AANA journal
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Case Reports
Anesthetic implications for implantation of a left ventricular assist device: a case study.
A left ventricular assist device (LVAD) is intended for use as a temporary bridge to transplantation in patients with end-stage cardiac failure until a donor heart becomes available. This case report discusses the anesthetic management of a patient undergoing implantation of an LVAD. Tremendous advances have been made in cardiac transplantation; however, there is an acute donor shortage in the face of an increased need for donor hearts. ⋯ Food and Drug Administration approved assist device, the Thermo-Cardiosystems, Inc. (Woburn, Massachusetts) implantable pneumatic LVAD is proving to be very successful as a bridge to transplantation. A case is presented of a 40-year-old male with debilitating cardiomyopathy in conjunction with mitral regurgitation, pulmonary hypertension, and mild tricuspid regurgitation. He had reached the point of multisystem organ failure which had left him incapacitated while awaiting cardiac transplantation.
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In Part A of this two-part Journal course, issues of safety during subarachnoid and epidural blocks were examined (see the August 1997 issue of the AANA Journal). Part B deals with the effectiveness of spinal and epidural blocks. Although the overall failure rate for subarachnoid and epidural blocks is low, regional anesthesia is not always effective. ⋯ While opioid induced respiratory depression was a significant hazard during the initial development of spinal and epidural opioid techniques, refinements in dosing and monitoring of these patients have reduced the incidence of this complication to a low level. While alpha agonists, such as epinephrine, do prolong the duration of some types of blocks, they also introduce or exacerbate problems, such as urinary retention, itching, and even hypotension. Whatever technique is used, careful patient selection, allowing adequate time for the block to set up, and administering small doses of a systemic analgesic or sedative if needed may make the difference between the success or failure of a well-performed block.
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The laryngeal mask airway (LMA) is an important new tool for managing the emergency airway. In a variety of emergency situations, the LMA may be considered instead of the face mask or the endotracheal tube. ⋯ The primary risk with the LMA is aspiration of gastric contents. Anesthetists should be familiar with its advantages, risks, indications, and uses.
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The effect of acrylic nails on the measurement of oxygen saturation as determined by pulse oximetry.
Pulse oximetry (Spo2) is a simple, noninvasive method that is widely used to determine oxygen saturation in patients undergoing surgical procedures. Artificial acrylic nails have recently become fashionable to strengthen and lengthen nails. This study investigates the effect of unpolished acrylic nails on the measurement of oxygen saturation by pulse oximetry. ⋯ Using a paired Student's t test, no statistically significant differences existed between readings. This study demonstrates that unpolished acrylic nails do not affect pulse oximetry measurements of oxygen saturation. Patients may not need to remove unpolished acrylic nails before surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of axillary block techniques: is there a difference in success rates?
This study compared the success rates between two accepted methods of performing axillary blocks, the peripheral nerve stimulator (PNS) and the transarterial (TA) techniques. Success was based on blocking the nerves involved in the surgery. Following institutional review board approval and informed consent, 57 patients between the ages of 18 and 86 years of age scheduled for elective upper extremity surgery were studied. ⋯ There were no significant side effects reported by the patients postoperatively. The axillary nerve was the only nerve with an increased success rate using the TA technique. This indicates that both techniques are equally acceptable.