AANA journal
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Comparative Study
Preoxygenation of patients for coronary artery bypass grafting: vital capacity versus tidal breathing.
Arterial oxygenation, as measured by serial arterial blood gases (ABGs) and in vivo polarographic PaO2 during the rapid sequence induction of general endotracheal anesthesia, was evaluated in 20 ASA physical class IV subjects undergoing elective coronary artery bypass grafting (CABG). Subjects received a narcotic premedication 30-60 minutes prior to arrival in the operating room. Subjects in Group I (n = 10) were preoxygenated with 3 minutes of tidal breathing, while Group II (n = 10) subjects took four vital capacity breaths (VCB) within 30 seconds. ⋯ After tracheal intubation, the mean PaO2 fell to 275.70 mmHg in Group I compared with 277.20 mmHg in Group II. There was no significant difference (p greater than 0.05) between the two methods of preoxygenation in their ability to increase arterial oxygen. In conclusion, vital capacity breathing is as effective as 3 minutes of tidal breathing in elevating the PaO2 in subjects with significant coronary artery disease prior to a rapid sequence induction.
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Herpetic whitlow is a herpes infection of the digits of the hand, first described in 1909, caused by either herpes simplex virus type 1 or type 2. It was not until 1959 that herpetic whitlow was reported to occur in health care professionals. Nurse anesthetists are among the many health care professionals considered to be at high risk for acquiring herpetic whitlow, making it an occupational, but preventable, disease. ⋯ Diagnosis can be made clinically and confirmed by many laboratory tests. Early recognition is most important, and treatment is symptomatic. The drug acyclovir has proven to be an effective chemotherapeutic agent for suppressive therapy.
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The purpose of this study was twofold. First, to identify current roles and future role perceptions for Certified Registered Nurse Anesthetists (CRNAs) using the delphi methodology. Second, to analyze the level of agreement or disagreement of anesthesiologists and CRNAs with the identified roles. ⋯ CRNAs and anesthesiologists differ in support for expanded practice in both current and future perceptions. 2. CRNAs and anesthesiologists differ on the issue of independent practice. 3. The perception of anesthesiologists relative to the anesthesia care team appeared to be influenced by a working relationship with CRNAs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Although oxygen has been known to be toxic for more than 200 years, the clinical importance of oxygen toxicity was not appreciated until an epidemic of retrolental fibroplasia occurred in the early 1950s. Oxygen at high partial pressures is toxic to the respiratory, cardiovascular, nervous, and gastrointestinal systems. Toxicity results from the formation of oxygen-free radicals. ⋯ Oxygen radical scavengers such as superoxide dismutase and catalase protect the body against normal levels of oxygen-free radicals. Oxygen toxicity can result from either reperfusion of ischemic tissue or prolonged exposure to high concentrations of oxygen. Limiting hyperoxia to maintain arterial oxygen percent saturation (SaO2) greater than or equal to 90% is recommended.