The Nursing clinics of North America
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Advances in many aspects of pediatric anesthesia have resulted in a significant reduction in morbidity and mortality in children. Research and development have created vast improvements in pharmacology. ⋯ Recognition of the psychological needs of children of all ages likely has reduced the incidence of lasting psychological effects after hospitalization. Finally, these important advances have made pediatric anesthesia a safer and more compassionate specialty.
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Extracorporeal membrane oxygenation (ECMO) is prolonged cardiopulmonary bypass used to treat critically ill patients with severe but reversible cardiac and/or respiratory failure. The severity of their symptoms, the rapid deterioration in their conditions, the difficulty in mechanical transportation, and the risks of traveling with an ECMO circuit often prohibit cannulation in an operating room. Cannulation for and decannulation after ECMO therapy can be safely accomplished in the intensive care unit by utilizing experienced perioperative nurses.
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General anesthesia is a state of reversible, descending depression of the central nervous system that is induced by inhalational or intravenous drugs. Components of general anesthesia include hypnosis, analgesia, amnesia, and muscle relaxation. Recognized anesthesia providers include CRNAs and anesthesiologists. Improvements in pharmacologic agents, technology, and education of providers have sharply reduced morbidity and mortality associated with anesthesia.
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The ultimate goal of preanesthetic evaluation and preparation of the patient is reduction of morbidity and mortality of surgery and anesthesia. Using advanced practice nursing skills of therapeutic communication, physical assessment, and attainment of a health history, the CRNA plans and implements the safest possible plan of anesthetic care.
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Regional techniques have become increasingly popular for anesthesia and analgesia for surgical patients. It is also frequently used for the patient with nonsurgical pain such as cancer. New discoveries in physiology, pharmacology, pain modulation and transmission as well as pain management therapies are a dynamic field of study in regional anesthesia and analgesia. Nurse-anesthetists provide regional techniques as part of their armamentarium of clinical skills.