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Unstructured, verbal, obstetrical anesthesia handovers have led to omission of critical information, which can harm patients or delay care. The SAFE Handover Tool is a standardized mnemonic: Sick patients, At-risk patients, Follow-ups, and Epidurals. Use of the tool during handover significantly increases the percentage of relevant parturients that are discussed and improves provider communication. This study implemented the SAFE Handover Tool for Certified Registered Nurse Anesthetists (CRNAs) in a Level III (Subspecialty) Maternal Care unit. A mixed methodology was used to operationalize handover quality. Descriptive, statistical, and content analyses showed significant improvements between PRE- and POST-implementation assessments of handover quality after using the SAFE Handover Tool. The SAFE Handover Tool improved the quality of CRNA communication and enabled situational awareness. A modified SAFE Handover Tool was subsequently integrated into the obstetrical anesthesia electronic charting system. The SAFE Handover Tool is a novel, low-cost, sustainable method to improve CRNA handovers and patient safety., Competing Interests: Name: Mark H. Gabot, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Carrie D. Hintz, DNP, RN, CEN Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Name: Sass Elisha, EdD, CRNA, FAAN, FAANA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. This article was funded in part by a research grant from Sigma Theta Tau International, Nu Iota Chapter. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Venous thromboembolism (VTE) is a serious pathophysiologic condition that is a major cause of morbidity and mortality, especially during the perioperative period. A collective term, VTE is used to describe a blood clot that develops inside the vasculature and results in a deep vein thrombosis (DVT) and/or a pulmonary embolism (PE). Deep vein thrombosis and PE are the third leading cause of cardiovascular mortality, superseded only by myocardial infarction and stroke. Patients who receive treatment for acute PE are 4 times more likely to die of a recurrent VTE within the next year. In hospitalized patients who have had surgery, the incidence of VTE and PE is estimated to be 100 times more prevalent than in the general population. The Joint Commission has established Surgical Care Improvement Project measures to address prophylactic interventions to minimize the incidence of VTE. This journal course will review the current approaches to pharmacologic and nonpharmacologic prevention and management of VTE during the perioperative period. Identification and treatment of deep vein thrombosis and acute PE are also described.

The incidence of angiopathology involving the aorta and microvasculature is expected to become more prevalent because of increased life expectancy and incidence of obesity. With the advent of endovascular aortic repair (EVAR), patients who were not considered surgical candidates for abdominal aortic aneurysmectomy because of their tenuous physical status can undergo corrective treatment and return to their activities of daily living. Because of the limited invasiveness of the procedure, it is unnecessary to cross-clamp the aorta, which minimizes hemodynamic variability and release of inflammatory mediators. As a result, the rate of myocardial ischemia, acute kidney injury, mesenteric ischemia, and blood loss is decreased. However, there are serious complications that can occur with EVAR, which include cerebral and myocardial ischemia, rapid massive hemorrhage, damage to access vessels, and endoleak. Presently, the most common anesthetic technique provided to patients undergoing EVAR is local anesthesia and monitored anesthetic care. A thorough understanding of the surgical procedure, perioperative process, and anesthetic considerations is vital to provide comprehensive care.

As the population ages, the number of patients in whom lung disease develops and who require surgical intervention will continue to rise. When compared with open thoracotomy, video-assisted thoracoscopic surgery (VATS) offers patients significant advantages. Decreased invasiveness results in less blood loss, a lower rate of infection, and less postoperative pain and allows for quicker recovery. A description of the significant physiologic changes related to pulmonary blood flow, ventilation, and perfusion when patients are placed in the lateral decubitus position is included. A common method of providing one-lung ventilation during VATS is via a double-lumen endotracheal tube. Proper use, placement, ventilation strategies, and methods to minimize the incidence and treat hypoxia for a double-lumen tube are reviewed. One-lung ventilation poses significant challenges for anesthetists. As a result, adequate preparation during the preoperative, intraoperative, and postoperative phases is essential.