AANA journal
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With more surgical procedures than ever before being performed in office settings, office-based anesthesia is a rapidly growing area of anesthesia practice. Although there are many advantages to office-based practice, limitations inherent to this setting, if not recognized and addressed, may threaten patient safety. ⋯ Anesthesia for cosmetic surgery procedures in the office setting is frequently performed under monitored anesthesia care (MAC) with its own unique safety considerations. Anesthetists practicing in office-based cosmetic surgery practices must understand the special characteristics of this setting, the MAC-based approach often used, the anesthesia and safety considerations for the cosmetic surgical procedures performed, and the importance of prophylaxis for venous thromboembolism.
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Current procedures for cleaning anesthesia airway equipment as assessed by the presence of visible and occult blood on laryngoscope blades and handles as labeled "ready for patient use" has been reported to be ineffective. Human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) are 2 commonly seen pathogens that frequently are found in the healthcare setting. It has been shown that HBV can survive on a dry surface for at least 7 days and both HIV and HBV are transmitted via blood. ⋯ To prevent further potential infections, it should be ascertained why anesthesia providers are not all using disposable laryngoscope blades. The purpose of this literature review is to determine the use and infection control practices of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade are reviewed, as well as the perceptions of anesthesia providers regarding disposable laryngoscope blades.
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Anesthesia is generally accepted as safe in most adult populations; however, in pediatric patients questions exist regarding the potential for long-term detrimental effects. Various anesthetic agents are associated with neuronal degeneration when administered to neonatal animals. The mechanism of damage is thought to be via accelerated apoptosis, a normally beneficial process in the maintenance of homeostasis. ⋯ Clear evidence exists that neuronal apoptosis occurs when anesthetics are administered to neonatal rodents and primates, and behavioral and cognitive testing from some authors indicate long-term effects persist well into an animal's adulthood. Preliminary human trials reveal a link between anesthesia and subsequent developmental delays. This review of the literature clarifies the need for further research in humans.
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Perioperatively, insulin to treat hyperglycemia is administered judiciously to minimize the risk of hypoglycemia. In patients with diabetes in whom preoperative blood glucose levels are on the low end of normal, hypoglycemia risk may be underestimated. This retrospective study enrolled subjects with presenting preoperative blood glucose values in these ranges: 70 to 89 mg/dL (low normal group) and above 249 mg/dL (hyperglycemia-treated group). ⋯ Accounting for differences between groups, the incidence of perioperative blood glucose levels below 70 mg/dL was greater in the low normal group than the hyperglycemia-treated group (17.2% vs 3.6%, P < .001). Of subjects whose blood glucose levels fell below 70 mg/dL, blood glucose levels dropped below 50 mg/dL in 40% of hyperglycemia-treated subjects and 4% of low normal subjects. Perioperative hypoglycemia was likelier to develop in patients with diabetes who presented preoperatively with low normal blood glucose values than in patients treated with insulin for presenting hyperglycemia.
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Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. ⋯ Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04), and endotracheal tube No. 7.0 (size 7 mm; P = .02). The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors.