AANA journal
-
General anesthesia aims to eliminate patients' awareness of excruciating pain during surgery. Nevertheless, rare occurrences of patient awareness continue because the problem is not yet completely preventable. One study puts the incidence of awareness at 0.18% for patients receiving muscle relaxants and at 0.10% for patients not given relaxant drugs. ⋯ Several depth-of-anesthesia monitors are available, but there is no ideal monitor that is 100% reliable. This review provides an overview of literature that reports findings associated with the monitoring and occurrence of intraoperative awareness. These studies indicate assessment methods that can be trusted when we provide general anesthesia and what measures can be taken to prevent recall by patients under general anesthesia.
-
In the United States today, as many as one third of the population suffers from chronic pain conditions. These syndromes cost an estimated $80 billion and are a major source of burden to the healthcare system as well as to the suffering patients. According to a study by Harvard Medical School in 1997, visits to alternative medicine providers had reached 629 million, mostly for these pain conditions. ⋯ Many now believe that acupuncture should be considered a valuable asset in the specialty of pain, and that it can be of value in comprehensive pain clinics as well as physical therapy practice. Acupuncture is certainly not a cure-all; however, researchers and experienced clinicians both attest to its benefits. This article is a review of the literature with regard to acupuncture as a modality for pain management.
-
Uterine rupture is an unexpected, relatively uncommon occurrence in the general obstetric population, but it is a potentially devastating complication. Uterine rupture of the unscarred uterus is extremely rare. Awareness of the risk factors as well as the signs and symptoms of uterine rupture are essential for an early diagnosis and prompt treatment. ⋯ An hour after delivery the patient began complaining of syncope; at this time bleeding was greater than expected and the obstetrician decided a dilatation and curettage for retained placenta was necessary. A dilatation and curettage was negative, and an ultrasound of the abdomen revealed the presence of significant blood clots, laparotomy was performed, and uterine rupture was identified. The patient developed disseminated intravascular coagulation, uterine bleeding continued, and the patient ultimately required a hysterectomy.
-
Preeclampsia developed in this patient 4 days' postpartum. Visual changes, headache, and elevated blood pressures were present on arrival to the emergency department. Coincident with the preeclampsia was a postdural puncture headache complicating the diagnosis of late postpartum preeclampsia. ⋯ Blood pressures continued to increase, however, and late postpartum eclampsia developed. We conclude that symptoms of a postdural puncture headache can mimic those of postpartum preeclampsia. Early recognition and treatment of postpartum preeclampsia may decrease patient mortality and morbidity by preventing late postpartum eclampsia.
-
Anesthesia-associated nerve injury is a common cause of patient morbidity and litigation. To identify factors associated with perioperative nerve injuries and rationalize preventive strategies, 44 cases from the American Association of Nurse Anesthetists (AANA) Foundation Closed Malpractice Claims Database pertaining to nerve injuries in which nurse anesthetists provided care were analyzed. Emerging patterns and themes related to the development of injury were identified. ⋯ Documentation on the anesthesia record of the use of intraoperative protective padding and patient position was lacking or inadequate in a majority of the claims. Effective strategies for the prevention of nerve injury during anesthesia are reviewed. Abnormal body habitus, several disease states, anesthesia technique, improper positioning, lack of adequate padding, and tourniquet use have been implicated as risk factors.