AANA journal
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In selecting an anesthetic agent to be used for neurosurgical procedures, the anesthesia provider must consider the agent's effects on intracranial pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic rate of oxygen consumption (CMRO2). The anesthetic of choice for neurosurgical procedures for many decades has been thiopental. It meets the strict requirements for neurosurgical procedures because it protects the brain from ischemia and herniation by lowering ICP through decreases in CBF and CMRO However, new drugs, including etomidate and propofol, have been introduced that offer anesthesia providers comparable neuroprotective actions plus other positive attributes. ⋯ The literature showed that all 3 anesthetic agents provide favorable neurological protection. Each drug has some undesirable side effects. Knowledge of these side effects and the patient's medical and surgical history can help CRNAs determine the most suitable anesthetic in specific situations.
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Droperidol has been an efficacious, inexpensive butyrophenone used since the early 1970s to prevent or treat postoperative nausea and vomiting. Because of reports of sudden cardiac death in patients receiving droperidol, the US Food and Drug Administration (FDA) recently placed significant restrictions on its administration. ⋯ Haloperidol is another butyrophenone with antiemetic properties but without the FDA restrictions. This article reviews the literature regarding haloperidol and supports its use as a safe substitute for droperidol in the prevention and treatment of postoperative nausea and vomiting.
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Case Reports
Cardiac arrest under anesthesia in a pediatric patient with Williams syndrome: a case report.
Serial cardiac arrests occurred during the induction of a 3-year-old boy for elective 1-sided orchiopexy surgery and evaluation under anesthesia of previously placed ear tympanoplasty tubes. The child's history included Williams syndrome along with hypercalcemia and mild supravalvular aortic stenosis. The initial arrests included significant ST wave changes along with profound brodycardia, hypotension, and pulseless electrical activity requiring full resuscitation twice. ⋯ The patient experienced several cardiac arrests during the cardiac catheterization procedure, necessitating emergency extracorporeal membrane oxygenation cannulation and immediate transfer to the operating room for emergency cardiac surgery. A thorough preoperative cardiac workup, including cardiac catheterization, electrocardiogram, and echocardiogram, may decrease mortality and morbidity in patients with Williams syndrome. However, cardiac catheterization has been associated with increased risk in this patient population.
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Little is known about how pressure-support ventilation affects diaphragm performance because there is no direct measurement of diaphragm function in the clinical setting. An indicator of diaphragm performance or work is the product of diaphragm muscle shortening and intrathoracic pressure during inspiration. We studied the effect of pressure-support ventilation on diaphragm shortening, diaphragm work, and other cardiopulmonary parameters. ⋯ Therefore, diaphragm work was decreased. The lack of an increase in diaphragm shortening in the presence of an increase in tidal volume indicated that there was an augmentation of thoracic volume in the coronal and/or horizontal axes instead of the cephalocaudal axes throughout inspiration. These findings may be useful to nurse anesthetists in the understanding of diaphragm work when patients are being ventilated with pressure-support ventilation.