AANA journal
-
Risk management and cost containment concerns inherent in central venous cannulation and pulmonary artery catheter insertion have prompted the search for noninvasive cardiac output methods. Thoracic electrical bioimpedance is one such method, revitalized since the early days of space flight. Thoracic electrical bioimpedance measures the impedance changes associated with plethysmographic changes within the thoracic cavity and determines cardiac output. An appreciation of the foundational principles underlying thoracic electrical bioimpedance when compared to the Fick, indicator dilution and Doppler cardiac output monitoring methods will facilitate the nurse anesthetist's understanding and utilization of these modalities.
-
Cost issues and questions related to graduate nurse anesthesia education are raised from the perspective of a dean of a college of nursing. Suggestions relative to these issues are made, and various funding mechanisms that exist in institutions of higher learning are briefly discussed in relation to their cost and benefits.
-
The production of microcatheters small enough to be threaded through 22- to 26-gauge spinal needles has focused renewed attention on the technique of continuous spinal anesthesia. This technique has a specific combination of advantages which cannot be duplicated by any other method of regional blockade. ⋯ Inadequate anesthesia, failure to thread the catheter, catheter breakage, prolonged neurologic deficits (e.g., cauda equina syndrome), and postdural puncture headache are uncommon complications. This installment of the AANA Journal Course will explore the latest developments regarding this emerging regional technique.
-
A 27-year-old white male was scheduled for a mediastinoscopy of an anterior mediastinal mass. The patient was induced with thiopental and succinylcholine, in anticipation of possible difficulty managing the airway. There was no distortion of the airway, and he was easily intubated with a No. 8.5 anode tube and given 20 mg of atracurium. ⋯ When the muscle relaxant was reversed, the increase in intrathoracic pressure caused the mass to compress the superior vena cava. The compression was released by placing the patient in a reverse Trendelenburg position, which caused the mass to shift. In addition to superior vena cava compression, other complications of anterior mediastinal masses include airway obstruction, distortion of anatomy, impaired cerebral circulation and myasthenic syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)
-
A young woman who sustained severe head trauma presented to the operating room for emergent surgical intervention. Her electrocardiogram (ECG) exhibited signs of myocardial ischemia, which resolved several days postoperatively. ECG changes suggestive of cardiac pathology can be associated with intracranial pathology, most notably subarachnoid hemorrhage. ⋯ Continuous ECG monitoring is essential. Ventricular dysrhythmias may prove resistant to conventional pharmaceutical management. Beta blockade may be indicated to prevent excessive cardiac stimulation by endogenous catecholamines, and, in addition, may prevent the formation of the microscopic cardiac lesions typical of this hyperstimulation.