AANA journal
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The purpose of this study was to systematically review the instruments used to obtain anesthesia-specific patient satisfaction data and to determine the degree to which each instrument controlled for measurement error bias, such as poor survey design. By using an assessment and evaluation tool developed for the present study that held proven internal reliability and construct validity, we analyzed and scored each instrument according to the presence or absence of measurement error in survey design. ⋯ One instrument, the Iowa Satisfaction With Anesthesia Scale (ISAS), developed by Dexter et al (1997), was the first found to inculcate scientifically accepted psychometric item construction algorithms, an indicator of measurement reliability. Although the ISAS holds substantial potential for future application in this realm, we recommend that it be refined further and that the search for a superlative instrument to obtain anesthesia-specific patient satisfaction continue.
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Randomized Controlled Trial Comparative Study Clinical Trial
Ondansetron versus dolasetron: a comparison study in the prevention of postoperative nausea and vomiting in patients undergoing gynecological procedures.
The purpose of this study was to determine if 4 mg of ondansetron and 12.5 mg of dolasetron were equally effective in preventing postoperative nausea and vomiting (PONV) in patients undergoing gynecological procedures. While the overall incidence of PONV appears to be 25% to 35%, the incidence among this patient population is considerably higher. Patients were assigned to 1 of 2 antiemetic treatment groups. ⋯ Data collection occurred perioperatively and in the 24 hours following surgery. chi 2 determined there was no statistical difference between groups related to emesis in the postanesthesia care unit (PACU), emesis in the 24 hours following surgery, and side effects. Results of this study showed there was no statistically significant difference between 4 mg of ondansetron or 12.5 mg of dolasetron when administered at the end of surgery for preventing PONV in patients undergoing gynecological procedures. Given the cost difference between these 2 antiemetics, there is a potential for significant cost savings in this high-risk patient population.
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Emergency and unexpected difficult airway management can rapidly deteriorate into a critical airway event (e.g., inadequate mask ventilation, failed tracheal intubation, or cannot ventilate-cannot intubate). Recommended options to resolve a critical airway event include the laryngeal mask airway, the esophageal tracheal Combitube (ETC; Tyco-Healthcare-Nellcor, Pleasanton, Calif), transtracheal jet ventilation, or a surgical airway to avoid potential neurological disability or death. Part 1, which was published in the February 2004 AANA Journal, reviewed use of the ETC in combination with the self-inflating bulb and/or portable carbon dioxide detector as an effective rescue airway system. ⋯ Part 2 reviews ETC advantages, contraindications, and reported complications in prehospital, emergency medicine, and anesthesia settings. Safe methods to exchange the ETC for a definitive airway also are described. Major ETC advantages include the following: (1) easy to learn, (2) can be inserted rapidly, (3) effectively secures the airway, (4) provides adequate lung ventilation, (5) minimizes aspiration risks, (6) facilitates application of high ventilatory pressures, and (7) can be exchanged safely for a definitive airway without compromising airway control or protection.
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Recent epidemiological research places the incidence of obstructive sleep apnea as high as 16% in the general population. Serious postoperative respiratory complications and death have been reported in this population. Anesthetic drugs contribute to these complications secondary to acute and residual influences on the complex orchestration of airway muscles and reflexes involved in airway patency. ⋯ The model postulates the oropharynx as a collapsible tube. The oropharynx remains open or partially or completely closed as a result of pressure upstream at the nose and mouth, pressure downstream at the trachea and below, or tissue pressure surrounding the oropharynx. This AANA Journal course provides an overview of the Starling resistor model, its application to obstructive sleep apnea, and preoperative and postoperative anesthetic considerations.