Nurse anesthesia
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Randomized Controlled Trial Clinical Trial
Do antiarrhythmic doses of magnesium potentiate vecuronium?
The purpose of this study was to investigate whether magnesium sulfate (MgSO4) at a dose commonly used to treat arrhythmias potentiates vecuronium. After Institutional Review Board approval, 20 randomly assigned, consenting patients received a bolus of either MgSO4 (30 mg/kg) or placebo in a blinded fashion. Immediately after receiving the bolus of either MgSO4 or placebo, the study patients were taken to the operating room (OR) and anesthetized. ⋯ A 30 mg/kg bolus of MgSO4 roughly doubled ultrafilterable magnesium levels from baseline. The limited sample size precluded making any firm conclusions from this data. The data trend suggested that antiarrhythmic doses of MgSO4 may not potentiate vecuronium.
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Randomized Controlled Trial Clinical Trial
Effect of transport time and FiO2 on SpO2 during transport from the OR to the PACU.
Early postoperative hypoxemia may be due to a reduced functional residual capacity, hypoventilation, and ventilation-perfusion mismatch. These factors reduce the partial pressure of the arterial oxygen which ultimately reduces the oxygen transported to the tissues by decreasing the hemoglobin saturation. This may lead to cellular ischemia and death. ⋯ The treatment group received 40% oxygen via a venturi mask during transport while the control group breathed room air. After a routine transport to the postanesthesia care unit, the SpO2 was again measured and the transport time was recorded. Oxygen saturation was found to be significantly greater in the group breathing supplemental O2 during transport.
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Case Reports
Contralateral tension pneumo/hemothorax resulting from left subclavian vein cannulation under general anesthesia.
A patient had a subclavian vein catheter placed under general endotracheal anesthesia with positive pressure ventilation. During placement, the superior vena cava, pleura, and pulmonary tissue were punctured, resulting in a tension pneumo/hemothorax, the detection of which was complicated by its slow onset and unusual location. The lesion required an emergent thoracotomy for repair.
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Clinical Trial Controlled Clinical Trial
Does the duration of N2O administration affect postoperative nausea and vomiting?
Nausea and vomiting are the most frequent postoperative complications in the ambulatory surgical setting. In the present study, data were obtained from 184 adult ambulatory cosmetic surgery patients to determine if the use of nitrous oxide (N2O) was associated with an increased incidence of postoperative nausea and/or vomiting (PNV). Anesthesia was induced with thiopental and maintained with an opioid (fentanyl or sufentanil) and isoflurane with or without N2O. ⋯ The major finding was that the incidence of PNV was directly related to the duration of anesthesia in the patients who received N2O, but not in those who were N2O-free. Anesthesia times and the percentages of patients who exhibited PNV in the N2O-free and N2O-treated groups, respectively, were: (1) less than 1 hour, 0% and 6.3%; (2) between 1.0 and 1.9 hours, 35.3% and 36.8%; (3) between 2.0 and 2.9 hours, 24.2% and 66.7% (p = .06); (4) between 3.0 and 5.3 hours, 35% and 100% (P less than .05). Thus, avoidance of N2O in ambulatory cosmetic surgery cases lasting 3, and quite probably 2 or more hours in which general anesthesia is maintained with a synthetic opioid and isoflurane appears to reduce the likelihood that these short-stay patients will experience PNV.
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The anesthetic technique chosen for a malignant hyperthermia (MH) susceptible patient should include drugs that do not trigger MH, while providing stress-free conditions. This case report describes a MH susceptible patient who was successfully induced and maintained with propofol for third molar extractions while under general anesthesia. Based on this case report, and the other relative few in the literature, it appears unlikely that propofol will trigger an episode of MH. Propofol provides the anesthetist with an alternative for inducing MH susceptible patients, but continued experience is necessary to document its safety and efficacy in these patients.