AANA journal
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Dislocation of the mandible is a possible complication of direct tracheal laryngoscopy. The temporomandibular joint (TMJ) is unique in that any movement of the bone always causes movement in both joints simultaneously. The entire TMJ is surrounded by a ligamentous capsule and is stabilized by 3 ligaments. ⋯ If mandibular dislocation should occur, prompt recognition and treatment of the dislocation is recommended. There are steps, used by dentists, which can be employed by the nurse anesthetist to relocate the mandible. The technique for intraoral bimanual relocation of the mandible is described.
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Intraoperative fluid management for the pediatric surgical patient is a critical element of the anesthetic care plan. In contrast with adult patients, the fluid management is systematized by the use of established protocols that calculate fluid on a per kilogram basis. Children are relatively volume sensitive, and mismanagement of fluid and electrolytes can contribute to morbidity and mortality in infants and young children undergoing even the simplest procedures. ⋯ Inappropriate overhydration can result in pulmonary edema and respiratory problems that can prove fatal. Regardless of the fluid management plan, perioperative fluid management must be flexible and take into account the physiologic development and age of the pediatric patient. The goals of intraoperative fluid management are to restore intravascular volume, maintain cardiac output, and, ultimately, ensure provision of oxygen to the tissues.
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Comparative Study
Preanesthesia detection of equipment faults by anesthesia providers at an academic hospital: comparison of standard practice and a new electronic checklist.
We hypothesized that our institutional standard practice for preanesthesia equipment checkout, based in part on US Food and Drug Administration recommendations, failed to detect a significant number of faults (absent or nonfunctional equipment). We designed a new, computer-based, highly interactive electronic checklist that emulated the checklist methods used in aviation and military settings and compared it to our standard practice in the detection of faulty equipment. Using a randomized, cross-over design, anesthesia providers searched for prearranged faults over a 2-day period using both the electronic and standard approaches. ⋯ The electronic checklist was superior to standard practice in the detection of "easy" and "difficult" equipment faults. However, even when the electronic checklist was used, a high proportion of difficult faults were missed. Whether the failure represents a need for improved checkout procedures and provider training or better equipment design will require further study.