AANA journal
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Muscle relaxants are routinely administered during anesthesia. The residual effects of nondepolarizing muscle relaxants must be reversed by the anesthesia provider prior to extubation of the trachea to ensure that patients can safely protect their own airways and maintain adequate ventilation. ⋯ This article describes the anesthetic management of a patient who experienced postoperative residual muscle weakness secondary to unsuspected hyperkalemia. A discussion of potassium's role in membrane excitability and factors that must be considered in the differential diagnosis of residual neuromuscular weakness is included.
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This study examined occupational stress in Certified Registered Nurse Anesthetists (CRNAs) practicing with anesthesiologists in anesthesia care team (ACT) settings. The focus was to examine the relationships among CRNA scope of practice (SOP) in ACTs, collaboration, and role-related occupational stress. A survey questionnaire was mailed to CRNAs from the 6 New England states, with a return rate of 30.87% (n = 347). ⋯ Respondents with a broader SOP reported higher collaboration than those with restrictions. Respondents reporting a broader SOP also experienced increased job stress in relation to role overload but used coping resources effectively. Implications for future studies include exploring strategies that achieve consensus between CRNAs and anesthesiologists in ACTs, emphasizing clearly defined roles and optimizing productivity.
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Despite great strides during the preceding 3 decades, the ability to consistently eliminate postoperative nausea and vomiting (PONV) continues to elude anesthesia practitioners. The occurrence of PONV related to anesthesia and surgery prolongs hospital stays and increases healthcare costs. Protracted recovery times place constraints on patients, healthcare systems, and healthcare financiers. ⋯ Eastern culture, on the other hand, relies heavily on naturopathic remedies whose successful use has spanned thousands of years. Increasing attention has been given to the potential benefits of nonpharmacological intervention for the prevention of PONV in association with anesthesia care. Therefore, the purpose of this AANA Journal course will be to focus attention on what is known and what is unknown in the literature regarding use of the nonallopathic remedy of acupressure as a nonpharmacological alternative to commonly utilized antiemetic prophylaxis.
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The alpha2-agonist dexmedetomidine is indicated for sedation of patients receiving mechanical ventilation in the intensive care unit. It has additional off-label uses for coadministration with local, regional, and general anesthesia. This report describes the use of dexmedetomidine as a sole sedating agent in conjunction with local anesthesia for major vascular surgery. ⋯ Dexmedetomidine should be used judiciously, and understanding the potential adverse effects and how to treat them is of paramount importance. However, with vigilant intraoperative monitoring of blood pressure, heart rate, and level of consciousness, it can be administered safely, thus lessening the anesthetic requirements and possibly improving the surgical outcome of the high-risk patient. This report describes the indications, dosing, off-label uses, pharmacodynamics, pharmacokinetics, and common adverse effects of dexmedetomidine.