AANA journal
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of axillary block techniques: is there a difference in success rates?
This study compared the success rates between two accepted methods of performing axillary blocks, the peripheral nerve stimulator (PNS) and the transarterial (TA) techniques. Success was based on blocking the nerves involved in the surgery. Following institutional review board approval and informed consent, 57 patients between the ages of 18 and 86 years of age scheduled for elective upper extremity surgery were studied. ⋯ There were no significant side effects reported by the patients postoperatively. The axillary nerve was the only nerve with an increased success rate using the TA technique. This indicates that both techniques are equally acceptable.
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Comparative Study
Recovery times from subarachnoid blocks using bupivacaine hydrochloride and tetracaine hydrochloride with and without epinephrine.
This retrospective study examined the length of time patients spent in the postanesthesia care unit (PACU) recovering from a subarachnoid block with either bupivacaine hydrochloride or tetracaine hydrochloride with and without epinephrine after total knee replacement surgery or total hip replacement surgery. One hundred subjects' charts were reviewed with 50 subjects receiving a subarachnoid block with bupivacaine (25 had epinephrine added to the bupivacaine) and 50 subjects receiving a subarachnoid block with tetracaine (25 had epinephrine added to the tetracaine). ⋯ Patient who received tetracaine stayed longer in the PACU (64.44 minutes) and took longer to bend their knees (73.17 minutes), flex their hips (99.65 minutes), and have return of sensation (68.88 minutes), compared to those who had received bupivacaine (P < .05). When epinephrine was added to the local anesthetic, it prolonged the time until the return of knee flexion, hip flexion, and sensation by 66.82, 87.65, and 76.77 minutes respectively (P < .05).
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Case Reports
Suspected malignant hyperthermia in a 13-month-old: today's "typical" episode--a case report.
A case of suspected malignant hyperthermia in a 13-month-old female, to whom succinylcholine was not administered, is presented. The patient presented for a repair of the right radial nerve under general anesthesia. Induction was accomplished with halothane, nitrous oxide, and oxygen. ⋯ Resolution of symptoms followed the administration of dantrolene sodium. The patient underwent an uneventful postoperative recovery and was discharged home. It was felt that the patient was too young to undergo a muscle biopsy for a caffeine-halothane stimulation test.
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Anesthesia providers must take appropriate precautions to reduce the potential for transmission of infectious agents to the patients under their care. The devastating spread of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) over the past decade has resulted in the development of specific guidelines for the cleaning, disinfection, sterilization, and handling of medical equipment and instruments. Contamination of laryngoscope blades and handles with visible and occult blood frequently occurs during routine airway management. ⋯ The extent to which contaminated anesthesia equipment plays in nosocomial infection is difficult to determine. The presence of blood is an indicator of potential cross-infection, since biological fluids, such as blood and saliva, are known to transmit infectious diseases. This study confirms that more rigorous decontamination protocols must be instituted to ensure complete removal of blood prior to sterilization, since laryngoscope blades and handles have irregular surfaces with repositories for infectious material.