AANA journal
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The electromyographic endotracheal tube (EMG-ETT) is a relatively new tool used to measure integrity of the vocal cord structures during surgery. We describe a case in which an EMG-ETT was inserted for the operative period but not replaced with an ETT during the immediate postoperative period. ⋯ The patient was not provided the pulmonary toilet necessary until the EMG-ETT was removed and replaced with a regular ETT. The purpose of this article is to make anesthesia providers aware that when mechanical ventilation is required during the postoperative period, the EMG-ETT should be removed and replaced with a regular ETT to facilitate pulmonary toilet.
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Gamma cyclodextrin and purified plasma cholinesterase are 2 novel pharmacological agents being investigated as to their suitability for antagonism of neuromuscular blockade. Both of these agents are devoid of cholinergic stimulation and the accompanying side effects because their action is independent of acetylcholinesterase inhibition. Gamma cyclodextrin antagonizes the steroidal neuromuscular blocker rocuronium via the chemical encapsulation of the molecule forming a "host-guest" complex through van der Waals and hydrophobic interactions in the plasma. ⋯ Org 25969, a modified gamma cyclodextrin, will antagonize profound neuromuscular block induced by rocuronium in approximately 2 minutes. A commercial preparation of purified human plasma cholinesterase has been shown to be effective in reversing succinylcholine or mivacurium-induced block. Administration of exogenous plasma cholinesterase also has been shown to be effective in antagonizing mivacurium-induced neuromuscular block, cocaine toxicity, and organophosphate poisoning.
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Clinical Trial Controlled Clinical Trial
The use of a computer website prior to scheduled surgery (a pilot study): impact on patient information, acquisition, anxiety level, and overall satisfaction with anesthesia care.
Scheduled surgery can often be a stressful time for patients. While anesthesia providers give a full explanation of care to the patient, research suggests that anxiety and time constraints imposed by the system may hinder the amount and quality of information provided. Use of technology to augment dissemination of information may have an impact. ⋯ The experimental group had a significant increase in posttest mSALT scores (P = .004). Neither the experimental nor the control group had a significant change in posttest state anxiety (P = .279 and .762) or trait anxiety (P = .823 and.570). The experimental group differed significantly from the control group in satisfaction with teaching (P = .019).
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Review Historical Article
AANA journal course: Update for nurse anesthetists--part 6--The long-term use of opiates for pain control: Laputa revisited?
Research seeking to resolve issues regarding the use of opiate analgesia in treating non-cancer-related chronic pain is confusing. In caring for a patient experiencing pain, the relief of pain is the primary objective. ⋯ Specifc and measurable outcomes of functionality are available to guide use; attention to these may help to significantly improve outcome of long-term opiate therapy. This course provides an evidence-based approach to selecting and using opiates in the management of chronic, non-cancer-related pain, critiquing the appropriateness of the associated intervention(s).
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Inadvertent postoperative hypothermia is common among patients in the postanesthesia care unit (PACU). Shivering traditionally is attributed to hypothermia, but it is not always thermoregulatory. The exact impact of hypothermia and shivering on standard PACU monitoring parameters of patients has not been sufficiently studied. ⋯ Our data confirm that standard PACU monitoring parameters are affected partially by hypothermia and shivering. A low incidence of shivering in normothermic patients and a high incidence of shivering in younger patients are discussed. Limitations of this study are reported.