AANA journal
-
Review Case Reports
Evidence-based anesthesia: fever of unknown origin in parturients and neuraxial anesthesia.
The safety of neuraxial analgesia in febrile patients is controversial. We performed an evidenced-based project in an effort to establish a guideline for our active obstetric clinical practice. Neuraxial anesthesia is generally safe for parturients, and complications are rare; however, serious adverse outcomes can result. ⋯ We recommend evaluation of each individual to determine the risks and benefits of the anesthetic. However, it is prudent to administer antibiotics before the regional anesthetic and adhere to strict aseptic technique. Postprocedure monitoring is essential for early detection and treatment of complications.
-
Randomized Controlled Trial Comparative Study
The influence of spinal needle orientation during administration of subarachnoid blocks on discharge criteria in same-day surgical patients.
Cost containment is a critical factor in today's healthcare industry, so finding ways to decrease length of stay is essential in anesthesia practice. We rely on rapid induction, recovery, and discharge to control cost in outpatient surgery. Subarachnoid block (SAB) is an acceptable anesthetic choice for many outpatient procedures. ⋯ Demographics (except weight) were not statistically different between the groups. Total hospital time did not differ between the groups. Regardless of needle orientation, patients in both study groups achieved discharge criteria in similar amounts of time.
-
High-frequency jet ventilation (HFJV) has been used in emergency airway scenarios and various surgical procedures. Although substantial literature is available regarding HFJV in these situations, there is only 1 publication to date concerning its use for cardiac radiofrequency ablation procedures. The following case study describes a 49-year-old man undergoing radiofrequency ablation in which HFJV was used. ⋯ In this case, a newly introduced in-line circuit filter was used. Impedance to passive exhalation was created after the filter became saturated from the high humidification. This event, its management, and the following discussion on the mechanics of HFJV and its use in radiofrequency ablation procedures make this case an educational value to all anesthesia providers.
-
The obligatory use of fluoroscopy for placement of epidural steroids is controversial. Proponents of the use of fluoroscopy cite studies that report up to 35% rates of inaccurate placement of epidural needles without the aid of fluoroscopic imaging. This case study presents a situation in which a loss-of-resistance technique resulted in an inadvertent discogram.
-
The turnover rate of nurse anesthesia faculty has been monitored by the Council on Accreditation of Nurse Anesthesia Educational Programs for a number of years. In 2005, the turnover rate remained high, at 22%, indicating a problem with faculty retention. This article reports the results of a study in which 25 long-time nurse anesthesia program directors were interviewed to gain insights into faculty retention. The interviews revealed reasons for becoming an anesthesia educator, positive and negative aspects of the job, changes over time, and reasons for longevity in their positions.