AANA journal
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Case Reports
Postoperative respiratory depression and unresponsiveness following epidural opiate administration: a case report.
The profound segmental antinociception that epidural opioids offer has increased their use over the last 2 decades. Though side effects may accompany the use of epidural opioids, clinicians have found that the advantages far outweigh the disadvantages. The following case report outlines a patient's postoperative course in which she experienced respiratory depression while receiving epidural opioids. The pharmacokinetics of lipophilic vs hydrophilic opioids in relation to the occurrence of respiratory depression is discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of needle size on success of transarterial axillary block.
The transarterial approach to brachial plexus block is a well-established method of producing anesthesia of the upper extremity. However, it is associated with a failure rate of 20% to 30%. Failure may be secondary to the common use of a relatively long needle, which can penetrate the posterior wall of the sheath and result in inadvertent injection of the local anesthetic into the surrounding tissue. ⋯ Success was defined as no discomfort at the time of incision. Success rates were compared using a chi 2 test, and a P value of less than .05 was considered significant. The overall success rate was significantly higher with the 26-gauge, 1/2-in needle (42/48 [88%]) than with the 22-gauge, 1 1/2-in needle (39/49 [69%]; P = .035).
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Emergency and unexpected difficult airway management can rapidly deteriorate into a critical airway event such as "cannot ventilate, cannot intubate" (CVCI). A critical airway event (i.e., inadequate mask ventilation, failed intubation, and CVCI) can be resolved by rescue ventilation, thus avoiding potential neurological disability or death. Recommended options include use of the larygeal mask airway, the esophageal-tracheal Combitube (ETC; Tyco-Healthcare-Nellcor, Pleasanton, Calif), transtracheal jet ventilation, or a surgical airway. ⋯ The SIB primarily assesses ETC location within the esophagus or the trachea; the carbon dioxide detector also permits monitoring lung ventilation. Use of the ETC in prehospital, emergency medicine, and anesthesia settings, including ETC advantages, contraindications, and reported complications will be reviewed in Part 2. How to safely exchange the ETC for a definitive airway also will be reviewed.
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The purpose of this article is to report the results of the 2001 Professional Practice Analysis performed by the Council on Certification of Nurse Anesthetists. This analysis was used to validate the content and test specifications for the National Certification Examination. A total of 2,545 surveys were mailed to 2 groups of Certified Registered Nurse Anesthetists and 1,197 surveys were returned, a response rate of 47%. ⋯ The results from this survey were consistent with previous surveys. The Rasch rating scale model was used to transform the results from ordinal data into a linear measure of the item frequency and importance. Members of the Council on Certification of Nurse Anesthetists carefully reviewed all the survey results and voted to maintain the current test specifications and percentages.
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This study describes the correlation between anesthesia providers by type (Certified Registered Nurse Anesthetist [CRNA] or anesthesiologist) and their respective rural or urban distributions across America. Analyses are based on county level data contained in several distinct databases with a given assumption that most providers practice and reside in the same rural or urban designation category. ⋯ Overall, analyses indicate that out of a total of 3,140 counties, there are 843 counties in the United States where neither anesthesiologists nor CRNAs reside. Ninety-seven percent (816) of these counties are nonmetropolitan.