AANA journal
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Sugammadex sodium is the generic drug name for the novel modified gamma cyclodextrin that terminates neuromuscular blockade induced by aminosteroidal neuromuscular blocking agents. Published phase II and phase III clinical data support preclinical and clinical phase I study findings of fast, safe, and efficacious reversal of all levels of neuromuscular blockade induced by rocuronium and vecuronium. ⋯ Special patient populations, including pediatric, elderly, cardiac, and renal-compromised subjects, have been studied in phase III. This update focuses on the most recent findings of phase II and III clinical studies.
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Randomized Controlled Trial
Will the addition of a sciatic nerve block to a femoral nerve block provide better pain control following anterior cruciate ligament repair surgery?
Two common forms of postoperative analgesia used in patients following an anterior cruciate ligament repair (ACLR) are the femoral nerve block (FNB) and the combined femoral-sciatic nerve block (FSB). The purpose of this study was to determine if the addition of the sciatic nerve block to the FNB is truly beneficial in ACLR patients requesting regional anesthesia for postoperative pain control. All subjects scheduled for an ACLR, requesting general anesthesia and preoperative placement of a peripheral nerve block (PNB), were randomized to receive an FNB or an FSB. ⋯ Significantly higher analgesic requirements, pain scores, and lower satisfaction scores were noted in the FNB group compared with the FSB group (P < .05). No other differences were noted between groups in demographic data. Based on this investigation, we concluded that the FSB, compared with FNB alone, provides superior postoperative analgesia in patients receiving an ACLR and should be included in the anesthetic care plan in which a PNB is planned to facilitate postoperative analgesia.
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Inguinal hernias are the most common diagnosis requiring surgical repair in children of all ages. Anesthetic management of premature infants is often difficult due to their comorbidities and propensity for apnea and bradycardia. ⋯ The purpose of this review is to determine the benefits and risks of spinal anesthesia in preterm infants undergoing herniorrhaphy. The use of spinal anesthesia in this population has been shown to decrease the incidence of postoperative adverse events.
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Student nurse anesthetists are often required to purchase an auscultatory earpiece device for use in the clinical setting. Although the device is required, students have observed that many anesthesia providers in the clinical setting no longer use this piece of equipment. The purpose of this project was to determine the number of anesthesia programs that required mandatory purchase of the auscultatory earpiece by student nurse anesthetists. ⋯ The survey was completed by 63 (60%) of the program directors, and 62 completed surveys were used in the analysis. Results revealed that 95% of the responding nurse anesthesia programs (59 of 62) require esophageal/ precordial stethoscope earpieces for their students, but 46% (27) of those programs provide the earpieces. Most (76%) of the programs required the use of the earpieces in the clinical setting, but only 45% thought that they should be used for monitoring every anesthetic delivered.
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The purpose of this column is to present the results of the 2007 Professional Practice Analysis (PPA) of the field of nurse anesthesia, conducted by the Council on Certification of Nurse Anesthetists. The PPA used survey and rating scale methodologies to collect data regarding the relative emphasis of various aspects of the nurse anesthesia knowledge domain and competencies. ⋯ Summaries of respondent demographics and educational and professional background are provided, as well as descriptions of how the survey results are used to develop test specifications. The results of this analysis provide evidence for the content outline and test specifications (content percentages) and thus serve as a basis of content validation for the National Certification Examination.