CRNA : the clinical forum for nurse anesthetists
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Throughout its pharmacological history in anesthesia practice, succinylcholine has been notorious for its role in causing life-threatening hyperkalemia. Normally the serum potassium level will increase .5 to 1.0 mEq/L because of a sustained opening of the receptors in the neuromuscular junction and release of myoplasmic potassium. However, in certain patients the drug will result in a much higher level of serum potassium. ⋯ The patient recovered without complications and was later discharged to home. Succinylcholine definitely has its use in anesthesia, but it is imperative for the provider to be discriminatory in its administration. An all-encompassing history is paramount to discover any hidden rationale not to use succinylcholine.(ABSTRACT TRUNCATED AT 250 WORDS)
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Post dural puncture headache is a common sequelae of spinal and, sometimes, epidural anesthesia. Since 1960, the practice of placing autologous blood into the epidural space to treat spinal headache has been used with great success. The blood patch can provide immediate symptom relief from spinal headache and repair of the CSF leak, which is the basic mechanism of post dural puncture headache. ⋯ This is a procedure not without complications and requires caution. Contained herein are recommendations for safe and effective use of the epidural blood patch. Following these procedures, anesthetists will likely see an 85% to 98% immediate cure rate for post dural puncture headache with the fewest possible complications.
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Case Reports
Eutectic mixture of local anesthetic cream--topical anesthesia for extracorporeal shock wave lithotripsy.
A 44-year-old man presented with a history of sudden onset left flank pain, accompanied by nausea and microhematuria. The diagnosis of ureteropelvic junction calculus was made and the patient was scheduled for extracorporeal shock wave lithotripsy (ESWL). ESWL uses an electrical spark to generate a shock wave that is focused on a stone in the ureter or kidney. ⋯ Eutectic mixture of local anesthetics (EMLA) cream (2.5% lidocaine and 2.5% prilocaine) has been used as a topical anesthetic on intact skin for various minor procedures. Studies have shown that it is effective in dramatically decreasing or eliminating the pain of ESWL. The use of topical EMLA as an anesthetic management technique for a patient undergoing ESWL is described.