AANA journal
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Current procedures for cleaning anesthesia airway equipment as assessed by the presence of visible and occult blood on laryngoscope blades and handles as labeled "ready for patient use" has been reported to be ineffective. Human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) are 2 commonly seen pathogens that frequently are found in the healthcare setting. It has been shown that HBV can survive on a dry surface for at least 7 days and both HIV and HBV are transmitted via blood. ⋯ To prevent further potential infections, it should be ascertained why anesthesia providers are not all using disposable laryngoscope blades. The purpose of this literature review is to determine the use and infection control practices of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade are reviewed, as well as the perceptions of anesthesia providers regarding disposable laryngoscope blades.
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The purpose of this study was to determine and compare the maximum concentration (C(max)) and time to maximum concentration (T(max)) of epinephrine administered via tibial intraosseous (IO), sternal IO, and intravenous (i.v.) routes in a porcine model of cardiac arrest during cardiopulmonary resuscitation. Five pigs each were randomly assigned to 3 groups: tibial IO, sternal IO, and i.v. Cardiac arrest was induced with i.v. potassium chloride. ⋯ There were significant differences in Cmax between the sternal IO and i.v. (P = .009) and tibial IO and i.v. (P = .03) groups but no significant difference between tibial and sternal IO groups (P = .75). Significant differences existed in Tmax between the tibial IO and i.v. (P = .04) and between tibial IO and sternal IO (P = .02) groups but no difference between the sternal IO and i.v. groups (P = .56). Intravenous administration of 1 mg of epinephrine resulted in a serum concentration 5.87 and 2.86 times greater than for the tibial and sternal routes, respectively.
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Case Reports
Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.
More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. ⋯ This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.
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Cocaine has been associated with acute hemodynamic changes, causing anesthesia providers to be concerned about adverse hemodynamic events during general anesthesia. We sought to determine if there were differences in the prevalence of adverse hemodynamic events, and if hemodynamic instability could be predicted in cocaine-positive patients undergoing general anesthesia for elective surgery. A retrospective cohort study was conducted in 300 (150 cocaine-positive, 150 cocaine-negative) consecutive adults with similar general anesthesia plans who were hemodynamically normal at baseline. ⋯ Slightly more than 50% of subjects were female, but cocaine-positive subjects were significantly more likely to be male (chi2 = 5.9; P = .02). Baseline systolic pressure (P = .001; mean difference, 6.5 mm Hg; 95% confidence interval [CI], 2.7-70.2), mean arterial pressure (P = .04; mean difference, 2.9 mm Hg; 95% CI, 1.0-5.7), and heart rate (P = .02; mean difference, 3.3/min; 95% CI, 0.46-6.2) were significantly higher, but not clinically important in the cocaine-positive cohort. Our study demonstrates that use of drug screen results alone is insufficient to predict the safe administration of general anesthesia in patients undergoing elective surgeries.
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Randomized Controlled Trial Comparative Study
Effects of using simulation versus CD-ROM in the performance of ultrasound-guided regional anesthesia.
The purpose of this study was to determine which method of teaching, CD-ROM, simulation, or a combination of both, was more effective in increasing the performance of ultrasound-guided regional anesthesia. No studies have investigated these methods. The framework for this study was critical thinking. ⋯ The means and standard deviations for pretest and posttest results, respectively, were: CD-ROM, 33 +/- 7%, 41 +/- 9%; simulation, 35 +/- 10%, 49 +/- 13%; and combination, 36 +/- 8%, 64 +/- 17%. The baseline for each group was 0. Use of a combination of CD-ROM and simulation should be considered in teaching ultrasound-guided regional anesthesia techniques.