CRNA : the clinical forum for nurse anesthetists
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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.
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Randomized Controlled Trial Clinical Trial
Effects of tourniquet time in knee arthroscopy patients receiving intraarticular morphine combined with bupivacaine.
The purpose of the study was to compare the duration of analgesia and the amount of supplemental postoperative analgesics required when morphine combined with bupivacaine was injected into the knee joint at the end of knee arthroscopy surgery. Varying tourniquet times of 0, 8, or 16 minutes were used after the injection. The variables examined were the duration of analgesia, and the amount of supplemental postoperative analgesics required in each subgroup. ⋯ No statistical differences were found between groups. All patients received analgesia with no reported side effects. Increasing the tourniquet time had no effect on the duration of analgesia or the amount of supplemental narcotics required in the postoperative period.
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Preemptive analgesia describes a situation where the administration of a pharmacological agent administered before the onset of a painful stimulus causes a decrease in the intensity of pain felt, and subsequently there is a decrease in the total amount of analgesic required compared with the administration of an agent after a painful stimulus. It is best understood if it is thought of as a block to afferent impulses that are trying to reach the central nervous system before a tissue injury. Preemptive analgesia, administered in the form of narcotics, nonsteroidal antiinflammatory agents, or local anesthetics, is thought to alter peripheral and central sensitization to nociceptive impulses.