AANA journal
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The study of anesthesia risk is fraught with methodological challenges and the epidemiological uncertainty peculiar to anesthesia: the true frequency of anesthetic mortality is unknown. If anesthesia mortality is as rare as 1 in 200,000 cases, the sample needed to study this phenomenon would be enormous. Existing studies provide insights to the genesis of damaging events and adverse outcomes in anesthesia. ⋯ Nurse anesthetist investigators had similar findings for respiratory claims. Patient acuity and procedure complexity may be less significant contributory factors to anesthesia risk than are provider vigilance and clinical decision making. Prospective multicenter studies conducted politically may be the only type of research that definitively addresses the myriad issues in anesthesia risk research.
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Hypothermia frequently is considered inadvertent in the perioperative setting. The preservation of vital body heat has been an issue since the 1800s. ⋯ Providing patients with an environment designed to foster normothermia can preclude the costs of longer hospital stays, prevent morbid conditions associated with hypothermia, and provide patients with a more comfortable perioperative experience. Our goal as perioperative healthcare providers is a normothermic perioperative experience for all patients.
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This case report involves the anesthetic management of a rare case of adult epiglottitis. It is unique in that there are real photographs of the illness and a previously undocumented use of a specific airway adjunct in acute epiglottitis, the Bullard laryngoscope. Management of the case from start to finish is discussed, as well as the usefulness of the Bullard laryngoscope in a difficult intubation scenario.
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The purpose of this study was to evaluate the anesthesia care provided during obstetric adverse events. Malpractice claims filed against nurse anesthetists for care involving obstetric anesthesia (n = 41) were extracted from the American Association of Nurse Anesthetists Foundation Closed Claim database. The events represented in the claims occurred from 1990 to 1996 and represented anesthetics provided by both anesthetists and anesthesiologists. ⋯ These maternal death cases were designated emergent in 56% (5) of the claims. The anesthetic care was deemed appropriate in 56% (23) of the claims. The median payment for appropriate care ($2,866.00) was less than for care determined to be inappropriate ($45,000.00).
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Clinical Trial Controlled Clinical Trial
The morphine-sparing effect of metoclopramide on postoperative laparoscopic tubal ligation patients.
Metoclopramide traditionally has been used as a prokinetic and antiemetic, but recently it also has been investigated as an agent to enhance analgesic efficacy. No definitive studies have been undertaken to determine whether metoclopramide can decrease postoperative analgesic requirements. The present study examined the effects of the administration of metoclopramide on the postoperative opioid analgesic requirements and pain intensity scores of patients following laparoscopic bilateral tubal ligation under general anesthesia. ⋯ Numeric rating scale pain scores were noted to be similar in both groups at all 3 time intervals examined. However, total postanesthesia care unit (PACU) morphine requirements were significantly higher in the placebo group than the metoclopramide group (P = .031). This study demonstrated that metoclopramide administered preoperatively can significantly decrease morphine requirements in the PACU but had no impact on pain intensity as rated by numeric rating scale pain scores.