Nurse anesthesia
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Case Reports Comparative Study
Isoflurane and mivacurium chloride neuromuscular blockade in patients with myasthenia gravis.
The relaxograph findings are presented in two patients. In the first, isoflurane alone is administered, and mivacurium with isoflurane is administered to the second patient with myasthenia gravis. A significantly lower dose of mivacurium is required. ⋯ In the patient that only received isoflurane, T1 was 60% to 70% of the baseline, indicating the neuromuscular blocking effects of isoflurane. These cases illustrate that inhalation anesthetics are adequate for muscle relaxant effects, and if neuromuscular blockers are necessary, then a lower dose of nondepolarizer should be administered, and the patient carefully monitored. Mivacurium appears to be an ideal agent for neuromuscular blockade in myasthenia gravis as long as careful neuromuscular blockade is performed.
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Echocardiography is recognized as a excellent diagnostic tool for non-invasive cardiac assessment. Recently, transesophageal echocardiography has been utilized as an "on line, real time" intraoperative monitoring device in cases where patients are at significant risk for intraoperative cardiac ischemia, large shifts in hemodynamic parameters, and/or air embolism. This advancement in cardiac and hemodynamic intraoperative monitoring is significant as it enables early recognition of cardiac ischemia through assessment of cardiac contractility and regional wall motion abnormalities; accurate volume status assessment with direct monitoring of cardiac chamber volumes, valvular function, and intracardiac shunting; and real time assessment of the presence, size, and location of intracardiac air. Transesophageal echocardiography is a safe and accurate tool enabling early recognition of those physiological intraoperative changes where early intervention is critical for improved patient outcome.
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This preliminary study determined certified registered nurse anesthetist (CRNA) practice experience and educational needs in the preoperative evaluation of patients using patient-controlled analgesia (PCA) for chronic and cancer pain management. A convenience sample (N = 29) of CRNAs practicing in a university teaching hospital completed the surveys developed by the investigator. Survey items related to CRNA experience with management of patients using PCA preoperatively, PCA modes of opioid delivery, and use of adjuvant medication for chronic and cancer pain patients. ⋯ Fifty-two percent of CRNAs disconnected the infusion and discarded the opioid preoperatively. Fourteen percent reported leaving the PCA device connected to the patient for use perioperatively or for continued pain management postoperatively. Based upon the findings of this preliminary study, CRNA education in management techniques for the use of PCA infusions in chronic and cancer pain is recommended.
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This article describes an airway management system designed to reduce the incidence of maternal and neonatal mortality and morbidity during cesarean section. This system was developed from a comprehensive topical review of the literature and implemented in a midwestern community hospital. The key features of the system include a strategy of early assessment and recognition of patients at risk for difficult intubation, and the establishment of management protocols designed to reduce the maternal risk associated with failed intubation.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of the effect of insulated and noninsulated head covers on heat loss during abdominal surgery.
Hypothermia is experienced by all patients undergoing major surgical procedures. Hypothermia can lead to postoperative complications affecting oxygenation with neurologic, immunologic, and metabolic consequences. Current methods of heat conservation used in the operating room include blanket warmers, fluid warmers, and anesthesia circuit warmers. ⋯ All subjects had routine heat conservation measures (blanket warmers, fluid warmers, and anesthesia circuit humidifiers). Following induction of anesthesia, subjects' temperatures were measured using an esophageal stethoscope with thermistor probe at 10 and 70 minutes. Results showed no significant differences between groups at either time point.