AANA journal
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Randomized Controlled Trial Clinical Trial
To reuse your circuit: the HME debate.
Heat and moisture exchangers (HMEs) have been used for more than 30 years for heat and moisture retention during general anesthesia. Studies about bacteriostatic vs nonbacteriostatic HMEs (BHMEs/NHMEs) have been conducted to assess their role in preventing bacterial transmission to the anesthesia breathing circuit; none have been done on anesthetized patients in the operating room. The present study adds to existing knowledge about the HME's ability to prevent transmission of bacteria, with implications for cost reduction resulting from reuse of anesthesia breathing circuits among patients. ⋯ These results support not reusing breathing circuits. Of 53 participants in group 2, 28 had positive ETT cultures with 7 showing transmission to anesthesia breathing circuit. Of 46 participants in group 1, 28 had positive ETT cultures with 9 showing transmission to anesthesia breathing circuit.
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Pulmonary edema is a generalized descriptive term for the accumulation of fluid within the interstitium and/or the alveolar spaces of the lungs. This accumulation of fluid has a cause that may be termed cardiogenic or noncardiogenic. ⋯ Some occurrences of NCPE can be traced directly to the administration of anesthesia. For example, NCPE can result from upper airway obstruction or the administration of naloxone.
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Radiofrequency (RF) interstitial tissue ablation is a new, minimally invasive procedure for patients with liver cancer who are not candidates for conventional therapy. The percutaneous RF ablation therapy involves placing a needle electrode under ultrasound guidance into a selected portion of the tumor and heating the tissue between 90 degrees C and 100 degrees C. ⋯ The patient's ability to cooperate with regard to breathing is critical for accurate needle placement. Intravenous sedation must be meticulously titrated to maintain a delicate balance of patient cooperation and optimal comfort.
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The provision of epidural analgesia for postoperative pain control offers many patient benefits and has become commonplace on many nursing units. Since nurses are responsible for the day-to-day management of patients receiving epidural analgesia, their knowledge, attitudes, and practices regarding this technique are pivotal to its success. Therefore, the purpose of the present descriptive study was to examine the knowledge base, attitudes, and clinical practice of registered nurses (N = 85) regarding postoperative epidural analgesia as managed by an acute pain service (APS). ⋯ Correct management of patients receiving epidural analgesia was being practiced by 77% of nurses. The satisfaction with the APS at this facility was 32% "very satisfied" and 62% "somewhat satisfied." The demographic characteristics that best predicted a higher score on the knowledge portion of the survey were greater years of practice as a nurse and receipt of pain education in nursing training. Nurses who had received inservice education about epidural analgesia rated a "good" self-knowledge of epidurals more often (40%) than those who did not (10%) and scored significantly higher on the knowledge portion of the survey.
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Case Reports
Epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report.
Arthroscopic shoulder surgery performed on a healthy female could have resulted in a fatal outcome when the epinephrine present in the arthroscopic irrigating solution contributed to the onset of ventricular tachycardia requiring defibrillation during surgery. During this procedure, the shoulder was infiltrated with 30 mL of a 1:100,000 solution of epinephrine into the subacromial space and glenhumeral joint. Subsequently, instrumentation of the glenhumeral joint by the orthopedic surgeon with a standard arthroscopy trocar resulted in a 0.5-cm size lesion to the posterior humeral cortex. ⋯ A diagnosis of epinephrine-induced ventricular tachycardia was made. The arthroscopic irrigating solution was immediately discontinued and lidocaine, 100 mg intravenously, was administered; however, the patient's cardiac rhythm degenerated into a sustained ventricular tachycardia that was unresponsive to pharmacologic intervention. A full code was called; the surgeon, anesthesia team, and operating room personnel succesfully provided advanced cardiac life support and cardioverted the patient back into a sinus rhythm with no untoward effects.