AANA journal
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Craniotomies are a common neurological intervention for intracranial tumor resections. Anesthesia techniques allow surgeons to aggressively and optimally resect neoplastic tissue while sparing normal cerebral tissue. Awake craniotomies are surgical techniques that enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback. ⋯ Preoperative evaluation, regional anesthesia, general anesthesia, and monitored anesthesia are necessary to achieve a successful surgical intervention with awake craniotomy. As awake craniotomy gains more popularity, dependable anesthesia techniques remain critical. A discussion follows of the role of anesthesia providers in awake craniotomy during the entire perioperative continuum.
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We studied the current literature on human patient simulation for preparing anesthesia and other healthcare providers for advanced airway management. A systematic review was conducted of articles published between 1990 and 2009 on advanced airway management for patients undergoing anesthesia and patients who are not. The search used 4 electronic databases: Cumulative Index to Nursing & Allied Health Literature, MEDLINE, PsycINFO, and Web of Science. ⋯ Those studies included analyses of different types of training and the perceived value of simulated training, and evaluations of equipment. Few studies have analyzed the effects of this modality on trainer skills and patient safety. There is a clear need for well-designed studies to examine these effects.
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The pathophysiologic mechanisms for complex regional pain syndrome (CRPS) are complex and elusive. The proposed etiologic mechanisms for CRPS include inflammatory responses, peripheral or central sensitization, and sympathetic dysfunction. Anesthesia care of patients with CRPS is challenging. Treatments including physiotherapy, peripheral vasodilators, sympathetic blockade, analgesics, and other systemic medications can help optimize mobility, perfusion, and pain relief for affected patients.
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Many modern diagnostic and surgical procedures rely heavily on the use of ionizing radiation. These procedures include computed tomography, nuclear medicine procedures, interventional radiology, and cardiac catheterization and electrophysiology procedures. ⋯ An overview of some of the basic principles of radiation biology, radiation physics, and radiation protection and specific guidelines related to radiation exposure and pregnancy are described. The effects of radiation exposure are cumulative and permanent, and an understanding of these principles and practices will help anesthesia providers keep their occupational exposure to a minimum.
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Sonography addresses a variety of concerns, such as patient safety and comfort, cost-effectiveness, time to complete a procedure, and success rates associated with invasive anesthesia procedures. Ultrasound guidance is commonly being used for the placement of nerve blocks, placement of peripheral and central lines, and arterial catheterization. ⋯ The general terms and application of ultrasound to the practice of anesthesia are discussed in this article, as well as the general principles and the interpretation of basic images. Common procedures that include its use are also reviewed.