AANA journal
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Economic assumptions and other factors affecting the economics of nurse anesthesia education are presented in Part 2 of this 2-part column. In Part 1, published in the October 2004 issue of the AANA Journal, general economic principles and healthcare economic principles in particular were described, explained, and related to the current US healthcare system.
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Knee arthroscopy is one of the most common orthopedic procedures done in the United States. It usually is performed as an outpatient procedure. This retrospective study was designed to assess the level of postoperative analgesia provided by the local knee block. ⋯ The severity of the knee pain was assessed using verbal pain rating scores during the anesthesia recovery period, before patients left the hospital, and again on the first postoperative day. Patients in group 2 had significantly lower pain scores compared with patients in group 1 during these periods. Results suggest that the local knee block provides superior postoperative analgesia for the knee arthroscopy patient.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia and effectiveness of levobupivacaine compared with ropivacaine in patients undergoing an axillary brachial plexus block.
A common anesthetic technique for the upper extremity is local brachial plexus anesthesia using levobupivacaine and ropivacaine. To our knowledge, no study has been performed measuring differences in analgesic efficacy and latency when these local anesthetics are used for brachial plexus anesthesia. We enrolled 54 adults, assessed as ASA class I or II, into this double-blind, prospective investigation to receive 40 mL of 0.5% ropivacaine or levobupivacaine with 1:200,000 epinephrine. ⋯ Return of motor activity was significantly faster in the ropivacaine group (778 minutes) than in the levobupivacaine group (1,047 minutes; P = .001). No other significant differences were noted between the groups. When considering levobupivacaine and ropivacaine for brachial plexus anesthesia, levobupivacaine should be considered when postoperative analgesia is a concern but not when an early return of motor activity is required.
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The purpose of this article is to discuss the benefits, safety, and efficacy of the laryngeal mask airway (LMA) and identify the risks and misconceptions associated with LMAs when used with positive pressure ventilation (PPV). Despite the abundance of supporting evidence that LMAs may be used successfully in a variety of age groups and surgical procedures using PPV, many anesthesia providers are still reluctant to choose an LMA when PPV is needed. This reluctance emerges from the misconception that when using an LMA with mechanical ventilation, there is an increased incidence of gastric insufflation, failed ventilation, and pulmonary aspiration. When compared to other airway adjuncts, however, the LMA is a safe, effective means of delivering ventilation under anesthesia.
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Decreased visual acuity and loss of visual ability are devastating anesthetic and surgical complications. The incidence is greater in patients with preexisting hypertension, diabetes, sickle cell anemia, renal failure, gastrointestinal ulcer, narrow-angle glaucoma, vascular occlusive disease, cardiac disease, arteriosclerosis, polycythemia vera, and collagen vascular disorders. Precipitating factors for ischemic optic neuropathy include prolonged hypotension, anemia, surgery, trauma, gastrointestinal bleeding, hemorrhage, shock, prone position, direct pressure on the globe, and long operative times. ⋯ Unacceptable hemoglobin and hematocrit values should be corrected preoperatively and levels monitored during the case to avoid intraoperative anemia in at-risk patients. The blood pressure of patients with predisposing diseases should be kept within normal limits. To avoid this devastating complication, it is imperative that anesthesia providers understand contributing factors and prevention strategies.