AANA journal
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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.
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Randomized Controlled Trial Clinical Trial
The use of nalmefene for intrathecal opioid-associated nausea in postpartum patients.
The aim of this study was to compare the severity of nausea and incidence of emesis in laboring parturients who received intravenous nalmefene or placebo following an intrathecal opioid (ITO). We randomly assigned 60 ASA class I or II multiparous women to receive nalmefene or placebo. Subjects received fentanyl, 25 micrograms, and morphine, 250 micrograms, intrathecally on request for analgesia. ⋯ There were no significant differences in age, weight, duration of labor, volume of intravenous fluids infused, time from last meal to delivery, or time from administration of the ITO to injection of the study drug. There were no significant differences in mean visual analog scale nausea scores or frequency of emesis for any time interval. Nalmefene, 20 micrograms, given intravenously within 30 minutes of vaginal delivery does not significantly reduce the nausea and vomiting associated with the use of ITOs for labor analgesia.
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The American Association of Nurse Anesthetists Foundation conducts an ongoing study of closed malpractice claims that involve nurse anesthetists. A team of 8 CRNA researchers has to date investigated 223 closed claim files from the St Paul Fire and Marine Insurance Company. Research findings have demonstrated that failure to provide appropriate anesthesia care relative to the Scope and Standards for Nurse Anesthesia Practice was significantly associated with adverse anesthetic outcomes. ⋯ In 55% of these claims, the medical history was not completely documented. The surgical procedure categories were general surgical (32%), obstetrical (27%), otolaryngogical (23%), orthopedic (14%), and gynecologic (5%). The involved standards of care are reviewed, and recommendations are made regarding consistent completion of preinduction activities.
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Hypothermia has long been common in anesthesia and has largely been seen as an inconvenience. For many years, it was viewed as inevitable. But hypothermia is much more than an inconvenience, and it is no longer inevitable. ⋯ Hypothermia may begin in the preoperative holding area, so efforts to prevent it should begin there as well. Effective intraoperative and postoperative warming methods are known and commonly available, but they remain underused. Understanding how and why core temperature declines in association with anesthesia and surgery and safe, effective methods to prevent that decline will enable nurse anesthetists and perioperative nurses to increase both the comfort and safety of their patients while reducing costs to the institution.
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In the administration of anesthesia, clinicians have traditionally relied on a variety of autonomic signs to assess the pharmacologic effects of anesthetic agents on the central nervous system. As any experienced clinician knows, these signs can be misleading and lead to overdosing or underdosing of anesthetic drugs. The development of a monitor to measure the bispectral index (BIS) provides anesthetists with the first clinically tested and US Food and Drug Administration-approved monitor to assess the effects of anesthesia on the cerebral cortex. This article reviews the development of the BIS monitor, compares the BIS monitor with other commonly used clinical monitors, assesses the cost-benefit from the use of this monitor, and explores some of the possible uses for this monitor outside of the operating suite.