AANA journal
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Polyuria has been reported as a side effect of sevoflurane administration, but because of its relative rarity, many practitioners are not aware of this potential phenomenon. Polyuria in its extreme form can cause undesirable hemodynamic changes. A case study, in an 18-year-old man, is presented highlighting polyuria as a probable side effect of sevoflurane administration.
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Review
Intraoperative magnetic resonance imaging for neurosurgical procedures: anesthetic implications.
Intraoperative magnetic resonance imaging (IMRI) for tumor resection allows a neurosurgeon to pinpoint the exact location of the tumor before resection and to navigate to the tumor after the incision is made. Although the anesthetic management is not substantially different from that for other neurosurgical procedures, strategies to keep the patient and operating room personnel safe can be challenging. Because of the risk of injury by the strong force of the magnet, safety precautions with respect to anesthetic delivery must be taken. ⋯ Surgical equipment and instruments must be MRI-compatible. Absolute contraindications to entering the MRI suite include pacemakers, cochlear implants, certain cranial aneurysm clips, and metal joints or implants. Goals of anesthesia delivery during IMRI procedures include the following: (1) promoting the safety of patients and staff, (2) preventing MRI-associated accidents, (3) identifying potential equipment-related hazards, (4) recognizing limitations of physiologic monitoring, and (5) acknowledging other potential hazards such as noise.
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Chronic pain is an extremely debilitating disease syndrome for which current treatment modalities are largely ineffective. This article presents the recently proposed contributions of neuroimmune activation to the maintenance of chronic pain. ⋯ Literature generated by the emerging field of central nervous system glial cell research, including genetic therapies, was reviewed to provide empirical support for this pathway. The clinical implications of neuroimmune activation to improved treatment of chronic pain states are discussed.
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One year after implementation of a 2005 Washington State law that granted Certified Registered Nurse Anesthetists (CRNAs) authority to prescribe schedule II through IV controlled substances, only 30% of CRNAs held prescriptive authority. The purpose of this study was to describe Washington State CRNA prescribing practices and workforce and practice characteristics. A questionnaire was mailed in 2006 to CRNAs licensed in Washington with addresses in Washington, Oregon, and Idaho. ⋯ Of CRNAs with prescriptive authority, 94.7% prescribed anesthetics, 60% prescribed nonsteroidal anti-inflammatory medications, and just 53.3% prescribed narcotic analgesics. Professional and policy controversies about autonomous prescribing for CRNAs are discussed. Further research is needed to determine the factors that limit CRNA prescribing and the transition to a new scope of practice.
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There have been many contradicting studies as to how well preoperative airway assessments predict difficult intubation. One of these measures, thyromental distance (TMD), has often been called into question. However, there have been no published studies evaluating whether anesthesia practitioners are measuring TMD accurately, especially if they use fingerbreadths as opposed to a centimeter ruler. ⋯ After their estimates were recorded, exact measurements of the fingerbreadth combinations were made at the distal interphalangeal (DIP) joints. The differences between the means of the estimated and the actual measurements were analyzed using an independent t test. There was a statistically significant difference between estimated and actual fingerbreadth measurement for the index finger (P < .006) but not for the combinations of fingers.