AANA journal
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Letter Case Reports
Experience with a patient having multiple gunshot wounds in combat.
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Randomized Controlled Trial Comparative Study
The effectiveness of inhalation isopropyl alcohol vs. granisetron for the prevention of postoperative nausea and vomiting.
We evaluated preemptive treatment for postoperative nausea and vomiting (PONV) with intravenous (IV) granisetron, 0.1 mg, introoperatively as compared with the use of 70% inhalation isopropyl alcohol and a control group for the prevention of PONV. We randomly assigned 57 women, 18 to 50 years old, undergoing laparoscopic procedures to 1 of 3 groups: (1) inhalation of 70% isopropyl alcohol, (2) 0.1 mg granisetron IV, and (3) no prophylactic treatment control. Participants were asked to rate their nausea and vomiting preoperatively, on arrival to postanesthesia care unit (PACU), at discharge from PACU, 6 hours after extubation, and 24 hours after extubation and any occurrence of nausea and vomiting using the numeric rating scale (NRS), 0 to 10. ⋯ There were no significant differences among the 3 groups in demographics, first episode of PONV, total number of episodes in 24 hours, NRS rating at rescue, and anesthetic duration. PONV and menstrual cycle phase had no positive correlation (P > .05). History of smoking, PONV, and motion sickness had no significant difference against any measure of PONV (P > .05).
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Case Reports
Double-lumen endotracheal tube for one-lung ventilation through a fresh tracheostomy stoma: a case report.
For one-lung ventilation in many surgical cases, double-lumen endotracheal tubes are the first-line choice for airway management. For most cases, double-lumen endotracheal tubes are faster, easier to place, cheaper, and less prone to malposition than today's bronchial blocker devices. This report describes an elective tracheostomy and the use of a double-lumen endotracheal tube directly through the fresh stoma site for a 55-year-old man with a known difficult airway who had undergone a left-sided radical neck dissection and postoperative radiation 10 years earlier. ⋯ During the past decade, unique modifications of the use of bronchial blockers and their use with tracheostomies have been reported. Complications have been reported with double-lumen endotracheal tubes and with more recent classic and modified uses of the bronchial blockers. This article discusses appropriate preoperative patient selection and intraoperative airway management plans for the modified use of one-lung anesthesia airway devices with an emphasis on use with tracheostomies.
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Comparative Study
The effects of valerian on the time course of emergence from general anesthesia in Sprague-Dawley rats (Rattus norvegicus).
Herbal use may be associated with increased morbidity and mortality as a consequence of interactions with anesthetic agents. The purpose of this study was to investigate the effects on emergence from isoflurane anesthesia using a combination of the herb valerian and midazolam compared with valerian alone, midazolam alone, and no additional drug-herb treatment in Sprague-Dawley rats. We assigned 32 male Sprague-Dawley rats to 1 of 4 groups: (1) isoflurane alone, (2) isoflurane plus valerian, (3) isoflurane plus midazolam, and (4) isoflurane plus a combination of valerian and midazolam. ⋯ A 1-way analysis of variance with a post hoc Scheffe procedure revealed that animals given a combination of midazolam and valerian took significantly longer to emerge from anesthesia (F = 58.21; P < .00) compared with all other groups. Awareness of possible interactions of herbals with conventional anesthetics is important so that potential problems may be recognized and treated. These data demonstrate the need for continued research concerning the effects of herbals and their potential for interaction with anesthetics.