AANA journal
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effects of propofol versus thiopental induction on postoperative outcomes following surgical procedures longer than 2 hours.
The use of propofol as an induction agent for surgeries lasting less than 2 hours has been shown to result in a faster emergence from anesthesia. Our study was performed to analyze the impact of propofol on surgical procedures lasting longer than 2 hours. A convenience sample of 84 men and women undergoing nonemergency laparoscopic procedures scheduled for longer than 2 hours were enrolled in this prospective study and randomly assigned to receive a standardized induction with thiopental or propofol. ⋯ No differences were found between the propofol and thiopental groups in demographics, total surgical time, anesthesia time, recovery times, postoperative analgesic and emetic requirements, satisfaction scores, or incidence of nausea and vomiting. Discharge times from the postanesthesia care unit and to home were similar between groups. Based on the results, we concluded that propofol offered no advantages over thiopental in postoperative outcomes in laparoscopic surgical procedures longer than 2 hours.
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Case Reports
Management of postoperative pain after T6 corpectomy: use of epidural bupivacaine and sufentanil--a case report.
The objective of this case report is to discuss the successful postoperative analgesic management in a patient who had disseminated rectal cancer pain and failed to obtain pain relief despite high-dose intravenous hydromorphone. A 45-year-old male had metastatic rectal cancer involving multiple vertebrae. After a T6 corpectomy, the patient failed to obtain effective pain relief with massive doses of parenteral opioids. ⋯ Epidural sufentanil was used to obtain adequate pain control. Postoperative epidural analgesia is a technique worthy of consideration for patients with extreme opioid dependency for corpectomy. Epidural sufentanil can successfully be administered for postoperative pain control for patients receiving a large dose of opioids for cancer pain.
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In this Journal course, the manifestations, etiologic and pathophysiologic factors, and incidence of Parkinson disease are reviewed along with current medical management. Medications and other factors that have an impact on the course of Parkinson disease are discussed. Suggested preanesthetic, intraoperative, and postoperative interventions are provided.
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Review Comparative Study
Transesophageal echocardiography as an alternative for the assessment of the trauma and critical care patient.
Transesophageal echocardiography was first described and used to monitor cardiac function in 1976. Initially adopted by cardiac anesthesiologists and cardiologists, it has gained acceptance as an important diagnostic tool in the monitoring and assessment of cardiac status in the critically ill and trauma patient population. ⋯ In addition, transesophageal echocardiography affords the practitioner reliable cardiac filling volumes based on direct left ventricular assessment compared to pressure data that are based on indirect right ventricular and pulmonary occlusive pressures. In a healthcare environment that seeks optimum patient assessment while requiring an approach that encourages cost-effective, noninvasive, and minimal patient risk, those nurse anesthetists who work in institutions that have transesophageal echocardiographic capabilities should learn this newer technology and begin to incorporate it into their practice.
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Multicenter Study
The role of the nurse anesthetist in the planning of postoperative pain management.
Adequate pain relief after surgery is essential for avoiding pain-associated stress and patient comfort in the postoperative period. The Swedish nurse anesthetist has an important role in the intraoperative management of the surgical patient by assessing and moderating individual physiological response evoked by surgical stimuli during general anesthesia. The extent to which knowledge of specific individual response patterns are used to plan postoperative pain management is unknown. ⋯ Nurse anesthetists (N = 101) at 4 academic hospitals in Sweden responded to a questionnaire focusing, in addition to demographic data, on intraoperative routines for postoperative pain management, perceived clinical relevance of used routines, personal involvement (in addition to existing routines) in postoperative pain management, factors influencing pain alleviation requirements, and the potential role of the nurse anesthetist for improved postoperative pain management. We found that type of anesthesia and type of surgical procedure were both factors considered important for postoperative pain management. A majority of the participants believed that pain management approaches were not appropriately individualized to the patient.