AANA journal
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Research in anesthesia risk management has focused primarily on adverse patient outcomes. Most risk management studies have evaluated the practices of the physician anesthesiologist, while minimal research has been conducted to examine anesthesia care provided by Certified Registered Nurse Anesthetists (CRNAs). For this reason, the American Association of Nurse Anesthetists Foundation supported an examination of closed malpractice claim files from St Paul Fire and Marine Insurance Company that involved insured CRNAs. ⋯ The results indicated that preoperative physical status, patient age, surgical procedure, type of anesthetic, age of anesthesia provider, and the type of anesthesia providers, (e.g., CRNA alone vs CRNA and anesthesiologist working together) did not have a statistically significant relationship with adverse anesthetic outcomes. However, providing appropriate care, being vigilant, encountering a less severe adverse outcome, and not being able to prevent the outcome were associated with smaller monetary awards. The findings of this study support those of similar studies.
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Comparative Study
Mode of delivery following labor epidural analgesia: influence of ropivacaine and bupivacaine.
Epidural analgesia is a popular and effective method for pain relief during labor. Bupivacaine is a commonly used local anesthetic for labor epidural analgesia. Ropivacaine is an amino acid local anesthetic that is structurally related to bupivacaine with a similar potency and duration, but ropivacaine has less cardiac toxicity than bupivacaine and produces less motor blockade. ⋯ The instrumental delivery rate was 14.2% for the bupivacaine group and 9.8% for the ropivacaine group. The cesarean section rate was 14% for the bupivacaine group and 10.2% for the ropivacaine group. At our facility, the use of ropivacaine decreased both cesarean section and instrumental delivery rates when compared with bupivacaine in the population studied.
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The purpose of this study was to identify the use of rapid-sequence induction (RSI) and its hybrids. For the study, 67 Certified Registered Nurse Anesthetists at 1 hospital completed a survey describing their experience using a modified technique for patients with a moderately increased risk of regurgitation and aspiration. Patient selection criteria and the use of aspiration prophylaxis, preoxygenation, cricoid pressure, and positive-pressure ventilation were evaluated. ⋯ The survey revealed that a modification of standard RSI is used commonly in clinical practice. These modified RSI techniques are not standardized, as variation was noted in the delivery of positive pressure ventilation. Further study is necessary to identify widespread use of modified RSI techniques and to clarify the risks and benefits of modified RSI.