AANA journal
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This article provides a systematic review of awareness with recall, also called intraoperative awareness. Major topics of this review include the incidence and causes of this phenomenon, in addition to an examination of current strategies for prevention of intraoperative awareness. ⋯ This Journal course explores evidence related to the utility and limitations of this monitor in clinical practice. It also reviews evidence-based practices that may decrease the incidence of awareness with recall, including avoidance of muscle relaxants and protocol-driven approaches to awareness prevention.
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The purpose of this evidence-based, quality improvement practice project was to increase anesthesia providers’ knowledge and awareness of the taping practice for securing the endotracheal (ET) tube that increases the patient’s exposure to pathogens and the risk of nosocomial infections. A change in the taping practice by anesthesia providers was the desired outcome. Participants completed an anonymous questionnaire about their knowledge and use of a taping practice to secure the ET tube. ⋯ A Mann-Whitney U test demonstrated statistical significance (U = 55, P = .003). Additionally, anesthesia providers gave a strong indication that they would not use adhesive tape that had fallen to the floor (U = 78, P = .04, Mann-Whitney U test). This project demonstrated that a change in practice occurred after an intervention regarding securing the ET tube with adhesive tape.
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Variables measured in modern pulse oximetry apparatuses include a graphic pulse curve and a specified perfusion value (PV) that could be a sensitive marker for detecting differences in sympathetic activity. We hypothesized that there is a correlation between a reduction of PV and the time to eye opening after anesthesia with propofol-remifentanil. This study includes 29 patients, ASA physical status 1 or 2, scheduled for elective thyroid surgery. ⋯ Results demonstrated that PVs before anesthesia and at eye opening were lower than 15 minutes after induction and at end of surgery (P < .05). The PETCO2 and difference of FI-PETO2 increased at eye opening compared with the end of surgery (P <.05). We conclude that the pulse oximetry PV and the increased PETCO2 could be useful variables to predict timing of recovery in terms of eye opening after intravenous anesthesia.