AANA journal
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Smoking tobacco using a waterpipe (hookah) is increasing worldwide and is remarkably common among adolescents and young adults in the United States. Contrary to misperceptions that waterpipe tobacco smoking presents fewer health risks than cigarette smoking, recent data demonstrate clearly that the smoke from a waterpipe contains many of the same toxicants that are in cigarettes, including the dependence-producing drug nicotine, cancer-causing polycyclic aromatic hydrocarbons, pulmonary disease-causing volatile aldehydes, and cardiovascular disease-causing carbon monoxide that can also lead to acute intoxication in waterpipe users. ⋯ Based on available evidence, there is no indication that waterpipe tobacco smoking is any less risky to patient health than cigarette smoking. Anesthesia providers should begin to assess patients for this form of tobacco use explicitly and should consider addressing it as they do cigarette smoking, with the additional precaution of presurgery carboxyhemoglobin measurement.
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Review Meta Analysis Comparative Study
To press or not to press, and if so, with what? A single question-focused meta-analysis of vasopressor choice during regional anesthesia in obstetrics.
Given the underlying assumption that reasonable maternal hemodynamics can be achieved with either ephedrine or phenylephrine, this focused meta-analysis addresses the impact of vasopressor choice on resultant neonatal Apgar scores during regional anesthesia. The literature was systematically searched for randomized trials of obstetric vasopressor use employing standard search tools. Only the highest quality trials were included. ⋯ Apgar scores at 1 and 5 minutes in the ephedrine group (served as control) vs the phenylephrine group did not differ at either time epoch; no abnormal values prevailed in either group (relative risk, 0.88; CI, 0.79-1.16). This meta-analysis focused on the most clinically relevant, immediately available information pertinent in the obstetric suite, the Apgar score, and found that ephedrine and phenylephrine did not differ in their effect on this metric. The current meta-analysis provides an updated, evidence-based validation of vasopressor use from the American Society of Anesthesiologists' 2007 "Practice Guidelines for Obstetric Anesthesia".
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Airway management in the morbidly obese, anesthetized patient can be especially challenging. Difficulties in fiberoptic intubation (FOI) can be experienced due to alterations in airway anatomy associated with morbid obesity and the effects of anesthesia. ⋯ The application of positive pressure via endoscopic mask ventilation during FOI can help to stent open collapsible airways and reestablish airway anatomy in morbidly obese patients. Although drawbacks exist, the endoscopic mask may be most effective at accomplishing this goal.
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Forced-air warming devices are effective for the prevention of surgical hypothermia. However, these devices intake nonsterile floor-level air, and it is unknown whether they have adequate filtration measures to prevent the internal buildup or emission of microbial contaminants. We rated the intake filtration efficiency of a popular current-generation forced-air warming device (Bair Hugger model 750, Arizant Healthcare) using a monodisperse sodium chloride aerosol in the laboratory. ⋯ Swabbing detected microorganisms within 100% of the forced-air warming blowers sampled, with isolates of coagulase-negative staphylococci, mold, and micrococci identified. Particle counting showed 96% of forced-air warming blowers to be emitting significant levels of internally generated airborne contaminants out of the hose end. These findings highlight the need for upgraded intake filtration, preferably high-efficiency particulate air filtration (99.97% efficient), on current-generation forced-air warming devices to reduce contamination buildup and emission risks.
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This report describes the noncardiac, nonobstetric surgical case of a 29-year old woman with idiopathic pulmonary arterial hypertension. To safely manage a patient with pulmonary hypertension, the anesthesia provider must have a thorough understanding of the disease and associated risks. This case study briefly summarizes the surgical case and then discusses history, current classifications, epidemiology, pathophysiology, contemporary treatments, and basic anesthetic management related to pulmonary hypertension.