AANA journal
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With more surgical procedures than ever before being performed in office settings, office-based anesthesia is a rapidly growing area of anesthesia practice. Although there are many advantages to office-based practice, limitations inherent to this setting, if not recognized and addressed, may threaten patient safety. ⋯ Anesthesia for cosmetic surgery procedures in the office setting is frequently performed under monitored anesthesia care (MAC) with its own unique safety considerations. Anesthetists practicing in office-based cosmetic surgery practices must understand the special characteristics of this setting, the MAC-based approach often used, the anesthesia and safety considerations for the cosmetic surgical procedures performed, and the importance of prophylaxis for venous thromboembolism.
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Current procedures for cleaning anesthesia airway equipment as assessed by the presence of visible and occult blood on laryngoscope blades and handles as labeled "ready for patient use" has been reported to be ineffective. Human immunodeficiency virus (HIV) and the hepatitis B virus (HBV) are 2 commonly seen pathogens that frequently are found in the healthcare setting. It has been shown that HBV can survive on a dry surface for at least 7 days and both HIV and HBV are transmitted via blood. ⋯ To prevent further potential infections, it should be ascertained why anesthesia providers are not all using disposable laryngoscope blades. The purpose of this literature review is to determine the use and infection control practices of disposable laryngoscope blades. Their frequency of use, their evaluation of ease of use, and any complications encountered when using the disposable blade are reviewed, as well as the perceptions of anesthesia providers regarding disposable laryngoscope blades.
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Anesthesia is generally accepted as safe in most adult populations; however, in pediatric patients questions exist regarding the potential for long-term detrimental effects. Various anesthetic agents are associated with neuronal degeneration when administered to neonatal animals. The mechanism of damage is thought to be via accelerated apoptosis, a normally beneficial process in the maintenance of homeostasis. ⋯ Clear evidence exists that neuronal apoptosis occurs when anesthetics are administered to neonatal rodents and primates, and behavioral and cognitive testing from some authors indicate long-term effects persist well into an animal's adulthood. Preliminary human trials reveal a link between anesthesia and subsequent developmental delays. This review of the literature clarifies the need for further research in humans.
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Placement of an epidural catheter in parturients can be challenging because the anatomic changes of pregnancy may make it difficult to palpate an ideal insertion point or detect loss of resistance. Preprocedural ultrasonography (U/S-P) is reported to facilitate placement of epidural catheters in parturients. ⋯ The purposes of this course are to describe the technique, systematically review the literature, and discuss techniques for integrating U/S-P into practice. It provides evidence demonstrating that U/S-P is a useful adjunct for placement of epidural catheters in obstetrical patients, especially patients with presumed "difficult backs" or obesity.
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The purpose of this course is to update nurse anesthetists about anesthetic-induced anaphylaxis. This course discusses the pathophysiologic process of anaphylaxis with descriptions of the allergic immune response and the mediators and mechanisms of mast cell activation. ⋯ Furthermore, the identification of the severity grade of hypersensitivity reactions and the appropriate treatment of perioperative anaphylaxis is discussed. In addition, postoperative and follow-up interventions, including testing for patients who have had an anesthetic-induced hypersensitivity reaction, are considered.