AANA journal
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Treating the pain that patients experience from repair of distal clavicle fracture can be a challenge for the anesthesia provider, possibly because of the dual innervation in this region. Dual innervations of the distal clavicular region also make selecting the correct regional block difficult. This article describes the first successful use of 2 separate ultrasound-guided perineural catheters placed for the purpose of treating distal clavicle pain and maintaining the analgesia. This technique also allows for the preservation of distal motor control in the affected limb.
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Comparative Study
Propofol compared with combination propofol or midazolam/fentanyl for endoscopy in a community setting.
This retrospective cohort study evaluated procedural efficiency and patient satisfaction in patients who had received propofol, midazolam/fentanyl/propofol (MFP), or midazolam/fentanyl, as sedation for either esophagogastroduodenoscopy or colonoscopy. Questionnaires about procedural times and patient satisfaction were administered. Use of propofol for colonoscopy resulted in shorter time (minutes) from induction to start of procedure (mean +/- standard deviation: propofol, 1.3 +/- 0.57; MFP, 3.2 +/- 2.2; midazolam/fentanyl, 3.8 +/- 2.7; P < .04) and shorter procedure time (propofol, 13 +/- 0.36; MFP, 15 +/- 0.004; midazolam/fentanyl, 75 +/- 0.005 minutes; P < .05). ⋯ Patients undergoing esophagogastroduodenoscopy who received propofol had a shorter recovery time (9 +/- 7 minutes vs MFP, 14 +/- 9 minutes, and midazolam/fentanyl, 19 +/- 11 minutes; P < .05). Patients receiving propofol felt less discomfort and need for adjustment in the sedation, and remembered less of the procedure compared with the MFP group. Propofol resulted in less time in the endoscopy unit, quicker recovery and discharge, and greater patient satisfaction than did balanced or conscious sedation.
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As the population ages, the number of patients in whom lung disease develops and who require surgical intervention will continue to rise. When compared with open thoracotomy, video-assisted thoracoscopic surgery (VATS) offers patients significant advantages. Decreased invasiveness results in less blood loss, a lower rate of infection, and less postoperative pain and allows for quicker recovery. ⋯ Proper use, placement, ventilation strategies, and methods to minimize the incidence and treat hypoxia for a double-lumen tube are reviewed. One-lung ventilation poses significant challenges for anesthetists. As a result, adequate preparation during the preoperative, intraoperative, and postoperative phases is essential.
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Anesthesia providers serve a vital role in preventing the transmission of disease by following safe injection practices, yet violations of these standards have occurred. The goal of this study was to determine the extent of unsafe injection practices that exist among student anesthesia providers. An online survey containing 8 yes-no questions that assessed injection practices as outlined by the American Association of Nurse Anesthetists was sent to student registered nurse anesthetists with at least 3 months' clinical experience. ⋯ Furthermore, 71 (22%) have reused a syringe or needle to withdraw medication from a multidose vial, and 160 (49%) have reentered a single-use medication vial to prepare doses for multiple patients. Students also were asked to report their experiences with nurse anesthetists who engaged in these practices. The results demonstrate that additional education on injection safety must take place to improve practice, increase patient safety, and reduce healthcare costs.