AANA journal
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Increased public attention to the costs of healthcare in the United States has resulted in greater scrutiny of all aspects of the health industry, including the education of healthcare providers. Because Certified Registered Nurse Anesthetists will, as in the past, have a major role in healthcare delivery systems of the future, knowledge of the educational costs and resulting benefits of this advanced practice nurse is important. This is the first comprehensive study of the economic investment in nurse anesthesia education. ⋯ Data were then collected to estimate the costs and benefits to the four entities as they function within this prototypical program. The study concluded that all entities realize a net benefit from the investment by sponsorship or association with nurse anesthesia education, except the academic institution, which is a nonprofit institution and does not show a gain. Nurse anesthesia students show the highest internal rate of return on their investment, followed by others (primarily other taxpayers), and the clinical institution.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of the recovery times of desflurane and isoflurane in outpatient anesthesia.
The low solubility of desflurane has been shown to contribute to faster awakening from anesthesia when compared with other anesthetics in common use. However, research has failed to consistently demonstrate faster discharge times from the postanesthesia care unit following the use of desflurane. This study was undertaken to compare the recovery and discharge times of outpatients undergoing procedures greater than 2 hours in length. ⋯ The results demonstrated no differences between the emergence or discharge times following desflurane or isoflurane. In addition, measured parameters, such as intraoperative vital signs and postoperative emesis and opioid requirements, were not different between the groups. The use of desflurane as part of a balanced anesthetic technique did not speed the emergence or discharge time when compared with isoflurane.
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The goal of mechanical ventilation is to maintain adequate gas exchange by opening and stabilizing alveolar units with minimal detriment to the pulmonary and circulatory systems. The optimal ventilatory strategy may be difficult to achieve, especially in patients with respiratory failure. Total liquid ventilation is a process whereby a liquid perfluorocarbon (PFC) replaces both the functional residual capacity and the tidal volume within the lung. ⋯ In PLV, a functional residual capacity of PFC liquid is maintained in the lung, and the patient is ventilated with a conventional gas mechanical ventilator. Studies of the acute respiratory distress syndrome in animal models and in human series have demonstrated encouraging results using PLV and PFC. The high density, low surface tension, and other qualities of PFC in the setting of PLV may offer a highly innovative approach that can be directed toward the management of patients in respiratory failure.
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Comparative Study
The effect of epidural analgesia on the second stage of labor.
A retrospective review of 202 randomly selected records of parturient labors examined the relationship between cervical dilation at epidural analgesia administration and length of the second stage of labor. The epidural group received bupivacaine 0.11% or 0.125% with sufentanil 1 to 2 micrograms/mL using a Bard Patient Controlled Anesthesia II pump. Labor management and outcomes were compared with a nonepidural group who chose unmedicated childbirth, intravenous narcotics, or pudendal block. ⋯ The epidural group experienced a significantly longer mean length of the second stage. Labors in the epidural group were 3.5 times more likely to have oxytocin induction or augmentation and 4.5 times more likely to experience instrument-assisted delivery. There were no significant differences in Apgar scores between the two infant groups.