AANA journal
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The case of Brase v Rees was presented before the US Supreme Court to consider the constitutionality of death by lethal injection as practiced in the state of Kentucky. The 3-drug combination of sodium thiopental, pancuronium bromide, and potassium chloride is a key aspect in question. Capital punishment conflicts with medical and nursing code of ethics preventing providers who are skilled at difficult intravenous (IV) access, assessment of appropriate sedation, and involvement without fear of disciplinary action. ⋯ Participation by skilled medical personnel has been a debate between the medical and legal communities since the inception of lethal injection. Healthcare should reevaluate the ethical and moral principle of beneficence as the legal system attempts to evaluate the constitutionality of lethal injection. Can a nurse or doctor step out of the role of medical professional, use knowledge and skill to make death by lethal injection more humane, and not violate the ethical principle of "do no harm"?
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Dexmedetomidine is a relatively selective alpha2 agonist with sympatholytic, sedative, amnestic, and analgesic properties. It is indicated for the short-term sedation of patients needing mechanical ventilation in the intensive care unit. ⋯ This article will provide the reader with a comprehensive review of the pharmacology, pharmacokinetics, and adverse effects of dexmedetomidine. A thorough understanding of this drug will enable the anesthesia provider to determine situations in which dexmedetomidine may be a useful drug to consider, whether as an adjunct or as a sole agent.
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This case report details the onset of masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis following a sevoflurane mask induction and succinylcholine administration in a 12-year-old boy. The patient had no family or personal history of neuromuscular disease or malignant hyperthermia. ⋯ Subsequent to this event, it was recommended that the patient undergo a workup for neuromuscular disease and malignant hyperthermia with muscle biopsy. Until this workup is completed, the family should advise anesthesia providers that the patient is "malignant hyperthermia susceptible." Masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis will be thoroughly discussed in this article.
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Review Case Reports
Methylene blue for refractory hypotension: a case report.
Methylene blue has multiple indications for use, but recently it has been shown to be useful in treating refractory hypotension. Anaphylaxis results in widespread vasodilation and hypotension. Epinephrine has been described as the drug of choice in the treatment of hypotension for anaphylaxis, but the increased heart rate may be poorly tolerated by some patients. ⋯ Furthermore, the patient required a decreased amount of vasoactive agents in the postoperative course. The suspected mechanism of action of methylene blue is inhibition of the enzyme nitric oxide synthase, which ultimately prevents the smooth muscle dilation that accompanies anaphylaxis. Methylene blue may be a valuable adjunct in the treatment of anaphylaxis and other causes of refractory hypotension.
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The use of a cuffed endotracheal tube (ET) has been discouraged in children up to 8 years of age. Recent literature suggests that this age-old argument is empirical rather than scientifically based. This AANA Journal course will examine the history of pediatric endotracheal intubation, suggested methods for choosing the appropriately sized ET emerging literature describing the advantages and disadvantages of the use of the cuffed ET in young children, and potential clinical problems that develop with the use of the currently available, manufactured, cuffed pediatric ETs.