CRNA : the clinical forum for nurse anesthetists
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This article addresses the use of peripheral nerve blocks as a primary or adjunctive technique of anesthesia for selective operative procedures. The use of these blocks can reduce the amount of inhalational and narcotic agents used during an anesthetic and facilitate a pain-free postoperative period.
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The most common local anesthetics in clinical use today are of two classes: amino-esters and amino-amides. These two classes differ not only in their chemical structure but also in regard to their metabolism and allergic potential. ⋯ The effects of local anesthetics are primarily caused by the blockade of the sodium channels, thus affecting the slow and fast depolarization phase of the action potential. With the basic understanding of the chemistry and pharmacology of the different local anesthetic agents, the nurse anesthetist can more effectively integrate the use of these drugs into their clinical practice.
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Spinal anesthesia has proven to be a reliable and safe technique of major conduction anesthesia for nearly a century. Epidural anesthesia is being used for a multitude of applications in the operating room, labor and delivery setting, and more for the relief of postoperative analgesia. It is also noted that a growing number of nurse anesthetists are expanding their expertise in regional anesthesia to include continuous spinal, spinal techniques for infants, and epidural anesthesia techniques. This article reviews the physiological and pharmacological factors influencing the choice of anesthetic agents for major conduction anesthesia and the suggested dosing regimens.
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The patient with asthma presents an anesthetic challenge to the anesthetist. A thorough preoperative assessment, careful anesthetic planning, smooth induction, maintenance and emergence of anesthesia, and an uneventful postanesthesia recovery are essential to prevent the untoward effects of acute asthma exacerbation during the perioperative experience. Careful planning, continuous observation, and accurate diagnostic decision making are the essential components in lowering anesthetic and operative risk for patients with asthma.