AANA journal
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Despite great strides during the preceding 3 decades, the ability to consistently eliminate postoperative nausea and vomiting (PONV) continues to elude anesthesia practitioners. The occurrence of PONV related to anesthesia and surgery prolongs hospital stays and increases healthcare costs. Protracted recovery times place constraints on patients, healthcare systems, and healthcare financiers. ⋯ Eastern culture, on the other hand, relies heavily on naturopathic remedies whose successful use has spanned thousands of years. Increasing attention has been given to the potential benefits of nonpharmacological intervention for the prevention of PONV in association with anesthesia care. Therefore, the purpose of this AANA Journal course will be to focus attention on what is known and what is unknown in the literature regarding use of the nonallopathic remedy of acupressure as a nonpharmacological alternative to commonly utilized antiemetic prophylaxis.
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The alpha2-agonist dexmedetomidine is indicated for sedation of patients receiving mechanical ventilation in the intensive care unit. It has additional off-label uses for coadministration with local, regional, and general anesthesia. This report describes the use of dexmedetomidine as a sole sedating agent in conjunction with local anesthesia for major vascular surgery. ⋯ Dexmedetomidine should be used judiciously, and understanding the potential adverse effects and how to treat them is of paramount importance. However, with vigilant intraoperative monitoring of blood pressure, heart rate, and level of consciousness, it can be administered safely, thus lessening the anesthetic requirements and possibly improving the surgical outcome of the high-risk patient. This report describes the indications, dosing, off-label uses, pharmacodynamics, pharmacokinetics, and common adverse effects of dexmedetomidine.
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This study explored Certified Registered Nurse Anesthetists' (CRNAs') knowledge about 8 common herbal supplements that potentially cause perioperative complications, beliefs regarding herbal supplement-anesthesia interactions, and preoperative assessment practices. A multiple-choice descriptive survey was mailed to a random sample of CRNAs from the American Association of Nurse Anesthetists (AANA). Although response was low (19%, N = 191), respondent demographics corresponded to AANA 2002 CRNA membership. ⋯ Most CRNAs (93%) wanted more educational opportunities on anesthesia and herbal supplements. The low knowledge scores and lack of confidence in familiarity with herbal supplement-anesthesia interactions highlight the need for further CRNA education. Nurse anesthesia educational curricula and continuing education programs should be reviewed and updated to ensure adequate instruction on herbal supplements.