AANA journal
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Multicenter Study
The role of the nurse anesthetist in the planning of postoperative pain management.
Adequate pain relief after surgery is essential for avoiding pain-associated stress and patient comfort in the postoperative period. The Swedish nurse anesthetist has an important role in the intraoperative management of the surgical patient by assessing and moderating individual physiological response evoked by surgical stimuli during general anesthesia. The extent to which knowledge of specific individual response patterns are used to plan postoperative pain management is unknown. ⋯ Nurse anesthetists (N = 101) at 4 academic hospitals in Sweden responded to a questionnaire focusing, in addition to demographic data, on intraoperative routines for postoperative pain management, perceived clinical relevance of used routines, personal involvement (in addition to existing routines) in postoperative pain management, factors influencing pain alleviation requirements, and the potential role of the nurse anesthetist for improved postoperative pain management. We found that type of anesthesia and type of surgical procedure were both factors considered important for postoperative pain management. A majority of the participants believed that pain management approaches were not appropriately individualized to the patient.
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Case Reports
Severe intraoperative hyponatremia in a patient scheduled for elective hysteroscopy: a case report.
Hysteroscopy is a minimally invasive procedure that may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for visualization of the endometrium. Potential risks include fluid volume overload, uterine perforation, hemorrhage, infection, and the need for immediate hysterectomy. ⋯ Hypotonic, electrolyte-free distention media have the potential to be absorbed in volumes large enough to cause hyponatremia and hypervolemia, complications initially described as transurethral resection of the prostate (TURP) syndrome. Hyponatremia and hypervolemia have been associated with hysteroscopic surgical procedures. The following is a case report detailing the perioperative events of a 40-year-old woman in whom severe hyponatremia developed during an elective hysteroscopy.
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A major responsibility of the nurse anesthetist is providing adequate pain relief. Current research suggests that provider gender, as well as patient gender, may affect the clinical assessment and treatment of pain. Implications of the undertreatment of pain may be avoided if the anesthetist is aware of potential gender bias when approaching a given clinical situation. ⋯ Significantly more male CRNAs (P < .05; chi 2) administered benzodiazepines along with the analgesic (21/74 [28%]) than did female CRNAs (11/59 [19%]); male CRNAs were more likely to administer benzodiazepines as part of their clinical management of cases involving males (13/38[34%]) than female patients (8/36 [22%]); however, this difference was not significant. Pain treatment strategies were indistinguishable between male and female anesthetists, as well as between male and female patients. However, gender-based differences in the use of sedation medication in concert with analgesic medication was an unexpected finding.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of inhaled isopropyl alcohol and intravenous ondansetron for treatment of postoperative nausea.
Postoperative nausea, a common complication in patients receiving general anesthesia, was studied in this randomized investigation to compare the efficacy of 70% inhaled isopropyl alcohol and intravenous ondansetron. For the study, 100 healthy women, ASA physical status I or II, scheduled for outpatient gynecologic laparoscopic procedures randomly received 4 mg of intravenous ondansetron or isopropyl alcohol for the treatment of postoperative nausea. Nausea was measured on arrival to the postanesthesia care unit, at first complaint of nausea, every 5 minutes after initiation of therapy until nausea resolution, and every 15 minutes thereafter using a 0 to 10 verbal numerical rating scale. ⋯ No statistically significant differences were found at any other time interval. Mean times from initiation of therapy to a 50% reduction in nausea between the ondansetron and alcohol groups were 6.3 minutes and 27.7 minutes, respectively (P = 0.022). Based on this study, it seems postoperative nausea can be resolved quicker using 70% inhaled isopropyl alcohol compared with intravenous ondansetron in women undergoing outpatient gynecologic laparoscopic procedures.
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Postoperative nausea and vomiting (PONV), a common problem with complex causes, may result in substantial complications. This Journal course discusses the pathogenesis of PONV and reviews antiemetic pharmacology. ⋯ State-of-the-art anesthetic techniques for prevention of PONV are described. Multimodal therapy with combined low-dose antiemetics affecting multiple receptors is suggested to prevent PONV in high-risk patients such as nonsmokers, females with a previous history of nausea, and patients with high postoperative narcotic requirements.