AANA journal
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Although estimates of anesthesia-related deaths today are as low as 1 in 200,000 to 300,000 cases, questions remain about surgical patients' safety related to types of anesthesia providers. We studied the effect of type of anesthesia provider on mortality rates of Medicare patients undergoing 8 different surgical procedures. Risk-adjusted mortality rates were analyzed for 404,194 inpatients undergoing surgery and having complete, unambiguous Medicare bills for anesthesia. ⋯ Mortality rates for conditions studied ranged from 0.11% to 1.20%. Observed and predicted values by type of provider were not statistically significantly different. Hospitals without anesthesiologists had results similar to hospitals where anesthesiologists provided or directed anesthesia care.
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Methemoglobinemia is a potential negative side effect associated with the use of benzocaine for topical anesthesia. A healthy patient admitted for an outpatient orthopedic procedure developed the clinical symptomatology of methemoglobinemia after topicalization of the airway with benzocaine. ⋯ Methemoglobinemia should be suspected in cases where decreased pulse oximeter readings develop in patients who have received benzocaine preoperatively. Appropriate steps should be taken to support the airway and oxygenation and monitor the patient while medication is administered to reduce methemoglobin to hemoglobin.
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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of tubocurarine, rocuronium, and cisatracurium in the prevention and reduction of succinylcholine-induced muscle fasciculations.
Fasciculations are a common side effect of the use of succinylcholine for tracheal intubation. Many anesthesia care providers prefer to prevent them due to a possible association between fasciculations and increased intracranial and intraocular pressures. The purpose of this study was to compare the effectiveness of tubocurarine, rocuronium, and cisatracurium in the prevention and reduction of succinylcholine-induced muscle fasciculations. ⋯ Therefore, rocuronium is a valid alternative to tubocurarine for defasciculation. Cisatracurium is inferior to rocuronium and tubocurarine for defasciculation. Therefore, the use of cisatracurium is not recommended for defasciculation.
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This study was conducted to determine the effects of spinal (n = 113) vs epidural (n = 31) anesthetic techniques on 3 common postoperative complications: pain, urinary retention, and mobility for patients undergoing inguinal herniorrhaphy. The study design was a retrospective chart review. Data were collected on 144 subjects who underwent herniorrhaphy between January 1 and December 31, 1999, had an ASA classification of I to III, and were older than 18 years. ⋯ This study demonstrates that epidural anesthesia results in less urinary retention and earlier mobility than spinal anesthesia in men undergoing inguinal herniorrhaphy. Minimizing postoperative complications is essential in order for the nurse anesthetist to provide a satisfactory anesthetic experience. This study's findings suggest that epidural anesthesia optimizes recovery for the patient undergoing inguinal herniorrhaphy.
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The laparoscopic approach to surgery is being used with greater frequency as our healthcare system continues to strive for shorter hospital stays and improved postoperative patient recovery times. However, laparoscopy is not without potential complications. This article presents 2 patient case studies. ⋯ The second patient's surgery involved an intraperitoneal approach. Massive subcutaneous emphysema developed in both patients. The phenomenon of subcutaneous emphysema associated with laparoscopic surgery will be defined and discussed.