AANA journal
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Case Reports
Anesthetic implications for implantation of a left ventricular assist device: a case study.
A left ventricular assist device (LVAD) is intended for use as a temporary bridge to transplantation in patients with end-stage cardiac failure until a donor heart becomes available. This case report discusses the anesthetic management of a patient undergoing implantation of an LVAD. Tremendous advances have been made in cardiac transplantation; however, there is an acute donor shortage in the face of an increased need for donor hearts. ⋯ Food and Drug Administration approved assist device, the Thermo-Cardiosystems, Inc. (Woburn, Massachusetts) implantable pneumatic LVAD is proving to be very successful as a bridge to transplantation. A case is presented of a 40-year-old male with debilitating cardiomyopathy in conjunction with mitral regurgitation, pulmonary hypertension, and mild tricuspid regurgitation. He had reached the point of multisystem organ failure which had left him incapacitated while awaiting cardiac transplantation.
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In Part A of this two-part Journal course, issues of safety during subarachnoid and epidural blocks were examined (see the August 1997 issue of the AANA Journal). Part B deals with the effectiveness of spinal and epidural blocks. Although the overall failure rate for subarachnoid and epidural blocks is low, regional anesthesia is not always effective. ⋯ While opioid induced respiratory depression was a significant hazard during the initial development of spinal and epidural opioid techniques, refinements in dosing and monitoring of these patients have reduced the incidence of this complication to a low level. While alpha agonists, such as epinephrine, do prolong the duration of some types of blocks, they also introduce or exacerbate problems, such as urinary retention, itching, and even hypotension. Whatever technique is used, careful patient selection, allowing adequate time for the block to set up, and administering small doses of a systemic analgesic or sedative if needed may make the difference between the success or failure of a well-performed block.
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The laryngeal mask airway (LMA) is an important new tool for managing the emergency airway. In a variety of emergency situations, the LMA may be considered instead of the face mask or the endotracheal tube. ⋯ The primary risk with the LMA is aspiration of gastric contents. Anesthetists should be familiar with its advantages, risks, indications, and uses.
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The effect of acrylic nails on the measurement of oxygen saturation as determined by pulse oximetry.
Pulse oximetry (Spo2) is a simple, noninvasive method that is widely used to determine oxygen saturation in patients undergoing surgical procedures. Artificial acrylic nails have recently become fashionable to strengthen and lengthen nails. This study investigates the effect of unpolished acrylic nails on the measurement of oxygen saturation by pulse oximetry. ⋯ Using a paired Student's t test, no statistically significant differences existed between readings. This study demonstrates that unpolished acrylic nails do not affect pulse oximetry measurements of oxygen saturation. Patients may not need to remove unpolished acrylic nails before surgery.
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Comparative Study
Recovery times from subarachnoid blocks using bupivacaine hydrochloride and tetracaine hydrochloride with and without epinephrine.
This retrospective study examined the length of time patients spent in the postanesthesia care unit (PACU) recovering from a subarachnoid block with either bupivacaine hydrochloride or tetracaine hydrochloride with and without epinephrine after total knee replacement surgery or total hip replacement surgery. One hundred subjects' charts were reviewed with 50 subjects receiving a subarachnoid block with bupivacaine (25 had epinephrine added to the bupivacaine) and 50 subjects receiving a subarachnoid block with tetracaine (25 had epinephrine added to the tetracaine). ⋯ Patient who received tetracaine stayed longer in the PACU (64.44 minutes) and took longer to bend their knees (73.17 minutes), flex their hips (99.65 minutes), and have return of sensation (68.88 minutes), compared to those who had received bupivacaine (P < .05). When epinephrine was added to the local anesthetic, it prolonged the time until the return of knee flexion, hip flexion, and sensation by 66.82, 87.65, and 76.77 minutes respectively (P < .05).