Do you have a story to share about yourself, a colleague or fellow CRNA professional? Is there something extraordinary within your job, mission work, or educational experience that you think would be valuable for your peers to learn and read about? If so, we would love to hear about it and feature it on our website! Contact us at NJANAcrna@gmail.com to submit your story and get more details!
**Here is our first story of one of our very own NJ CRNA's featured in the "CRNAs: The Future of Anesthesia Care Today" Campaign.
Tracy Castleman, CRNA, MS
It seemed like an ordinary case, but looks can be deceiving. The 60-year-old patient had been diagnosed in the early stages of prostate cancer, and his surgeon had determined that the best course of action was a robotic prostatectomy. The procedure, which can last from 2-6 hours, requires the patient to be placed in a steep Trendelenburg, a head-down/feet-up position where the patient lays on his back with his feet elevated at least 30-40 degrees higher than his head.
Upon reviewing the patient’s chart during the preoperative visit, Castleman noticed what no one else had: The patient’s left eye had been removed when he was 19 years old due to a degenerative disease that had threatened to spread to his healthy right eye. Moreover, the 20/800 vision in his right eye was fragile, which required him to apply four different eye drops daily to maintain use of that eye. Add a history of hypertension and the impending increase in eye pressure caused by the surgical position to the list of vision considerations, and it gave the 23-year CRNA veteran cause for concern.
Alarmed by these pre-existing conditions, Castleman used her knowledge of and experience with the possible effects of anesthesia and surgical positioning on the eyes to determine her next steps. She was well aware that when a patient is in the “head-down” position, the blood flow pressure changes to all of the organs, including the eyes. If the patient stayed in the “head-down” position for the length of time the surgery required, there was a very real possibility he could lose the sight in his right eye due to increased intraocular pressure.
Despite the surgical team’s desire to start the case on schedule, Castleman pulled the surgeon and the anesthesiologist aside and made her concerns known. As a result, the surgeon had a long discussion with the patient and his wife, which included a phone consultation with the patient’s ophthalmologist. After weighing the risks and benefits of alternative treatments for his prostate cancer, the patient accepted the possibility of permanent blindness and chose to go forward with the robotic prostatectomy. He was appreciative of the information and the time spent discussing his treatment options.
After six and a half hours of surgery, the results were successful and the patient’s eyesight was unaffected.
Tracy Castleman has been a practicing CRNA for 23 years. Tracy specializes in general and obstetric care.
* Story reprinted with permission from the AANA