AANA journal
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Randomized Controlled Trial Clinical Trial
The addition of clonidine to bupivacaine in combined femoral-sciatic nerve block for anterior cruciate ligament reconstruction.
Clonidine has been shown to prolong sensory analgesia when given as an adjunct to peripheral nerve blocks but has not been evaluated when given in conjunction with a femoral-sciatic nerve block. The purpose of this investigation was to determine whether the addition of clonidine to a femoral-sciatic nerve block would prolong the duration of sensory analgesia in groups of patients undergoing anterior cruciate ligament (ACL) reconstruction. This prospective, randomized, double-blind investigation was performed on 64 subjects undergoing ACL reconstruction. ⋯ No significant differences were noted between groups for pain intensity scores, duration of sensory analgesia, postoperative analgesic requirements, or overall patient satisfaction. Both groups reported minimal amounts of postoperative pain and high analgesic satisfaction scores. Based on our results, we do not recommend the addition of clonidine to a femoral-sciatic nerve block when given to facilitate postoperative analgesia in patients undergoing ACL reconstruction.
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Arterial catheterization for hemodynamic monitoring is used widely in clinical management. Complications of connulation have been recognized since introduction of the technique. This review examines radial, brachial, axillary, and femoral cannulation sites. ⋯ Axillary cannulation provides data closely approximating aortic pressure and poses minimal thrombotic risk but is associated with brachial plexus compression. Femoral cannulation provides a pulse contour approximating aortic with minimal thrombotic risk. There is little evidence to show increased incidence of catheter-related systemic infection at this site.
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The incidence of surgical fires is rising. One agency estimates that the frequency of surgical fires is comparable to that of wrong-site surgery with an incidence of 50 to 100 fires annually. ⋯ This AANA Journal course discusses the need for a clearly formulated plan, rehearsing a response to fires in or on the patient, and clearly designated prevention parameters. As part of the surgical team, the vigilance and dedication of nurse anesthetists can lead the efforts to prevent adverse outcomes from surgical fires.
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An increasing number of surgical patients preoperatively are taking anticoagulant medications. These patients are at an increased risk for development of epidural hematoma with spinal or epidural anesthesia. It is the responsibility of the anesthesia provider to understand and anticipate this risk and to alter the anesthetic plan accordingly. ⋯ Antiplatelet drugs, oral anticoagulants, heparin, low-molecular-weight heparin, other new anticoagulants, and herbal medications are reviewed. When spinal or epidural anesthesia is considered for a patient who has been taking anticoagulant medications, the risk of epidural hematoma vs the benefits of regional anesthesia must be weighed carefully. Appropriate management of the patient extends well into the postoperative period and should include anesthesia providers, attending physicians, and nurses.