AANA journal
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of axillary block techniques: is there a difference in success rates?
This study compared the success rates between two accepted methods of performing axillary blocks, the peripheral nerve stimulator (PNS) and the transarterial (TA) techniques. Success was based on blocking the nerves involved in the surgery. Following institutional review board approval and informed consent, 57 patients between the ages of 18 and 86 years of age scheduled for elective upper extremity surgery were studied. ⋯ There were no significant side effects reported by the patients postoperatively. The axillary nerve was the only nerve with an increased success rate using the TA technique. This indicates that both techniques are equally acceptable.
-
Case Reports
Suspected malignant hyperthermia in a 13-month-old: today's "typical" episode--a case report.
A case of suspected malignant hyperthermia in a 13-month-old female, to whom succinylcholine was not administered, is presented. The patient presented for a repair of the right radial nerve under general anesthesia. Induction was accomplished with halothane, nitrous oxide, and oxygen. ⋯ Resolution of symptoms followed the administration of dantrolene sodium. The patient underwent an uneventful postoperative recovery and was discharged home. It was felt that the patient was too young to undergo a muscle biopsy for a caffeine-halothane stimulation test.
-
Anesthesia providers must take appropriate precautions to reduce the potential for transmission of infectious agents to the patients under their care. The devastating spread of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) over the past decade has resulted in the development of specific guidelines for the cleaning, disinfection, sterilization, and handling of medical equipment and instruments. Contamination of laryngoscope blades and handles with visible and occult blood frequently occurs during routine airway management. ⋯ The extent to which contaminated anesthesia equipment plays in nosocomial infection is difficult to determine. The presence of blood is an indicator of potential cross-infection, since biological fluids, such as blood and saliva, are known to transmit infectious diseases. This study confirms that more rigorous decontamination protocols must be instituted to ensure complete removal of blood prior to sterilization, since laryngoscope blades and handles have irregular surfaces with repositories for infectious material.
-
Randomized Controlled Trial Clinical Trial
Comparison of intubating conditions related to timed dosages and a nerve stimulator based on the measurement of acceleration using mivacurium.
A quantitative method of monitoring neuromuscular blockade has been recently introduced. It has been suggested, when using mivacurium, that a standardized passage of time be used for induction. The purpose of this study was to determine whether a difference existed in intubating conditions when using mivacurium between a timed-dose technique and the ParaGraph (Vital Signs, Inc., Totowa, New Jersey). ⋯ Of the ParaGraph group, 100% had good to excellent intubating conditions, and 85% of the timed-dose group had fair to excellent intubating conditions. Time to intubation was longer in the ParaGraph group, with a mean of 216 seconds compared with 121 seconds in the timed-dose group. The variable time to onset of mivacurium indicates that a timed-dose technique may yield less than optimal intubating conditions despite manufacturer recommendations.
-
Randomized Controlled Trial Clinical Trial
The safety and efficacy of granisetron in postoperative vomiting in pediatric patients undergoing tonsillectomy.
A high incidence of vomiting after tonsillectomy is consistently reported in the literature. Multiple trials with different pharmacological agents and alternative anesthetic techniques have been used in an attempt to decrease this, but results have been inconclusive and adverse effects occur frequently. The purpose of this study was to examine the safety and efficacy of granisetron (Kytril) in the prevention of postoperative vomiting in children undergoing tonsillectomy. ⋯ A reduction in the incidence and severity of vomiting was shown to be significant in the experimental group, both in the hospital and at 24 hours postoperatively. High patient satisfaction was also reported in this group. Clinically, the prophylactic administration of granisetron intraoperatively in pediatric tonsillectomy patients should be considered to reduce the incidence and severity of postoperative vomiting.