AANA journal
-
A rescue airway device is used when conventional methods of intubation fail to achieve control of the airway. Although the laryngeal mask airway is often used in the operating room should endotracheal intubation fail, the esophageal-tracheal double-lumen airway represents another alternative rescue airway device. ⋯ The most commonly used esophageal-tracheal double-lumen airway device is the Combitube (TYCO Healthcare, Pleasanton, Calif), which will be used to illustrate insertion techniques needed in the use of esophageal-tracheal double-lumen airways. Nurse anesthetists should familiarize themselves with the function and placement of the device in case it is needed.
-
Postdural puncture headache (PDPH) is a debilitating side effect of spinal anesthesia, the result of dural puncture and cerebrospinal fluid (CSF) leakage with an incidence of 3% to 75% in patient populations. Despite numerous in vitro and in viva studies that have identified predictors associated with PDPH, debate continues on the best technique to reduce CSF leak after dural puncture. The purpose of this in vitro study was to evaluate the relationship between spinal needle type (pencil tipped or cutting), needle size (22 or 25 gauge), and dura penetration angle from perpendicular (90 or 30 degrees), with the resulting CSF leak measured after dural puncture. ⋯ The relationship between variables was analyzed. Our results found between needle tip designs a 5-fold increase in mean leak (Quincke > Whitacre) and between needle diameters (25 > 22 gauge), a 6-fold greater mean leakage. Puncture angle demonstrated no significant effect.
-
This study aimed to determine whether the PAXpress airway (Vital Signs, Totawa, NJ) should replace the standard laryngeal mask airway (LMA Classic) in our practice. Records of patients who had been ventilated with a PAXpress airway or an LMA were examined. Responses of patients in the postanesthesia care unit (PACU) or from routine postoperative calls the following day were noted. ⋯ In the PAXpress group, all but 2 of the 13 patients interviewed (85%) reported a sore throat. The average degree of soreness for this group (4.5) was significantly higher than that reported in the LMA group (P < .001). The PAXpress airway is more likely to cause irritation (often severe) of the airway and, therefore, should not replace the standard LMA in our practice.
-
Prompt administration of intravenous (i.v.) dantrolene sodium (DS) is the primary determinant of successful treatment of malignant hyperthermia (MH) syndrome. Because DS has a long reconstitution time for use in treating an MH crisis, we evaluated an alternative technique for hastening the reconstitution. Simulating real-world conditions, with equipment common to the operating room environment, we conducted a randomized, controlled, single-blind study dividing 16 DS vials into 2 equal groups: warm (41 degrees C) and ambient temperature (22 degrees C). ⋯ The Icarus effect was clearly demonstrated: warmed diluent vs ambient temperature hastened the reconstitution time for DS. The mean time to particulate-free DS solution suitable for i.v. injection with the warm diluent was 58.88 seconds compared with 93.87 seconds for the ambient temperature group (P <.001). A practical method using a reliable and safe warming device readily available to anesthetists and ubiquitous to the operating room environment speeds the time to administration of DS ultimately reducing morbidity and mortality associated with MH.
-
Biography Historical Article
Agatha Cobourg Hodgins: she only counted shining hours.