CRNA : the clinical forum for nurse anesthetists
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Outpatient surgery has become increasingly popular. Technical advances in both surgery and anesthesia have made the practice of ambulatory surgery safe and attractive. ⋯ The valid patient complaint of postoperative nausea and vomiting has been shown to significantly delay discharge from the recovery area after ambulatory surgery. This article reviews the numerous factors that have been identified as fostering the postoperative complication of nausea and vomiting.
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In the last 5 years, the number of nonoperating room procedures performed on the pediatric population requiring sedation has skyrocketed. Some of these procedures, such as bone marrow aspiration or dental restorations, may be painful, whereas others, such as magnetic resonance imaging, are not painful but require a motionless patient. Anesthesia departments are being tasked more and more frequently to provide the sedation and monitoring for these procedures. ⋯ Currently, there are several medications or combinations of medications that offer advantages over the commonly used chloral hydrate and "lytic" cocktail. Selection of medication(s) should be based on the type of procedure (painful v painless), the length of the procedure, the medical condition of the patient (current medications, fasting status, and disease processes or metabolic disorders), and the need for anxiolysis or amnesia. This article briefly reviews: (1) developmental changes and metabolic capacity in the pediatric patient; (2) the American Academy of Pediatrics guidelines for care of the pediatric patient undergoing sedation; (3) basic pharmacology of sedative-hypnotics and opioids; and (4) patient monitoring and discharge.
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Randomized Controlled Trial Clinical Trial
Comparison of ondansetron, metoclopramide, and placebo in the prevention of postoperative emesis in children undergoing ophthalmic surgery.
A common and distressing adverse effect following general anesthesia is nausea and vomiting. Pediatric ophthalmic surgery is associated with a high (50%-80%) incidence of postoperative emesis. Vomiting postoperatively may cause a prolonged hospital stay, and if it is persistent, may lead to unanticipated hospital admission after ambulatory surgery. ⋯ The incidence of emesis and adverse effects were observed in the postanesthesia care unit and documented for 24 hours postoperatively. Analysis of variance showed that ondansetron significantly decreased (P = .05) the incidence of emesis in the postanesthesia care unit and during the first 24 hours postoperatively (P = .049). Additionally, parents of children in the ondansetron group reported a high degree (94%) of satisfaction with the experience.
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Children with craniofacial anomalies, in particular those with facial clefts and the associated syndromes of Treacher Collins, Pierre Robin, and Klippel-Fiel and craniosynostosis and its related syndromes, present some of the most hazardous and difficult challenges that anesthetists may encounter within the entire practice of pediatric anesthesia. Through this review of the embryological development of the above-listed anomalies, the specific concerns of the airway and coexisting congenital defects, the reader will develop a better understanding of each anomaly in order to create a safe anesthetic plan for the management of children with these types of craniofacial conditions.
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In the United States, trauma continues to be the leading cause of death in children between the ages of 1 and 15 years of age. Children die from trauma at a rate five times greater than from leukemia which is the next leading cause of death in this age group. The acutely injured child is brought to community hospitals as well as university hospitals. ⋯ Only with this knowledge will there be a decrease in the morbidity of the traumatized pediatric patient. The CRNA should be able to rapidly assess and gain control of the pediatric airway and assure adequate respiration. Initial assessment of the pediatric trauma patient also includes the restoration or maintenance of hemodynamic stability.