AANA journal
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Review Case Reports
Acute circulatory and respiratory collapse in obstetrical patients: a case report and review of the literature.
Venous air embolism is the entrapment of air into the venous system producing signs and symptoms due to obstruction of pulmonary arterial blood flow. We present a healthy, 27-year-old, full-term parturient admitted for postdate induction of labor. Cesarean delivery was required following fetal distress. ⋯ The diagnosis may be facilitated by precordial Doppler monitoring, transesophageal echocardiography, or by the identification of air when aspirating from a right heart catheter. Management includes optimum patient positioning, aspiration of air, discontinuation of nitrous oxide, administration of 100% oxygen, and flooding the surgical site with saline to avoid further air entry. Preventive strategies are also discussed.
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The esophageal Doppler monitor is a recent development in hemodynamic monitoring that is used for surgical patients. It is relatively noninvasive and measures descending aortic blood flow by the Doppler effect. A comparison of this new monitor with the pulmonary artery catheter is cited numerous times throughout the literature and overall correlates well. Studies of the esophageal Doppler monitor show it to be a safe addition to operating room monitors for use by the anesthetist.
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Comparative Study Clinical Trial
The effect of nitrous oxide on laryngeal mask cuff pressure.
During general anesthesia with the laryngeal mask airway (LMA), a significant increase in cuff pressure due to diffusion of nitrous oxide through the cuff wall occurs. This descriptive clinical study was conducted in a university teaching hospital ambulatory surgical center with 100 patients (ASA physical status, I-III; age, 5 months to 76 years; weight, 5.8-146.3 kg) undergoing general anesthesia with an LMA. The airway pressure at which the LMA seal was broken (leak pressure) was determined immediately after the insertion of the LMA. ⋯ The LMA cuff pressure was determined by connecting the check valve of the LMA pilot balloon to a sphygmomanometer. The mean LMA cuff pressure increased 16 +/- 8.2 mm Hg (1- to 30-minute group), 38.11 +/- 15.87 mm Hg (31- to 60-minute group), 39.53 +/- 16.9 mm Hg (61- to 90-minute group), 42.63 +/- 20.36 mm Hg (91- to 120-minute group), and 44.25 +/- 14.03 mm Hg (120- to 350-minute group). This study demonstrated that there was a gradual increase in the cuff pressure well over a 3-hour period during nitrous oxide and oxygen anesthesia.
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The present study examined the differences between anesthesia care team (ACT) and non-ACT practice types. Six practice variables were analyzed. We prepared and distributed a 13-item questionnaire to 1,000 practicing Certified Registered Nurse Anesthetists (CRNAs) with a 44.4% response rate. ⋯ However, only 49% (n = 24) of non-ACT nurse anesthetists were employees, and almost 43% (n = 21) were self-employed. The present study demonstrates that significant differences exist between the 2 nurse anesthesia practice types examined. As nurse anesthesia practice arrangements continue to change and fewer CRNAs are hospital employed, each nurse anesthetist must be aware of current practice trends and understand the alternatives.
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Recent clinical studies using the bispectral index monitor to predict movement, measure the level of consciousness, and reduce the cost of anesthesia have renewed interest in the use of a monitor to assess the effects of anesthetics on the brain. In 1937, Gibbs described electroencephalographic changes during the administration of general anesthetics. ⋯ The purpose of this article is to provide a historical perspective of the development and use of the processed electroencephalographic monitor. This article also describes studies of clinical usefulness of the bispectral index monitoring device in anesthesia practice today.