continue to help in meeting the healthcare needs of patients.
Cooperative Behavior↗
A study of clinical decision making by certified registered nurse anesthetists.
Anesthesia outcomes and related risk factors have been studied for more than 100 years. Varying sample sizes and research methods have been used, with research findings that were open to multiple interpretations. Research with closed malpractice claims demonstrates that American Society of Anesthesiologists physical status II patients undergoing elective procedures are most likely to experience damaging events intraoperatively with resultant postoperative adverse outcomes. The process of care, including clinical decision making, contributes to adverse outcomes. Clinical decision making can be difficult to assess and measure. In this study, the cognitive psychology framework of information-processing theory and literature pertaining to the use of heuristics, or rules of thumb, and clinical biases, were used to analyze cases from the AANA Foundation closed malpractice claims database. This database contains more than 300 files involving St Paul Fire and Marine Insurance Company-covered CRNAs from across the United States. These files were analyzed by 10 CRNA investigators on the AANA Closed Claims research team. Variables such as inadequate preinduction activities, e.g., incomplete preanesthetic assessments, and use of cognitive biases and inaccurate probability estimation were associated with adverse outcomes in this research sample. Teaching of decision science in basic and continuing nurse anesthesia education is advocated.
Anesthetics↗
The perioperative implications of obstructive sleep apnea.
Patients with obstructive sleep apnea provide significant challenges to the perioperative team. This disorder is often undiagnosed and coexists with other disease processes such as hypertension, congestive heart failure, and cor pulmonale. The prevalence of obesity in American society suggests that an increasing number of patients with sleep apnea will present for surgery. During the perioperative period, life-threatening problems can occur during anesthetic induction and emergence. The pathophysiology of obstructive sleep apnea is reviewed here along with the anesthesia implications of this disease process. Members of the perioperative team need to be aware of the implications of sleep apnea so that surgical outcomes can be optimized.
Anesthesia↗