AANA journal
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Randomized Controlled Trial Comparative Study Clinical Trial
The effect of Pencan needle orientation on spinal anesthesia outcomes.
Slow resolution of block and incidence of side effects deter many practitioners from choosing spinal anesthesia for out-patient surgical procedures. Some studies suggest that controlling bevel or side port orientation of a spinal needle during anesthetic injection can affect occurrence of side effects and time to block resolution. The objective of this study was to determine the effects of varying Pencan spinal needle (B-Braun, Bethlehem, Pa) side port orientations on duration of block and incidence of side effects in groups of patients receiving spinal anesthesia. ⋯ Differences were noted in time to discharge from the hospital (P = .027) and time to first voiding (P = .023) in the lateral compared with the cephalad and caudad orientation groups. Patients in whom the lateral needle side port orientation was used for injection were discharged earlier and had fewer side effects. This could translate into significant savings, financially and in terms of staff requirements.
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Patients with Down syndrome, or trisomy 21, present a unique set of anesthetic considerations to anesthesia providers. Down syndrome is the most prevalent genetic disorder worldwide and affects more than 1 in 800 live births. ⋯ The purpose of this review is to describe clinically significant findings that are common to patients with Down syndrome. In addition to the presentation of clinical anomalies associated with trisomy 21, specific anesthetic considerations and interventions are reviewed.
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We describe a patient who sustained facial burns during a tracheotomy. The electrosurgical unit indirectly started the fire during monitored anesthesia care when a high inspired oxygen concentration was being delivered to the patient by simple face mask. This case points out the need for prevention strategies, intraoperative vigilance, and quick intervention to prevent further patient injury any time the electrosurgical unit is used in an oxygen-enriched atmosphere.
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The electromyographic endotracheal tube (EMG-ETT) is a relatively new tool used to measure integrity of the vocal cord structures during surgery. We describe a case in which an EMG-ETT was inserted for the operative period but not replaced with an ETT during the immediate postoperative period. ⋯ The patient was not provided the pulmonary toilet necessary until the EMG-ETT was removed and replaced with a regular ETT. The purpose of this article is to make anesthesia providers aware that when mechanical ventilation is required during the postoperative period, the EMG-ETT should be removed and replaced with a regular ETT to facilitate pulmonary toilet.