AANA journal
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Historical Article
Discovery of Modern Anesthesia: A Counterfactual Narrative about Crawford W. Long, Horace Wells, Charles T. Jackson, and William T. G. Morton.
The discovery of anesthesia occurred during a narrow time span in the mid-19th century, but there is no agreement about who deserves credit for this important American contribution to medicine. Based mostly on an examination of primary sources, we explore how formal and informal interactions between the principals affected their careers, lives, and attribution of credit for the discovery of anesthesia. There should be no controversy as to which individual deserves credit for the discovery of anesthesia if credit is ascribed for specific contributions. ⋯ Charles T. Jackson suggested the use of ether as an anesthetic agent to Morton. We also assert that had these individuals not known one another, the discovery of anesthesia would have proceeded in approximately the same timeframe, but Wells, Morton, and Jackson would have enjoyed more productive careers as well as longer, more peaceful lives.
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Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. A literature search revealed 253 potential sources, with 25 meeting search criteria: 7 randomized controlled trials, 4 descriptive studies, 8 case series, and 6 case reports. ⋯ Evidence from lower-level sources suggested that several interventions were helpful, including using a controllable stylet, a fiberoptic bronchoscope in conjunction with the GlideScope, or an intubation guide, and twisting the endotracheal tube to facilitate passage into the trachea. Providers must consider the risks and benefits of any technique, particularly if the device manufacturer does not recommend the technique. Further rigorous investigations should be conducted examining methods to increase success.
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The AANA Foundation Closed Claims Researchers evaluated 245 closed claims spanning from 2003-2012. The majority of claims comprised CRNA providers whom are mainly male, independent contractors, certified between 1980-1999, and with malpractice coverage limits of $1 million/$3 million. The median age for all claimants was 50 years old, and 63.7% of claimants were female. ⋯ Regardless of severity of injury, reviewers determined that 45.5% of negative outcomes were preventable, 32.7% of the anesthesia treatment was inappropriate, and 29% of negative outcomes were caused by CRNAs' actions. Reviewers found that no AANA Standards were breached in 45.7% of claims; however, Standards 4, 5, and 3 were the most common standards breached. The most costly severity classification was major permanent injury (ie, paraplegia, blindness, loss of two limbs, or brain ddamage) with a median payment of $299,810.
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Ankle blocks are routinely indicated for surgical anesthesia and postoperative analgesia of procedures involving the foot. Traditionally, ankle blocks have been performed by relying on landmark identification of nerves. The literature regarding the performance and efficacy of ankle blocks is inconsistent. ⋯ The ability to identify peripheral nerves, view needle movements in real-time, and observe the spread of local anesthetic has been shown to result in greater block efficacy, even with reduced volumes of local anesthetic. Additionally, ultrasound imaging gives the provider the option to perform regional anesthesia in specific patient populations not considered possible when using landmark technique. Despite the limited literature on ultrasound-guided ankle blocks, outcome metrics seem to be consistent with those of other peripheral nerve blocks performed using this technology.
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Case Reports Comparative Study
Far Forward Anesthesia and Massive Blood Transfusion: Two Cases Revealing the Challenge of Damage Control Resuscitation in an Austere Environment.
Since the beginning of Operation Enduring Freedom and Operation Iraqi Freedom, the US military has treated more than 51,000 casualties and sustained more than 6,600 deaths. The past decade of conflict has solidified major advances in the use of blood component therapy and the liberal use of fresh whole blood during damage control resuscitation. This resuscitation strategy, combined with far forward damage control surgery, rapid aeromedical evacuation, and major improvements in critical care air transportation and personal protective equipment has led to a 90% to 92% survival rate in US casualties. ⋯ Both patients suffered severe trauma and required massive blood transfusion and damage control surgery. In describing these 2 cases, we wish to share our experience with damage control, resuscitation in an austere environment, as well as advocate for the critical role of the Certified Registered Nurse Anesthetist in advancing the knowledge and execution of this lifesaving strategy in both military and civilian trauma centers. In addition, we suggest alternatives to the current transfusion strategy, which will mitigate limitations currently encountered.