CRNA : the clinical forum for nurse anesthetists
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The increased use of continuous spinal anesthesia (CSA) in recent years has resulted in research efforts directed at reducing the complications associated with the technique. Complications of CSA are categorized as general, the same as those associated with single-shot spinal anesthesia, and specific, those associated solely with CSA. ⋯ The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration.
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The use of adjuvant drugs for regional anesthesia may be indicated for a variety of reasons. Some general patient considerations, indications for the commonly used sedatives and analgesics, and administration techniques for these agents for patients having regional anesthesia are discussed.
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Randomized Controlled Trial Comparative Study Clinical Trial
Total intravenous anesthesia with a continuous propofol-alfentanil infusion.
A total intravenous anesthetic using propofol and alfentanil was evaluated to determine if it would provide a shorter recovery-room stay than a more traditional balanced anesthetic using isoflurane and alfentanil. Forty-three ASA I or II patients between 17 and 50 years of age undergoing major abdominal or orthopedic procedures were studied. The propofol group received alfentanil 50 mg/kg followed by propofol 1 mg/kg for anesthesia induction. ⋯ One episode each of intraoperative awareness and delayed eye opening occurred in the propofol group. Total intravenous anesthesia using propofol and alfentanil is just as effective as a balanced inhalation anesthetic and provides equally rapid recovery. However, practitioners are cautioned to include an amnestic adjuvant when using propofol as the sole anesthetic agent.
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The anesthetist must be aware of anesthesia implications for the surgical patient who is taking prescribed psychotropic medications. The number of patients taking psychotropic medications who present for surgery is increasing. Psychotropic medications combined with anesthesia can produce serious complications. This article reviews commonly known psychotropic medications and introduces the anesthetic implications of two new drugs, fluoxetine and buspirone.
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Malignant hyperthermia (MH) is an uncommon and potentially fatal pharmacogenetic complication of anesthesia. It is commonly triggered by administration of halothane and succinylcholine. The treatment of choice is to administer dantrolene sodium while simultaneously discontinuing the triggering agent. ⋯ Anesthesia can be safely administered to MH-susceptible patients. Nontriggering agents are used, and meticulous monitoring of the patient is performed. All anesthesia providers should be familiar with MH.