AANA journal
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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.
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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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There is an absence of systematic study regarding the authenticity of the simulation experience in anesthesia except for bias prone "participant perception" assessments. Forty-two senior level graduate nurse anesthesia students were videotaped as they were exposed to short (20-30 minutes) but intense simulated crisis situations. Three observers with intimate knowledge of the operating room (OR) evaluated the films using a pilot-tested authenticity tool. ⋯ There was concern that the brevity of the scenarios did not reflect the realities of patient care during procedures of average length. Simulation is likely of maximal benefit if the participant perceives it as legitimate and authentic. Our study indicates the authenticity of anesthesia simulation is in evolution with much potential for improvement.