CRNA : the clinical forum for nurse anesthetists
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In the obstetric setting, spinal and epidural analgesia/anesthesia are the 2 most frequently used forms of analgesia and anesthesia. One of the potential complications of these procedures is the postdural puncture headache (PDPH), and there is a high probability that the anesthetist will have occasion to evaluate the headache complaints of the parturient. The author reviews the differential process and discusses some of the causes and treatments of headaches in the parturient.
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Combined spinal epidural anesthesia offers the advantages of each method while minimizing their respective disadvantages. First described in 1937, this technique has risen in popularity over the last 15 years and is being used successfully in orthopedic, urologic, and gynecologic surgeries and for anesthesia/analgesia for labor and delivery as well as cesarean section. The history and development of combined spinal epidural anesthesia/analgesia, the different techniques, and controversies and problems associated with its use are discussed. The use of the technique of obstetric anesthesia/analgesia is also examined.
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Comparative Study
Accuracy of blood loss determination by health care professionals.
Patients undergoing surgery will likely experience some degree of blood loss. There is much literature examining effects of blood loss, but little was found that examined accuracy of estimation of blood loss. The research question for this study was: How accurate are surgical health care professionals in their estimations of blood loss? This study was a pre-experimental between-subject design that used a convenience sample of 85 volunteers who worked in the surgical and postsurgical units of a rural southern 450-bed hospital. ⋯ The variables that were examined and were compared included the professional group, years of experience in surgery or the postanesthesia care unit (PACU), and their estimation of blood loss. Their estimation of blood loss was compared with the actual amount of blood to determine whether one group was more accurate than another statistically and whether increasing years of experience improved accuracy. The statistical tests used were simple and multiple regressions.
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The Agency for Health Care Policy and Research (AHCPR) established guidelines for the use of meperidine (demerol), a common inpatient analgesic. These guidelines define standards of care for acute and chronic cancer pain management and address many of the problems with meperidine and its metabolite, normeperidine. The purpose of this study was to determine whether meperidine was prescribed in compliance with AHCPR guidelines, whether patients exhibited any adverse reactions to meperidine, and to determine the analgesic efficacy of meperidine. ⋯ Higher analgesic satisfaction scores were noted when meperidine was given with concurrent analgesics. Meperidine also was administered to patients in renal failure or with medications contraindicated with meperidine use. No significant adverse effects were noted with meperidine use in this sample population other than an increased incidence of confusion in the elderly population.