AANA journal
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The incidence of surgical fires is rising. One agency estimates that the frequency of surgical fires is comparable to that of wrong-site surgery with an incidence of 50 to 100 fires annually. ⋯ This AANA Journal course discusses the need for a clearly formulated plan, rehearsing a response to fires in or on the patient, and clearly designated prevention parameters. As part of the surgical team, the vigilance and dedication of nurse anesthetists can lead the efforts to prevent adverse outcomes from surgical fires.
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Arterial catheterization for hemodynamic monitoring is used widely in clinical management. Complications of connulation have been recognized since introduction of the technique. This review examines radial, brachial, axillary, and femoral cannulation sites. ⋯ Axillary cannulation provides data closely approximating aortic pressure and poses minimal thrombotic risk but is associated with brachial plexus compression. Femoral cannulation provides a pulse contour approximating aortic with minimal thrombotic risk. There is little evidence to show increased incidence of catheter-related systemic infection at this site.
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Decreased visual acuity and loss of visual ability are devastating anesthetic and surgical complications. The incidence is greater in patients with preexisting hypertension, diabetes, sickle cell anemia, renal failure, gastrointestinal ulcer, narrow-angle glaucoma, vascular occlusive disease, cardiac disease, arteriosclerosis, polycythemia vera, and collagen vascular disorders. Precipitating factors for ischemic optic neuropathy include prolonged hypotension, anemia, surgery, trauma, gastrointestinal bleeding, hemorrhage, shock, prone position, direct pressure on the globe, and long operative times. ⋯ Unacceptable hemoglobin and hematocrit values should be corrected preoperatively and levels monitored during the case to avoid intraoperative anemia in at-risk patients. The blood pressure of patients with predisposing diseases should be kept within normal limits. To avoid this devastating complication, it is imperative that anesthesia providers understand contributing factors and prevention strategies.