AANA journal
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Serotonin syndrome is a rare but potentially fatal adverse drug reaction associated with increased serotonergic activity in the central nervous system. It is characterized by a triad of symptoms, which include altered mental status, neuromuscular hyperactivity, and autonomic instability or hyperactivity. ⋯ Although this article focuses on serotonin syndrome as a result of an adverse interaction of selective serotonin reuptake inhibitors (SSRI) and fentanyl, it is important for not only anesthesia professionals, but all clinicians--such as those in emergency medicine and critical care--to be aware of this syndrome and its management. This article discusses the clinical manifestations of the serotonin syndrome and highlights reported cases of serotonin syndrome specifically related to an interaction between SSRIs and fentanyl, a commonly used opioid in anesthesia practice.
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Informatics is a new science within healthcare and anesthesia that leverages computer technology to improve patient safety, the quality of care provided, and workload efficiency. In clinical anesthesia practice, appropriate application of informatics promotes data standardization and integrity, and supports clinical decision-making. This article describes current issues in anesthesia information management to support the critical need for Certified Registered Nurse Anesthetists (CRNAs) to influence functionality, adoption, and use of an anesthesia information management system. The use of informatics tools and concepts should enable CRNAs to enhance their bedside vigilance, align their practice with evidence-based clinical guidelines, and provide cost-effective care for patients and healthcare systems.
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The goal of this research was to investigate, through active-duty Army anesthesia providers, their perceptions on emergence delirium (ED) in US combat veterans. Specifically, the pharmacologic, physiologic, and psychological characteristics associated with ED. An online survey was sent to all active-duty Army anesthesia providers with a response rate of 34%. ⋯ Young age (57.5%) and traumatic brain injury (54.2%) were believed to be the most likely physiologic factors, with posttraumatic stress disorder (88%) and anxiety (84.8%) rated highest for psychological factors related to ED. This study emphasizes the need to develop a prospective clinical database involving all military anesthesia providers that could collect demographic, pharmacologic, psychological, and physiologic information on all combat veterans undergoing anesthesia. This kind of longitudinal data would provide answers to many of the unanswered questions that we currently have regarding combat veterans and ED.
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Mechanical ventilators have evolved from basic machines to complicated, electronic, microprocessing engines. Over the last 2 decades, ventilator capabilities and options for critical care and anesthesia ventilators have rapidly advanced. These advances in ventilator modalities--in conjunction with a better understanding of patient physiology and the effects of positive pressure ventilation on the body--have revolutionized the mechanical ventilation process. ⋯ The wording describing the standard ventilatory modes on select present-day ventilators has changed, yet the basic principles of operation have not changed compared with older ventilators. Anesthesia providers need to understand these ventilator modes to best care for patients. This literature review encompasses a brief history of mechanical ventilation and current modes available for anesthesia and critical care ventilators, including definitions of each mode, definitions of the various descriptive labels given each mode, and techniques for optimizing and meeting the ventilator needs of the patient while avoiding complications in the surgical and critical care patient.