AANA journal
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An increasing number of surgical patients preoperatively are taking anticoagulant medications. These patients are at an increased risk for development of epidural hematoma with spinal or epidural anesthesia. It is the responsibility of the anesthesia provider to understand and anticipate this risk and to alter the anesthetic plan accordingly. ⋯ Antiplatelet drugs, oral anticoagulants, heparin, low-molecular-weight heparin, other new anticoagulants, and herbal medications are reviewed. When spinal or epidural anesthesia is considered for a patient who has been taking anticoagulant medications, the risk of epidural hematoma vs the benefits of regional anesthesia must be weighed carefully. Appropriate management of the patient extends well into the postoperative period and should include anesthesia providers, attending physicians, and nurses.
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The purpose of this study was to systematically review the instruments used to obtain anesthesia-specific patient satisfaction data and to determine the degree to which each instrument controlled for measurement error bias, such as poor survey design. By using an assessment and evaluation tool developed for the present study that held proven internal reliability and construct validity, we analyzed and scored each instrument according to the presence or absence of measurement error in survey design. ⋯ One instrument, the Iowa Satisfaction With Anesthesia Scale (ISAS), developed by Dexter et al (1997), was the first found to inculcate scientifically accepted psychometric item construction algorithms, an indicator of measurement reliability. Although the ISAS holds substantial potential for future application in this realm, we recommend that it be refined further and that the search for a superlative instrument to obtain anesthesia-specific patient satisfaction continue.