AANA journal
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With more surgical procedures than ever before being performed in office settings, office-based anesthesia is a rapidly growing area of anesthesia practice. Although there are many advantages to office-based practice, limitations inherent to this setting, if not recognized and addressed, may threaten patient safety. ⋯ Anesthesia for cosmetic surgery procedures in the office setting is frequently performed under monitored anesthesia care (MAC) with its own unique safety considerations. Anesthetists practicing in office-based cosmetic surgery practices must understand the special characteristics of this setting, the MAC-based approach often used, the anesthesia and safety considerations for the cosmetic surgical procedures performed, and the importance of prophylaxis for venous thromboembolism.
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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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Anesthesia is generally accepted as safe in most adult populations; however, in pediatric patients questions exist regarding the potential for long-term detrimental effects. Various anesthetic agents are associated with neuronal degeneration when administered to neonatal animals. The mechanism of damage is thought to be via accelerated apoptosis, a normally beneficial process in the maintenance of homeostasis. ⋯ Clear evidence exists that neuronal apoptosis occurs when anesthetics are administered to neonatal rodents and primates, and behavioral and cognitive testing from some authors indicate long-term effects persist well into an animal's adulthood. Preliminary human trials reveal a link between anesthesia and subsequent developmental delays. This review of the literature clarifies the need for further research in humans.
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Airway management following severe gasoline burn injury can be difficult. Because patients with severe burns may be treated at a variety of hospitals that provide emergent care, it is valuable for Certified Registered Nurse Anesthetists who work in such facilities to have an understanding of the care of these patients. Airway management is an extremely important consideration in the care of burn victims. ⋯ This article reports the experience of caring for a female who was involved in an altercation, doused with gasoline, and set on fire. Consequently, airway obstruction developed and progressively worsened. Airway management interventions began with bag-valve-mask-assisted ventilation and progressed through orotracheal intubation attempts, attempts to insert a laryngeal mask airway, cricothyrotomy, emergency tracheostomy, and surgical tracheostomy.
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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.