AANA journal
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Fires in the operating room continue to present a hazard to patients, at times with catastrophic and debilitating results. Recent data from closed claim files reveal oxygen, electrosurgical unit (ESU), and surgical drapes are common components of the fire triangle in the operating room. In this era of biotechnological sophistication, why are surgical drapes flammable? The purpose of this study was to test the flammability of different surgical drape materials and to determine the time to ignition using a bipolar ESU device in 21%, 35%, and 100% oxygen concentrations. ⋯ Time to ignition decreases with increasing concentrations of oxygen as expected. One of the surgical drapes tested was advertised to the hospital as nonflammable. Future research should focus on surgical drape materials and aim to reduce the flammability of such items in the operating room.
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Randomized Controlled Trial Comparative Study
Labor epidural anesthetics comparing loss of resistance with air versus saline: does the choice matter?
This study examined whether air or saline, used for the loss-of-resistance (LOR) technique, resulted in a difference in pain relief or adverse events for laboring parturients. Previous studies had mixed findings regarding the onset of analgesia and subsequent pain relief. Research questions were as follows: Is there difference in analgesic onset for patients receiving air vs saline during the LOR technique? Do women receiving the air method for LOR experience any difference in the quality of pain relief from that of women receiving saline? Is there any difference in the incidence of analgesic distribution or segmental pain relief in women receiving the air vs the saline method? Is there any difference in the incidence of adverse effects in women receiving air vs saline during the LOR technique? This was an experimental, prospective study with 50 women. ⋯ A dermatome level recorded the spread of analgesia. No significant differences were found between groups for onset or quality of analgesia. There was a significant increase in the number of subjects who experienced segmental blocks after receiving air during the LOR technique.
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This case study describes a 51-year-old, ASA physical status II Hispanic man who underwent liposuction to the anterior neck and resection of adipose tissue of the posterior neck. The patient was diagnosed with multiple symmetric lipomatosis, better known by its eponym, Madelung disease. This disease is characterized by abnormal adipose tissue growth primarily in the neck and shoulder regions. ⋯ In addition, flexion and extension of the neck was limited by a minimum of 20 degrees because of the pathology. The patient was deemed as having a difficult airway, and an awake fiberoptic intubation was planned and used successfully. The subsequent surgical procedure progressed without incident, and the patient was transferred to a stepdown unit for monitoring of his airway postoperatively.
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Review Case Reports
Isoproterenol-induced elevated bispectral indexes while undergoing radiofrequency ablation: a case report.
The use of bispectral index (BIS) for monitoring neuronal function under general anesthesia has been expanding in practice. However, the meanings of the values are not always clear and have been shown to be altered by such drugs as ketamine, ephedrine, and physostigmine. ⋯ The patient reported no intraoperative recall despite BIS values in the high 70s. This case reinforces that BIS values require interpretation and can only be relevant to the circumstances of the individual case.
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Preoperative cardiac assessment has become an integral part of contemporary anesthesia practice. Simple clinical markers can identify high-risk patients, but the question of how to reduce cardiac complications among high-risk patients has been controversial. Good quality randomized controlled trials have showed that neither preoperative coronary revascularization nor the placement of pulmonary artery catheters reduces perioperative cardiac complications. ⋯ The data supporting these conclusions are reviewed in an evidence-based manner. At present, it is prudent to treat moderate- to high-risk patients undergoing elective surgery with beta-blockers if possible. Because not all patients are candidates for beta-blocker therapy, data regarding the perioperative use of alternative medications to reduce perioperative cardiac complications have been explored and are reviewed.