AANA journal
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Randomized Controlled Trial Clinical Trial
Use of a simple forearm tourniquet as an adjunct to an intravenous regional block.
Intravenous regional anesthesia (IVRA) is a well-recognized technique for producing anesthesia during surgical procedures of the extremities. It has been suggested that the application of a tourniquet to the forearm may improve the quality of the block. The purpose of this investigation was to determine whether the application of a forearm tourniquet would accelerate onset time and improve the density and quality of an intravenous regional block. ⋯ Paired t tests were used to examine differences between groups on the variables studied. It was noted that the arm with the tourniquet had a shorter time for the onset of anesthesia (P = .0008) and had lower 10-minute VAS tolerance (P = .0469). This investigation suggests that the application of a simple forearm tourniquet as an adjunct to IVRA provides a more rapid onset of anesthesia than when no tourniquet is applied and may improve the density and quality of the block.
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Case Reports
Use of the Cook airway exchange catheter in "bridging" the potentially difficult extubation: a case report.
The Cook airway exchange catheter (CAEC) is a long, flexible, hollow tube designed to facilitate the exchange of an in situ endotracheal tube. The primary use of the CAEC had been as a tube exchanger in the critical care setting. ⋯ The potential strategies that we considered in this case were (1) extubating the patient in a deep plane of anesthesia; (2) extubating conventionally, with the patient awake; and (3) extubating the patient awake, with a "bridge" to full extubation. After carefully weighing the options, we decided to use the CAEC as a tool that would allow us, if the patient did well, to go forth to full extubation, or, if the patient's condition deteriorated, to return to reintubation, or even oxygen insufflation, which would create a "bridge" to extubation.
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This qualitative study identifies and describes different ways in which newly graduated nurse anesthetists (NAs) experience and perceive nurse anesthesia. It explains different approaches to nurse anesthesia care and, thus, to clinical nursing care (in an anesthesia and surgical context), provided by new NAs. ⋯ The results were divided into 3 categories, which describe nurse anesthesia from the perspectives of (1) maintaining physical well-being; (2) being protectors and advocates; and (3) ability to perform good nurse anesthesia given all the demands placed on the NAs. The results indicate that, for the new NAs, the nurse anesthesia care situation was largely influenced by context and generated feelings of inadequacy because the NAs could not provide the emotional support that they believed their patients required.
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Randomized Controlled Trial Clinical Trial
Is there postoperative evidence of implicit learning following aural stimuli at moderate hypnotic BIS levels during general anesthesia?
Patients may develop behavioral changes after the administration of a general anesthetic without a triggering stimulus. This phenomenon, referred to as implicit learning, continues to be debated. Some researchers have denied the phenomenon takes place, while others have demonstrated behavioral changes not related to recall. ⋯ A posttest was administered to determine explicit recall, as well as implicit memory formation. No patients had explicit recall. There was no difference in the implicit memory scores between patients in the experimental group and the control group.
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Case Reports
Continuous spinal anesthesia for cesarean section for a morbidly obese parturient patient: a case report.
This case report details the successful anesthetic management of a morbidly obese parturient patient who presented for a repeat, elective cesarean section. The preanesthetic evaluation and the indications for choosing a continuous spinal anesthetic are discussed. Evaluation of the anesthetic plan is also discussed through a review of the postoperative scenario.