Journal of perianesthesia nursing : official journal of the American Society of PeriAnesthesia Nurses
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J. Perianesth. Nurs. · Feb 1997
ReviewUnexpected awareness and memory in the perianesthesia setting.
Unexpected awareness and memory with general anesthesia are phenomena that can occur in the intriguing interface between consciousness and unconsciousness. Studies suggest that, for some patients, cognitive processing remains active even during deep anesthesia; that is, an apparently unconscious patient still may be registering information. ⋯ Post-traumatic stress disorder as well as medical malpractice litigation may result from awareness or memory during anesthesia. Implications for the use of opioids, benzodiazepines, and muscle relaxants in the perianesthesia setting as well as nursing interventions addressing unexpected awareness or memory are discussed.
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The new ASPAN Standards of PeriAnesthesia Nursing Practice, 1995 continue to recommend a minimum of two nurses in the PACU during phase I recovery. During the 1995 midyear meeting of the American Society of PeriAnesthesia Nurses, a position paper was passed in support of two nurses in the PACU during phase I recovery. Throughout the country, on some occasions, nurses continue to work alone in the PACU. This article suggests strategies for planning safe and competent care while working alone in the PACU.
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A project is described in which a standard in the Post Anesthesia Care Unit (PACU) for managing patients with acute pain was implemented. The nurses' documentation and their perceptions concerning pain management were assessed. ⋯ The pre-audit of PACU nursing documents showed that the assessment of pain was noted in terms of presence or absence but not quantified by the use of a measurement standard. After the implementation of a pain standard, results of the post-questionnaires showed changes in behaviors, attitudes, and knowledge that showed significant increases in the use of a numerical or visual pain tool, and an increase in documented evaluation of pain.
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Whenever the human body is subjected to anesthesia and an invasive surgical procedure, the potential for complications exists. A goal of perioperative care is to minimize that risk while providing the safest care available for the patient. ⋯ The evaluative process must be cost-effective and efficient without compromising reliability. This article familiarizes and updates the perianesthesia nurse on management issues for the surgical patient.
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Plasma cholinesterase (PCE) is an enzyme necessary for the metabolism of certain anesthetic-related medications. Individuals with abnormal cholinesterase activity (e.g., insufficient quantity of functional PCE or atypical PCE genotypes) may exhibit a prolonged paralytic response to the muscle relaxants succinylcholine and mivacurium. A review of perianesthesia nursing considerations and treatment modalities relating to patients presenting with this interesting clinical picture will be offered.