CRNA : the clinical forum for nurse anesthetists
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The evolution of anesthesia safety has paralleled the evolution of anesthesia over the last several hundred years. This article describes the introduction of safer practices of anesthesia and the impetus for these changes in practice that improved patient safety. It discusses both the role of technology in the advancement of safety and the policies developed by professional organizations of anesthesia care providers.
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Certified Registered Nurse Anesthetists (CRNA) have an ethical obligation to assure the safety of the anesthetized patient. Maintenance of orotracheal tube intra-cuff pressure (IcP) in a range preventing aspiration and avoiding tracheal ischemia is one way to enhance patient safety. Currently, no standardized method of cuff inflation and IcP maintenance is used in anesthesia practice. ⋯ Elapsed time for the IcP increase ranged from 2 to 52 minutes (mean = 12.34, median = 8 minutes). During anesthesia with 50% to 70% N2O, IcP will increase from initial safe levels to ischemia producing levels. Devices and approaches designed to limit N2O induced IcP increase have been described, however only direct IcP monitoring has been shown to assure safe initial and ongoing IcP.
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Many anesthesia practitioners reuse disposable syringes and multidose drug vials from case to case despite the known hazards of blood-borne disease transmission. This practice may be hazardous to both patients and practitioners. ⋯ Contaminated multidose vials have been associated with the transmission of both hepatitis B and bacterial infections. This article examines the potential risks of contamination from the reuse of disposable syringes and the myth about the cost savings of this practice.