CRNA : the clinical forum for nurse anesthetists
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This article provides an overview of the current status of general anesthesia and regional anesthesia techniques including complications occurring after using these techniques. The advantages, disadvantages, mortality, and morbidity are described for these two techniques.
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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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Randomized Controlled Trial Comparative Study Clinical Trial
A comparison of intraoperative morphine sulfate and methadone hydrochloride on postoperative visual analogue scale pain scores and narcotic requirements.
Morphine sulfate and methadone hydrochloride exhibit very different half-lives but are described as having an analgesic potency of one. The use of a drug like methadone may provide prolonged and constant analgesia in the perioperative setting. This double-blinded investigation used methadone and morphine intraoperatively and measured pain scores and narcotic requirements in the first 24 hours postoperatively. ⋯ Fifteen patients received morphine and fifteen patients received methadone. There was no significant difference between the two groups in terms of age, height, weight, and ASA status. No statistically significant difference was observed among the two groups between the amount of analgesic requirements postoperatively or in the visual analogue scale pain score.
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Randomized Controlled Trial Clinical Trial
Comparison of sufentanil versus fentanyl with 0.125% bupivacaine for continuous labor epidural anesthesia.
The search for an ideal combination of agents for labor epidural anesthesia has become a focus of current research studies. This study was performed to determine if a combination of sufentanil with bupivacaine would show superior analgesia and fewer side effects when compared with an equipotent combination of fentanyl with bupivacaine in continuous labor epidurals. After the approval of the Human Investigations Committee and written consent from the subjects, 54 parturients were assigned to receive one of two epidural drug combinations in a randomized double-blind design. ⋯ There were no statistically significant differences found in VAS scores or requirement for epidural top-up injections between the two groups. Demographics, side effects, apgar scores, and maternal satisfaction scores were also comparable. Both sufentanil and fentanyl with bupivacaine provide comparably safe and satisfactory analgesia for labor epidural anesthesia.