AANA journal
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Biography Historical Article
AANA's first annual meeting: the first-fruit of an adventure.
The75th Annuual Meeting of the American Association of Nurse Anesthetists will take place this year in Minneapolis, Minnesota. This column looks back at the Association's first Annual Meeting, held September 13-75, 1933, in Milwaukee, Wisconsin. Discussion includes Gertrude Fife's and Helen Lamb's work in organizing the meeting and the program, a day-by-day look at the meeting events and speakers, and the response to first Annual Meeting.
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The Ohmeda Universal Portable Anesthesia Complete (U-PAC) draw-over anesthetic system is active in the US Army inventory. It is standard equipment for Certified Registered Nurse Anesthetists assigned to US Army Forward Surgical Teams and Joint Special Operations Command. The purpose of this article is to describe a practical and field-expedient U-PAC draw-over vaporizer setup used during Operation Iraqi Freedom I (February 2003 to July 2003). ⋯ This setup strengthens the standard U-PAC draw-over system delivery because it increases fractional inspired oxygen concentrations, promotes hands-free operation, enhances circuit cleanliness reducing cross contamination, and provides an alternate method for draw-over anesthesia administration in austere conditions when a ventilator may not be available or practical. It integrates and builds on the core concepts of draw-over anesthesia delivery in the literature. The Gegel-Mercado setup is combat proven.
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Randomized Controlled Trial
The effectiveness of 4% intracuff lidocaine in reducing coughing during emergence from general anesthesia in smokers undergoing procedures lasting less than 1.5 hours.
Coughing commonly occurs in patients emerging from general endotracheal anesthesia and is prominent in smokers due to underlying airway irritation. Clinical techniques used to mitigate emergence coughing include intravenous narcotics, intravenous or topical lidocaine, and deep extubation. Reduction of coughing by instilling lidocaine into the endotracheal tube cuff has been shown to be effective in long cases. ⋯ The control group received 5 mL of saline, and the experimental group received 5 mL of 4% lidocaine. On emergence, the anesthesia provider counted and recorded the number of coughs before awake extubation. This study did not show a correlation between use of intracuff lidocaine and a decrease in emergence coughing in procedures lasting less than 1.5 hours in patients who smoke.
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Even though the supply of blood products has never been safer, disease transmission remains the chief patient concern about transfusions. The primary concerns for anesthetists center on risks associated with blood transfusions, such as transfusion-related acute lung injury, anaphylactic transfusion reaction, clerical errors resulting in ABO incompatibility, and blood products contaminated with infectious organisms. These concerns, combined with patients' religious tenets and other factors, have contributed to renewed efforts to minimize blood transfusion without negative patient consequences. Achieving this goal requires a concerted effort by surgeons, perioperative nurses, and anesthesia providers.
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The use of antifibrinolytic therapy is commonplace in coronary artery revascularization procedures. Cardiac surgery accounts for more than 700,000 surgeries per year, with approximately 70% of these cases requiring antifibrinolytic therapy for coronary artery bypass graft (CABG) procedures. ⋯ However, new data have emerged regarding an increase in adverse outcomes associated with serine protease inhibitors. The purpose of this review article is to describe the clinical significance of antifibrinolytic therapy and the current implications associated with its use.