Anesthesia concerns for children with tuberous sclerosis.

Tuberous sclerosis (TS) is a relatively rare, autosomal dominant syndrome that displays high genetic penetrance in affected families. It is identified by a classic triad of symptoms including epilepsy, skin lesions, and mental retardation. Tuberous sclerosis causes hamartomas in multiple organ systems, including the brain, skin, heart, kidneys, lungs, and liver. Awareness of the signs and symptoms and the organs involved is critical to provide safe and effective anesthesia care. We describe a 10-year-old girl with TS scheduled to receive a general anesthetic for laser treatment of facial angiofibromas. The patient had several coexisting maladies from TS, including hypertension, autism, seizure disorder, cardiac rhabdomyomas, developmental delay, and bilateral polycystic renal disease. The laser procedure was performed, and there were no surgical or anesthetic complications. However, the potential for complications due to TS remained high throughout the provision of anesthesia care. Increased knowledge of TS and diligence in anesthesia practice can greatly reduce these risks.

Nurse anesthesia students with disabilities: a legal and academic review of potential professional standards.

Establishing suitable and proper program admission criteria that protect both the rights of disabled applicants and professional needs to educate competent practitioners concern every nurse anesthesia educational program. Disabled Americans must be legally protected while ensuring that future nurse anesthetists meet expectations for professional competency To balance these demands, academic programs must establish criteria that define qualifying standards for practice. Such criteria serve the important function of providing notice to prospective applicants, as well as to established practitioners, about minimum professional competencies and behaviors. This paper, based on a presentation, "Special Needs Students--an Attorney's Perspective," to program faculty of the American Association of Nurse Anesthetists in Ft Lauderdale, Fla, in February 2005, posits specific language to aid in defining admission criteria that are both inclusive and exclusionary. It seeks to stimulate debate about developing some professional consensus on a matter of continuing importance.

Economics and the education of nurse anesthetists: Part 2.

Economic assumptions and other factors affecting the economics of nurse anesthesia education are presented in Part 2 of this 2-part column. In Part 1, published in the October 2004 issue of the AANA Journal, general economic principles and healthcare economic principles in particular were described, explained, and related to the current US healthcare system.