AANA journal
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Patients who are Jehovah's Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. 'Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. Several blood conservation techniques are available for consideration, including acute normovolemic hemodilution. ⋯ Leaving the procured blood continuously attached to the patient through the collection tubing makes the procedure acceptable to most Jehovah's Witness patients. Current literature is unclear when this technique should be used. In this particular case, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah's Witness who was undergoing major surgery.
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The American Association of Nurse Anesthetists (AANA) is committed to advancing evidence-based nurse anesthesia practice. This determination is evident across multiple activities within the Association. This editorial describes the AANA's evidence-based policy and process for the development of those practice-related documents that require approval from the AANA Board of Directors. Additionally, several of the Association's initiatives geared toward fostering the advancement of evidence-based nurse anesthesia practice are described.
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Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. Does the placement of epidural catheters risk the introduction of tattoo pigment dyes into the epidural space through the process of coring? Are there specific risks associated with tattoo dyes and epidural needle placement? We performed a comprehensive review of the literature using multiple search databases with the intent to form guidelines for practice using a level of evidence taxonomy. ⋯ Continued investigation is necessary before comprehensive practice guidelines regarding the practice of placing epidural needles and catheters through lumbar tattoos can be developed. We suggest avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.
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Comparative Study
Patient outcomes comparing CRNA-administered peripheral nerve blocks and general anesthetics: a retrospective chart review in a US Army same-day surgery center.
We compared outcomes between patients receiving general anesthesia (GA) vs regional block (RB) in a military same-day surgery unit (SDSU), where Certified Registered Nurse Anesthetists (CRNAs) delivered all RBs and GA. All patient charts from 2003 through 2006 were reviewed. Patients were included if they were 18 years or older, had an ASA physical status I or II, and underwent a shoulder or knee arthroscopy that used either RB or GA. ⋯ The GA group received more morphine equivalents of narcotic in the operating room (22.9 vs 15.1 mg, P < .001) yet still had higher pain scores postoperatively than the RB group (1.1 vs 0.3, P < .001). The GA group received a significantly greater number of antiemetic doses intraoperatively (0.58 vs 0.04, P < .001) but still had a higher, although nonsignificant, rate of emesis (15.5% vs 10.0%). Patients receiving RB had less pain and received less analgesia without any increase in postoperative nausea and vomiting, hospital time, or anesthesia-related complications.
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Familial hyperkalemic periodic paralysis (HYPP) is a rare genetic disorder in which the sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum potassium lead to inactivation of sodium channels, causing episodic weakness or paralysis. Exposure to cold, anesthesia, fasting, emotional stress, potassium ingestion, and rest after exercise can stimulate an attack. ⋯ Careful attention was given to monitoring and maintenance of core temperature, use of insulin and glucose to maintain normokalemia, and carbohydrate loading the night before surgery. The patient recovered from the anesthetic without complication and had pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization.