AANA journal
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The problems of intraoperative learning and awareness during surgery have consequences for both the patient and the medical team. With or without recall, the patient can suffer severe emotional trauma that may result in psychological damage. Successful litigation against the anesthesia professional has been increasing in numbers as failure to provide adequate anesthesia can be considered a breach of the unwritten contract between patient and anesthetist. ⋯ To date, means of monitoring real-time levels of intravenous agents have not yet been fully tested and proven. Therefore, monitoring minimum alveolar concentrations of inhaled anesthetics may be the best currently available method of ensuring anesthetic depth. Investigations comparing the correlation between nitrous oxide and isoflurane minimum alveolar concentrations and anesthetic depth have indicated specific levels at which intraoperative learning ceases to occur.
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Comparative Study
Evaluation of a nasal/oral discriminate sampling system for capnographic respiratory monitoring.
Although continuous end-tidal carbon dioxide (PETCO2 mmHg) measurements permit the earliest detection of alveolar hypoventilation, apnea and/or obstruction, technical difficulties have thus far precluded its reliable implementation in the spontaneously breathing patient with a natural (e.g., nonartificially secured) airway. Among the technical difficulties is the fact that conventional sampling devices do not take into account the possibility that breathing may take place primarily through either the nose or the mouth. As a result, the efficacy of a new nasal/oral discriminate sampling system (NODSS) was examined for capnographic observation of respiratory adequacy. ⋯ A comparison between PaCO2 values and noninvasive nasal and/or oral PETCO2 obtained by NODSS showed a positive correlation (r value) of 0.602 to 0.849 when statistically analyzed by Pearson's product-moment correlation coefficient. There was no significant difference between the mean (PaCO2-PETCO2) gradient derived through nasal sampling, as compared to the mean gradient derived by oral sampling with this device (P > 0.05). Noninvasive capnographic monitoring by NODSS is a convenient, reliable, effective, and accurate alternative to direct arterial blood gas determination that may be used for the early detection of respiratory inadequacy in the spontaneously breathing patient who has a natural airway.
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Case Reports
Adenosine treatment of supraventricular tachycardia following epidural test dose: a case study.
This is a case report of supraventricular tachycardia following initiation of epidural analgesia with use of an epinephrine test dose in a parturient during active labor. Vagal stimulatory efforts failed to interrupt the arrhythmia, but treatment with adenosine was successful. Fetal monitoring with a scalp electrode provided evidence of fetal well-being throughout the episode. Adenosine was chosen because of its safety for both the mother and the fetus and its lack of the hypotensive effect often seen with verapamil.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of four intraoperative warming devices.
Several methods of heat conservation and transfer have been suggested as aids to reducing heat loss during anesthesia. This study evaluated and compared the effectiveness of four warming and heat maintenance therapies. The efficacy of various heat conservation modalities was evaluated in 60 patients in five groups of 12 each, four experimental groups, and a control group. The study concluded that the Bair Hugger is more effective in maintaining normothermia during general anesthesia than is a reflective blanket, humidistat, or heated humidifier.
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A 36-year-old male presented with knife-inflicted neck trauma. He was intubated in the emergency department but subsequently experienced an unplanned extubation. Multiple attempts at reintubation were unsuccessful with cricothyrotomy providing lifesaving. The patient was then fiberoptically intubated under controlled conditions sparing the victim from what otherwise would probably have been a tracheostomy.