AANA journal
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In Phase I of this international study, we systematically identified, for the first time, that nurses were providing anesthesia services in more than 100 countries, which is about 60% of all member states of the World Health Organization. The purpose of Phase II reported here, was to describe nurse anesthesia practice, education, and regulation in those countries. Data were collected from 96 countries, in all world regions, and at four levels of development, then were analyzed for commonalties and differences. ⋯ Nurse anesthetists worldwide are making a significant contribution to health. These data can serve as a basis for future decisions about human, fiscal, and government resources required to make anesthesia services available to each country's population. They can also provide opportunity to identify educational requirements to assure the safety and well-being of patients worldwide requiring anesthesia services.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pediatric endotracheal tube selection: a comparison of age-based and height-based criteria.
Many methods are taught and used clinically to determine what size uncuffed endotracheal tube is required for the pediatric patient. The purpose of this study was to compare the effectiveness of two methods of selection used clinically: (1) the traditional age-based (AB) formula; (age in years +16) divided by 4, and (2) the method based on body length using the Broselow pediatric resuscitation tape. Following institutional review board approval, 174 patients were prospectively studied after informed consent was obtained. ⋯ Since the AB formula ([age in years +16] divided by 4) is reliable and easily applied, it appears acceptable for routine anesthesia cases in the pediatric population requiring endotracheal intubation. The AB formula ([age in years +18] divided by 4) should be used cautiously because of the high failure rate. In circumstances in which general information, such as age, is not available and endotracheal intubation is needed, the Broselow tape allows reliable endotracheal tube size identification and should be readily available.
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The lungs can be separated by use of either a double-lumen tube (DLT) or a bronchial blocker (BB). Correct positioning of DLTs and BBs is often the most important determinant as to whether thoracic surgery cases (in particular one-lung ventilation cases) and differential lung ventilation in the intensive care unit proceed smoothly. If the method of lung separation is correct, the operative nondependent lung will collapse completely and easily, the surgeon will be able to work efficiently without damaging the operative lung, and the nonoperative lung will be unobstructed and easy to ventilate. For both DLTs and BBs, the key to precise positioning is to visualize, with a fiberoptic bronchoscope, through the tracheal lumen, the occluding endobronchial cuff/balloon just below the tracheal carina.