AANA journal
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Emergence agitation (EA) can be a distressing side effect of pediatric anesthesia. We retrospectively reviewed the records of 7 pediatric oncology patients who received low-dose ketamine in conjunction with propofol for total intravenous anesthesia (TIVA) repeatedly for radiation therapy. EA signs were observed in all 7 patients in association with propofol TIVA but did not recur in any of 123 subsequent anesthetics sessions during which low-dose ketamine was added to propofol. Based on this experience, we suggest that low-dose ketamine added to propofol may be associated with prevention of EA in children with a history of EA with propofol TIVA.
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This study examined whether combining lipid emulsion and advanced cardiac life support (ACLS) improves survival in an unanesthetized swine model of bupivacaine- and hypoxia-induced cardiovascular collapse. Arterial and venous catheters and a tracheostomy were surgically placed in 26 swine receiving inhalation anesthesia. After a 1-hour recovery period, bupivacaine (5 mg/kg) was administered intravenously over 15 seconds. ⋯ There was no significant difference in survival between the saline group (4/12, 33%) and lipid emulsion group (6/12, 50%; P > .05). Additionally, there was no significant difference between groups of surviving animals in the time to ROSC (P > .05). The combination of lipid emulsion and ACLS did not improve survival from bupivacaine- and hypoxia-induced cardiovascular collapse in unanesthetized swine.
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Postoperative visual loss (POVL) is a rare but catastrophic complication after nonocular surgery. Previously POVL has been reported in lengthy, prone, lateral, or cardiopulmonary cases, with extreme blood loss, hemodilution, and hypotension. The author's index case of POVL following a lengthy operation in steep Trendelenburg position (ST) prompted study of the relationship between intraocular pressure (IOP), mean arterial pressure (MAP), and time spent in ST. ⋯ The OPP ranged from 50 to 82 mm Hg at start of surgery and from 21 to 75 mm Hg after 120 minutes. Increased IOP and reductions in OPP in relationship to position change were statistically significant (P < .001), with OPP falling below IOP in 10 cases. Findings suggest a relationship between prolonged ST and reduced OPP, challenging the accepted view that cerebral and ophthalmic circulatory autoregulation prevents elevated compartment pressures and reductions in perfusion.
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Recent research reaffirms that Certified Registered Nurse Anesthetists (CRNAs) are critical to the delivery of anesthesia in the United States and argues persuasively for the removal of barriers-including supervision requirements--that prevent CRNAs and other advanced practice registered nurses (APRNs) from practicing to the full extent of their education and training. As we as a nation strive to make healthcare accessible, ever safer, and affordable, the health system must use anesthesia professionals as efficiently as possible. Repealing the federal Medicare physician supervision requirement for nurse anesthetists is an important step toward achieving this goal.