AANA journal
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Review Comparative Study
Novel preoperative pharmacologic methods of preventing postoperative sore throat due to tracheal intubation.
Postoperative sore throat (POST) is usually self-limiting but was rated by patients as one of the top 10 most undesirable anesthetic outcomes. Pharmacologic interventions that have been suggested to decrease the incidence of POST include application of local anesthetics and corticosteroids to the cuff of the endotracheal tube. These interventions often require extra steps during induction of general anesthesia. ⋯ The severity of POST was also typically reduced. Preoperative ketamine and aspirin gargle are probably the most promising for providers practicing in the United States. However, before these agents are recommended for general use, large multicenter trials should be done exploring not only efficacy but also dose-response relationships and side effects.
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Comparative Study
Effects of intraosseous transfusion of whole blood on hemolysis and transfusion time in a swine model of hemorrhagic shock: a pilot study.
This prospective, experimental, mixed study determined whether there were differences in intraosseous (IO) and intravenous (IV) whole blood transfusion relative to hemolysis and transfusion time. Swine were assigned to the IV group (n = 6) with an 18-gauge catheter in the auricular vein or the IO group (n = 7) with a 15-gauge 10 needle in the proximal humerus. Following baseline specimen collection, 900 mL of blood was collected from each animal. ⋯ The IV group's mean transfusion time was 13.48 +/- 4.1 minutes; the IO group, 28.70 +/- 19.51 minutes. Intraosseous transfusion does not significantly increase hemolysis or transfusion time compared with IV transfusion. Clinically, it can take up to twice as long to transfuse 900 mL of blood IO compared with IV.
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Fractures of the proximal upper extremity present a challenge to the anesthesia provider when administering a regional anesthetic because the dermatomal distribution of the upper extremity requires more local anesthetic coverage than any single brachial plexus nerve block can provide. A 60-year-old woman underwent intramedullary nailing of a pathologic humeral fracture using a combination of regional and general anesthesia. This case study shows how ultrasound guidance permitted the performance of both an interscalene and supraclavicular nerve block for a single procedure without the increased volume of local anesthetic that would normally be required, while still providing complete coverage of the entire upper extremity.
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Since the Food and Drug Administration approved the da Vinci Surgical System in 2000, robotic surgery is becoming increasingly popular in the operating room. Despite its popularity and proposed benefits, robotic surgeries encompass many complications that are often confounded by the patient's physiology and comorbidities. This article illustrates a case study of a patient who underwent a da Vinci ureterectomy. The case study will highlight the implications and complications that may arise with pneumoperitoneum and steep Trendelenburg positioning, and an overview of the current literature in robotic surgery will be presented.
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Intraoperative volume administration has long been a topic of debate in the field of anesthesia. Only recently, however, has the conversation shifted to a discussion of appropriate intraoperative volume. A thorough review of the literature explores the history of today's widely accepted fluid administration equation and discusses possible explanations and consequences of iatrogenically induced hypervolemia. Current studies exploring various volume administration techniques are reviewed, as are emerging technologies available to help guide anesthesia providers with intraoperative fluid management.