CRNA : the clinical forum for nurse anesthetists
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Review Case Reports
Current perspectives on the perioperative management of the latex-allergic patient.
The increasing incidence of latex allergy necessitates thorough preanesthetic screening for risk factors, which will be delineated in this article, that are associated with latex allergy. The pathophysiology, epidemiology, and testing procedures for latex allergy will be reviewed. This case report will illustrate the management of a patient who was found to be latex-sensitive during surgery and the management of intraoperative anaphylaxis is provided. Safe perioperative care can be provided for latex-sensitive patients if latex avoidance techniques are used consistently.
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The 21st century will bring a new era of cost containment to the arena of ambulatory surgery force practitioners of anesthesia to reevaluate practice patterns. Along with the current increased interest in cost containment and optimal use of limited resources, growing concerns about patient outcome result in controversial issues in adult and pediatric outpatient anesthesia that must be addressed in the areas of preoperative evaluation, patient preparation and selection, laboratory screening, and practical discharge criteria. The future challenge for all practitioners is to provide high-quality anesthesia care at a reduced cost.
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Postoperative nausea and vomiting are common and distressing postsurgical complications. Prevention or early treatment of this complication should be a goal of all anesthesia providers. ⋯ Pharmacological actions and side effects of commonly used antiemetics are addressed. The new serotonin antagonists and combined antiemetic therapy are highlighted.
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Review Comparative Study
Setting the record straight on nurse anesthesia and medical anesthesiology education.
The history, qualifications, capabilities, and legal status of nurse anesthetists in the United States have been perceived by organized anesthesiology as both a professional and economic threat to the medical specialty. Such threats often lead to turf battles in which groups try to seek public affirmation of their point of view through ongoing public and/or government relation debate and activism. Medicine, including anesthesiology, has used educational preparation of physician and nurse specialists as a favorite topic for such activism. ⋯ This article is aimed at setting right the facts in the current debate used by the American Society of Anesthesiologists in regards to the comparative analysis of CRNA and anesthesiologist education. Because medicine most often uses length of education as a quality measure of that education, regardless of the validity of such arguments, this comparison is set within that framework. Unfortunately, it will not be the last work on this subject.
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The National Practitioner Data Bank (NPDB), created by the 1986 Health Care Quality Improvement Act, has been in operation since 1990. Hospitals and other credentialing bodies must query the NPDB when granting and renewing privileges. The NPDB receives about 25,000 reports of adverse actions against health practitioners each year. ⋯ Only 2% of matched reports to the NPDB made a difference in hospital privileging decisions. A limitation of NPDB information is that malpractice payments recorded in the NPDB do not necessarily constitute a comprehensive and definitive reflection of actual health care incompetence. All health care providers need to be aware of the NPDB, its mission, potential impact on their ability to be credentialed, and proposed additional uses of its information.