AANA journal
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Review Meta Analysis Comparative Study
Evidence for using air or fluid when identifying the epidural space.
Lumbar epidural analgesia is frequently employed to provide pain relief for women during labor. Anesthesia providers use various methods to identify the epidural space. Some providers use air, some use fluid, and others use a combination of air and fluid during the loss of resistance technique. ⋯ The evidence reviewed was inconclusive in determining whether a difference in analgesia quality results from the use of air or fluid during the loss of resistance technique. Future studies should include an adequate number of subjects and address other problems such as operator experience, observer blinding, equivalence of subject characteristics, outcomes definition and measurement, and composition of epidural solution. Providers should consider other factors when selecting loss of resistance medium, such as the reported complications of large amounts of air injected into the epidural space and surrounding structures.
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Treating the pain that patients experience from repair of distal clavicle fracture can be a challenge for the anesthesia provider, possibly because of the dual innervation in this region. Dual innervations of the distal clavicular region also make selecting the correct regional block difficult. This article describes the first successful use of 2 separate ultrasound-guided perineural catheters placed for the purpose of treating distal clavicle pain and maintaining the analgesia. This technique also allows for the preservation of distal motor control in the affected limb.
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Comparative Study
Propofol compared with combination propofol or midazolam/fentanyl for endoscopy in a community setting.
This retrospective cohort study evaluated procedural efficiency and patient satisfaction in patients who had received propofol, midazolam/fentanyl/propofol (MFP), or midazolam/fentanyl, as sedation for either esophagogastroduodenoscopy or colonoscopy. Questionnaires about procedural times and patient satisfaction were administered. Use of propofol for colonoscopy resulted in shorter time (minutes) from induction to start of procedure (mean +/- standard deviation: propofol, 1.3 +/- 0.57; MFP, 3.2 +/- 2.2; midazolam/fentanyl, 3.8 +/- 2.7; P < .04) and shorter procedure time (propofol, 13 +/- 0.36; MFP, 15 +/- 0.004; midazolam/fentanyl, 75 +/- 0.005 minutes; P < .05). ⋯ Patients undergoing esophagogastroduodenoscopy who received propofol had a shorter recovery time (9 +/- 7 minutes vs MFP, 14 +/- 9 minutes, and midazolam/fentanyl, 19 +/- 11 minutes; P < .05). Patients receiving propofol felt less discomfort and need for adjustment in the sedation, and remembered less of the procedure compared with the MFP group. Propofol resulted in less time in the endoscopy unit, quicker recovery and discharge, and greater patient satisfaction than did balanced or conscious sedation.
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As the population ages, the number of patients in whom lung disease develops and who require surgical intervention will continue to rise. When compared with open thoracotomy, video-assisted thoracoscopic surgery (VATS) offers patients significant advantages. Decreased invasiveness results in less blood loss, a lower rate of infection, and less postoperative pain and allows for quicker recovery. ⋯ Proper use, placement, ventilation strategies, and methods to minimize the incidence and treat hypoxia for a double-lumen tube are reviewed. One-lung ventilation poses significant challenges for anesthetists. As a result, adequate preparation during the preoperative, intraoperative, and postoperative phases is essential.