AANA journal
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of 4 analgesic agents for venipuncture.
This study compared pain on application, pain on venipuncture, cost, and convenience of 4 analgesic agents used for venipuncture. A convenience sample of 280 preoperative subjects was assigned randomly to 1 of 4 groups. Group 1 received 2.5% lidocaine--2.5% prilocaine cream (LPC) topically, Group 2 received dichlorotetrafluoroethane spray (DCTF), Group 3 received 0.5% lidocaine subcutaneously, and group 4 received normal saline with 0.9% benzyl alcohol (BA) subcutaneously. ⋯ Lidocaine, DCTF, and BA were equally convenient to use, while LPC was the least convenient, (P < .05). Lidocaine had low pain on venipuncture and low cost and convenience of use, but it was less than ideal in terms of pain on application. The BA had all the qualities of an ideal analgesic agent for venipuncture in this sample and should be considered as an analgesic agent for venipuncture.
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The following is a case report of a patient who had an intravenous (i.v.) catheter inserted into her cephalic vein and thereafter sustained an injury to the superficial branch of the radial nerve. When an i.v. catheter penetrates a nerve, it can cause temporary or permanent damage. After sustaining an injury, a nerve will regenerate in an attempt to reconnect with the fibers it once innervated. ⋯ Third, if a patient complains of paresthesias or numbness near the i.v. site, remove the i.v. catheter immediately. Fourth, limit the amount of probing after inserting the catheter into the skin. Finally, if nerve damage is suspected from a peripheral i.v. cannulation, consult a hand specialist promptly.
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Some operating room (OR) managers face the dilemma whereby all cases in a surgical suite are not completed during a regularly scheduled (e.g., 8-hour) day. If the anesthesia group at the surgical suite plans for its employed anesthetists to work a fixed number of hours each day, then more than 1 shift of anesthetists may be needed to care for the patients in the ORs. ⋯ The method uses data from surgical services information systems or hospital information systems to compensate for seasonality or seasonal variation in the number of ORs running at different times of the day. We also consider application of our method to scheduling surgical nurses with multiple overlapping shifts throughout the day.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of Whitacre spinal needle orifice direction on the level of sensory blockade.
The purposes of the present study were to determine if the direction of the needle orifice during injection of anesthetic into the subarachnoid space, using a 25-gauge Whitacre spinal needle (Becton Dickinson, Franklin Lakes, NJ) to deliver 15 mg of 0.75% hyperbaric bupivacaine, affected the level of sensory blockade achieved, and if there was a difference in time from injection to surgical anesthesia based on needle orifice direction. A convenience sample was selected from patients presenting for elective surgical procedures. All patients received a standard anesthetic solution using a standard technique and duration of injection. ⋯ An incidental finding was that all failed blocks were from the caudad group. There was no statistically significant difference in time from injection to surgical anesthesia between the treatment groups. Although the data support no statistically significant difference between the treatment groups for either research question, the cephalad group provides for a more precise height of block.
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Anesthesia for the patient with a perforated globe can be complicated. Cognizance of the anatomy and physiology of the eye, including maintenance of intraocular pressure, is essential for the development of an anesthetic plan. ⋯ However, methods to achieve this end may place the patient at risk for aspiration. Various techniques that attempt to accomplish this goal are described, including the use of narcotics, lidocaine, nitroglycerin, alpha (alpha 2) agonism, beta (beta) adrenergic and calcium channel blockades, plus the laryngeal mask airway.