AANA journal
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Laryngoscope handles do not usually come in direct contact with the patient's mucous membranes. Consequently, routine disinfection of laryngoscope handles is not currently standard practice unless gross contamination is clearly evident. Recent reports indicate that apparently clean handles may be contaminated with blood or body fluids. ⋯ Organisms were categorized as contaminants or opportunistic pathogens. The presence of opportunistic pathogens places anesthesia providers and patients at risk of nosocomial infections. Based on the recommendations of the 1997 American Association of Nurse Anesthetists' Infection Control Guide and the results of the present study, institutional guidelines should be established for the use of disposable laryngoscope covers, high-level (destroying all microorganisms with the exception of high numbers of bacterial spores) disinfection, or sterilization of laryngoscope equipment between each patient use.
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Randomized Controlled Trial Comparative Study Clinical Trial
Induction pain perception after premedication with propofol vs lidocaine: a pilot study.
Propofol, an intravenous (i.v.) sedative-hypnotic agent, is commonly used for the induction of general anesthesia. It has, however, a substantial potential for causing burning pain at the i.v. site. Several preinduction pharmacologic agents are used routinely to blunt or diminish this burning sensation. ⋯ The incidence of severe pain, however, was more frequent in the propofol group. The small number of patients experiencing severe pain precluded statistical analysis. Blunting pain associated with propofol warrants further study.
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A universal goal of anesthesia providers is to provide the safest, most effective anesthesia and analgesia for their patients. When reports emerge showing problems or complications with an agent or technique that previously was thought safe, recommendations often are adopted in anesthesia departments to avoid or abandon the agent or technique, or alternatives are sought. Hyperbaric 5% lidocaine has been an effective and safe spinal anesthetic agent for short procedures for years. ⋯ Substantial research has been conducted detailing the search for reasons these complications occur and how to prevent them. A sample of the findings is summarized in an attempt to present current knowledge about the apparent causes and prevention of transient neurologic symptoms. There is promising research showing that safe and effective short-acting intrathecal anesthesia can be accomplished with procaine, prilocaine, meperidine, and sufentanil.
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Dental guards are an airway adjunct recommended for patients at risk for dental injury during airway instrumentation; however, reportedly only 2% of anesthesiologists use dental guards during intubation. In this case report, a 64-year-old patient was admitted for a right retromastoid craniectomy with microvascular decompression of the fifth cranial nerve. The patient had crowns on all her maxillary teeth. ⋯ Apparently during the busy sequence of events following intubation, the dental guard was overlooked and was displaced into the posterior oropharynx. Recommendations for the proper use of dental guards are needed to avoid complications; however, there is a scarcity of information available in the conventional anesthesia literature regarding this intubation adjunct. We recommend careful documentation, clear communication with all team members, and attention to avoid displacement during subsequent airway manipulation.
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The purposes of this study were to (1) describe the microenvironment in terms of oxygen concentration beneath the drapes of healthy subjects who were simulating patients undergoing minor surgical procedures with supplemental oxygen and to (2) evaluate the efficacy of using a scavenger system beneath the drapes. A convenience sample of 12 healthy volunteer subjects was studied in an ambulatory surgery center operating room, which was ventilated with 25 air exchanges per hour. The study was carried out in 2 parts. ⋯ With supplemental oxygen and no scavenger system, oxygen concentrations beneath the drapes were consistently elevated (as high as 45% with 4 L/min) compared with normal ambient concentrations (21%) or with concentrations obtained at the surgical site (as high as 23.4%). With the scavenger system in place, mean +/- SD oxygen concentrations reached 34.08% +/- 5.52% beneath the drapes. Statistical analyses revealed that significantly higher oxygen concentrations occurred beneath the drapes with each incremental change in oxygen flow rate, and regardless of the oxygen flow rate used, oxygen concentrations beneath the drapes were significantly reduced with the use of the scavenger system.