AANA journal
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Pulmonary aspiration during anesthesia, although rare in most patients, remains a very real concern for anesthesia providers. Recently, an extensive collection of data has emerged demonstrating a seemingly benign effect of gastric pH and volume from clear liquids consumed 2 to 3 hours prior to surgery in select patients. This AANA Journal course will evaluate the risk of pulmonary aspiration and relate this to specific identifying characteristics described to influence risk. Gastric physiology will be reviewed and current research will be examined evaluating the impact of clear liquids on specific outcome variables.
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The laryngeal mask airway (LMA) was invented by Dr. Archie Brain at the London Hospital, Whitechapel, in 1981. Dr. ⋯ The LMA is not a substitute for a properly placed endotracheal tube in this situation. The American Society of Anesthesiologists' difficult airway algorithm recommends the insertion of an LMA when ventilation and/or intubation are difficult. The distal aperture of the LMA is in close approximation to the vocal cords, so a 6.0-mm internal diameter endotracheal tube can be passed over an intubating stylet or a pediatric fiberoptic bronchoscope to secure a patient's airway.
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Clinical Trial Controlled Clinical Trial
The intraoperative use of Amicar to reduce bleeding associated with open heart surgery.
In an effort to reduce morbidity associated with transfusion of blood products, Amicar is used as a prophylactic inhibitor of hyperfibrinolysis associated with diffuse perioperative bleeding in patients undergoing open heart surgery. Previous studies indicate a significant reduction of intraoperative and postoperative bleeding in patients receiving Amicar during open heart surgery. ⋯ The study found a significant reduction in postoperative chest tube output for the group receiving Amicar, as well as a reduction in perioperative blood product transfusion in patients who received Amicar. One patient in the Amicar group experienced a thrombotic event.
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Scoliosis surgery presents the anesthetist with specific clinical challenges. Since scoliosis is the most common problem for which patients of congenitally short stature present to the operating room, the preoperative evaluation of dwarfs is discussed here in the context of a patient with spondyloepiphyseal dysplasia congenita. ⋯ Consideration is given to cervical spine abnormalities, congenital absence of the odontoid process, pulmonary function abnormalities, and mucopolysaccharidosis (a syndrome which may compromise airway management). The intraoperative monitoring of somatosensory evoked potentials and their significance are also discussed.