CRNA : the clinical forum for nurse anesthetists
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Preemptive analgesia has recently been the subject of much discussion in the literature including a recent editorial which describes some of the difficulties surrounding the subject. The concept of preemptive analgesia is frequently misunderstood by anesthesia providers especially relative to the use of regional anesthesia. This confusion hampers anesthetists in their practice when they seek to provide optimal pain care for their patients, and especially when regional block is not an option in their particular practice or is inappropriate either for the individual patient or for the surgery being undertaken. This article attempts to differentiate preemptive analgesia from regional anesthetic blockade, and discusses other interventions which may also play a role in producing some measure of preemptive effect.
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The purpose of this investigation was to determine, through current research in the literature, if a background basal infusion should routinely be used to improve the efficacy of traditional-demand patient-controlled analgesia (PCA) and would the safety of the PCA technique be maintained with the addition of a continuous infusion. Of the nine studies investigating PCA with and without continuous infusion, six found no improvement in pain control with the addition of a continuous infusion. ⋯ Many studies reported an increased incidence of side effects with the addition of a continuous infusion. This modality of PCA should be reserved for use in patients in whom traditional-demand PCA does not satisfy analgesic requirements.
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Review Case Reports
Laryngeal mask airway in anesthetic care: clinical cases and discussion.
The laryngeal mask airway (LMA) is rapidly becoming an essential tool in the anesthetist's armamentarium for airway management. Approved for use in the United States in 1992, the LMA has several uses, notably anesthesia traditionally administered by mask. ⋯ Techniques are described for the use and maintenance of the LMA. Two illustrative clinical cases are presented.