AANA journal
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Patients are admitted for surgery while taking a wide array of medications, and nurse anesthetists must evaluate their effectiveness and compatibility with anesthesia. Anesthetists must be familiar with the basic pharmacology of each drug and the potential adverse effects and possible drug interactions that may occur when anesthetic drugs are administered. If a medication requires discontinuation, we must ensure that the patient's disease remains controlled throughout the perioperative period. ⋯ Most medications taken for minor disorders that do not have systemic effects can be safely continued without incident. Some medications may require discontinuation or temporary alteration of the dosing schedule to avoid problems in the perioperative period. This course reviews the current literature regarding the anesthetic management of several commonly encountered drug classes.
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Case Reports
Multidisciplinary management of peripartum cardiomyopathy during repeat cesarean delivery: a case report.
Peripartum cardiomyopathy is a potentially fatal form of heart failure associated with pregnancy. A 29-year-old African American woman, gravida 3, para 2, at 36 weeks' gestation had a history of cardiomyopathy, morbid obesity (body mass index > 70 kg/m2), uncontrolled hypertension, obstructive sleep apnea, and required a repeat cesarean delivery. ⋯ This case report illustrates the recognition of peripartum cardiomyopathy and the risks early in pregnancy. It also describes the appropriate medical management, including transesophageal echocardiography and the need for collaboration of multiple medical specialists before and during delivery to provide the best possible outcome for both mother and infant.
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An innovative partnership with Kaiser Permanente's Institute for Culturally Competent Care (ICCC) enabled the Kaiser Permanente School of Anesthesia/California State University Fullerton (KPSA) to present a formal, 4-module cultural competency certification program within the nurse anesthesia curriculum. The goals of developing the cultural competency curriculum were to increase students' awareness of cultural differences and to enhance students' communication skills with an increasingly diverse patient population. ⋯ The collaboration between the ICCC and KPSA represents a unique opportunity for the organization and for KPSA to have an impact on patient care. This article describes the genesis and evolution of the collaboration as well as the impact of this ongoing educational effort.
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Randomized Controlled Trial Comparative Study
Comparison of 2 laryngeal tracheal anesthesia techniques in reducing emergence phenomena.
Endotracheal intubation (ETT) can cause emergence phenomena (EP) including coughing, sore throat, and dysphonia. Two methods used to prevent EP are the administration of local anesthetics directly onto airway structures using a specialized laryngotracheal instillation of topical anesthesia (LITA) tube (Sheridan Catheter Corporation, Argyle, New York) or the placement of a local anesthetic into the ETT cuff. The purpose of this study was to determine which method was better at preventing ERl In this prospective, randomized, comparative analysis, a sample of 160 ASA class I through III patients were randomly assigned to receive their EP prophylaxes either by placement of alkalinized lidocaine directly into the ETT cuff at intubation or by injection into a specialized port on the LITA tube approximately 30 minutes before extubation. ⋯ The incidence of cough and sore throat was higher in the LITA group, achieving significance in the postanesthesia care unit and after discharge to home. No difference in any of the other variables was noted between groups. Our study demonstrated greater efficacy in decreasing the incidence and severity of EP by placing an alkalinized solution of lidocaine into the ETT cuff on intubation.