AANA journal
-
Randomized Controlled Trial Comparative Study
Ventilation with increased apparatus dead space vs positive end-expiratory pressure: effects on gas exchange and circulation during anesthesia in a randomized clinical study.
Atelectasis formation can be reduced by positive end-expiratory pressure (PEEP), but resulting increases in intrathoracic pressure could affect circulation. We have earlier demonstrated that increased tidal volumes with larger apparatus dead space improves oxygenation and sevoflurane uptake. In the present study, we hypothesize that isocapnic ventilation with increased tidal volumes increases oxygen and sevoflurane uptake similar to ventilation with PEEP, but with less impact on cardiac output. ⋯ Oxygen tension and arterial sevoflurane concentration were significantly higher in the DS group (P < .05). Cardiac output decreased significantly less in the DS group compared with the PEEP group (5% and 33%, respectively; P < .05). Consequently, isocapnic ventilation with increased tidal volumes using apparatus dead space increased oxygen and sevoflurane tensions in arterial blood and preserved cardiac output better than did PEEP.
-
Some providers advocate using laryngeal mask airways (LMAs) for procedures performed in the prone position to meet the demands of quicker operating room turnover time requirements, staffing reductions and the desire to expedite patient recovery in the postoperative period. We provide an update to a 2010 systemic review examining the use of LMAs in patients in the prone position. Six peer-reviewed articles described the use of LMAs in prone patients: a randomized controlled trial, 2 description studies, a case series, and 2 case reports. ⋯ There must be a plan to control the airway if problems are encountered with the LMA. These devices might be considered as a bridge device when a prone patient is accidentally extubated. Additional rigorous studies are needed before use of LMAs in this manner can be widely recommended.
-
Clinical Trial
Utility of thromboelastography during neuraxial blockade in the parturient with thrombocytopenia.
No consensus exists on when it is safe to administer neuraxial blockade in a patient with a low platelet count. It has been suggested that thromboelastography (TEG) may be useful in assessing platelet function in parturients with thrombocytopenia. ⋯ All parturients whose platelet count was less than 100,000 mm(-3) were required to have TEG before a neuraxial technique was administered. This case series suggests that neuraxial techniques in parturients can be performed with a platelet count greater than 56,000 mm3 and a normal TEG result.
-
Comparative Study
Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients.
We wanted to determine whether 1 of 3 brachial plexus blocks was best for one of our most common surgeries, the cubital tunnel release with or without transposition of the ulnar nerve. Brachial plexus blocks can provide excellent results for upper extremity surgery, but we noticed inexplicable block failure for cubital tunnel releases with an incision in the proximal arm. In this case series, we initially reviewed 90 patients receiving axillary, infraclavicular, or supraclavicular blocks to determine if one block performed better for a surgical procedure that proceeds up the inner aspect of the arm. ⋯ By increasing the volume, there appeared to be less need for surgeons to "touch up" blocks in the operating room. We suggest that increasing the volume of the intercostobrachial nerve block may improve success. Further studies to identify the intercostobrachial nerve by ultrasound are needed.
-
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex procedure used for the treatment of various types of cancer. Specifically, HIPEC has shown success where treatment failure sites (metastases) thrive. A classic example of one such area is the peritoneal surface, which remains a prominent failure site for patients with gynecologic and gastrointestinal cancer. ⋯ Anesthetic complications are common during this procedure with disturbances in hemodynamics, coagulation, and respiratory gas exchange. A knowledge of what to anticipate anesthetically will guide the practitioner to achieve successful management during and after the case. In this case report, a 71-year-old woman was treated for stage Ill peritoneal and ovarian cancer by cytoreductive surgery with HIPEC.