AANA journal
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As part of its ongoing work, the AANA's Practice Committee reviewed the Scope and Standards for Nurse Anesthesia Practice, particularly focusing on the Standards for Nurse Anesthesia Practice. Revisions and updates were made to the standards to ensure clarity and reflect current anesthesia practice. ⋯ This is not an exhaustive discussion of all changes made to the document. The updated Standards for Nurse Anesthesia Practice are presented in their entirety.
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Palliative sedation is a technique of providing a sedative for end-of-life care to patients with intractable pain. The literature discusses the techniques and use of palliative sedation. Numerous articles have been written regarding the issues surrounding its use, but no literature has discussed the prescription or administration of palliative sedation by a nurse anesthetist. ⋯ Few other healthcare disciplines can provide the patient care and empirical knowledge that is imperative in the care of the dying patient. This article discusses the concept and ethics of palliative sedation and presents a case of providing palliative sedation to a terminally ill patient by an experienced nurse anesthetist. Palliative sedation should be understood, embraced, and utilized as an area of expertise suited for nursing anesthesia.
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Case Reports
Effects of ketamine on major depressive disorder in a patient with posttraumatic stress disorder.
Ketamine has been used in anesthesia for many years and in various environments with an acceptable safety margin. The side effects of hallucinations and paranoid thoughts need to be overcome for acceptance of ketamine infusion in mainstream psychiatry. ⋯ It is proposed that ketamine has potential for treatment of major depression associated with posttraumatic stress disorder (PTSD) in combat veterans. This patient, who had debilitating and treatment-resistant major depression and PTSD, was treated by intravenous infusion of ketamine and experienced substantial short-term resolution of symptoms.
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The purpose of this evidence-based project was to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Frequency of use, ease of use, and complications encountered when using the disposable blade were evaluated before and after an in-service program designed to increase the use of disposable blades. Participants completed an anonymous questionnaire about their knowledge and practice regarding disposable laryngoscope blades. ⋯ After the intervention, 25% of anesthesia providers described performance as their reason for not using the disposable laryngoscope blade, which was down from 60% at the project's start. Inventory showed a 23% increase in use of disposable laryngoscope blades after the intervention, which a single-proportion Z test showed was statistically significant (Z = 2.046, P = .041). This evidence-based project shows that a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades, which should translate to improved patient outcomes.
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Hypertension is a common chronic condition in many patients requiring anesthesia. Pharmacologic therapy is a mainstay of treatment for hypertension, with angiotensin-converting enzyme (ACE) inhibitors being a frequently prescribed class of drugs. The American College of Cardiology and American Heart Association 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery provide information on many drug classes used in the treatment of hypertension; noticeably absent is a guideline for ACE inhibitors. ⋯ Vasopressin and methylene blue have been found to be effective treatments for ACE inhibitor-associated refractory hypotension. With the prevalence of hypertension and use of ACE inhibitors, anesthesia providers are likely to encounter refractory hypotension of this nature. The absence of guidelines regarding ACE inhibitors in the perioperative period contributes to a lack of consistency in practice.