AANA journal
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Randomized Controlled Trial Clinical Trial
The effect of glycopyrrolate premedication on postoperative sore throat.
Patients given general endotracheal anesthesia commonly experience postoperative sore throat and/or hoarseness. Our study examined whether the occurrence of postoperative sore throat was associated with the use of a glycopyrrolate premedication and found that it was. ⋯ After surgery, an interviewer, unaware of the subject's group assignment, questioned each subject about the presence of a sore throat and, if present, asked the patient to rate its severity. We found that patients who did not receive preoperative glycopyrrolate were significantly less likely to report having a sore throat or reported having a less severe sore throat than patients who did receive glycopyrrolate.
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Review
AANA Journal course: update for nurse anesthetists--genetic testing for malignant hyperthermia.
The "gold standard" for the determination of susceptibility to malignant hyperthermia has long been the caffeine-halothane-contracture test, which is costly and invasive. As the workings of molecular genetics are better understood, research is being applied to finding the causative gene for malignant hyperthermia. Once this gene is identified, genetic testing will involve a much simpler, less invasive test that uses blood samples to detect susceptibility. ⋯ Review of the literature reveals that malignant hyperthermia has been linked to the ryanodine receptor in swine and in some humans. It has also been linked to chromosome 19q12-13.1, which is where the gene encoding the ryanodine receptor lies. The literature further reveals that malignant hyperthermia may be a heterogeneous disorder, which means that more than one gene is responsible for its expression.
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The June 1996 article in Anesthesia and Analgesia by Abenstein and Warner entitled "Anesthesia Providers, Patient Outcomes, and Costs" presents important information about anesthesia services, but it contains a number of errors and questionable interpretations that could lead to inappropriate programs and policies. Among the most important points of fact we clarify in our paper are: 1. Three organizations that accredit, certify, and govern nurse anesthetists are organized in similar fashion to three comparable bodies governing anesthesiologists. ⋯ The use of a hypothetical example related to Medicare reimbursement in New York to justify the implication that CRNA-delivered services are more costly than anesthesiologist-delivered services is misleading and not borne out in the literature. We hope that planners and policy makers will read the article by Abenstein and Warner with extreme caution. Taking some of their statements and conclusions seriously could lead to policies and programs that are not focused in science.
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Nurse anesthetists make significant contributions to healthcare worldwide. A little known fact is that, in many countries of the world, nearly all anesthesia is provided by nurses. This international survey, in five languages, was done to provide information about nurse anesthesia care delivered in countries in the regions of the world designated by the World Health Organization. ⋯ A goal of disseminating data in this article is to further validate these 1992-1994 study findings. Readers are encouraged to contact the authors with follow-up information. Support for the study was provided by the American Association of Nurse Anesthetists, Council on Recertification of Nurse Anesthetists, and the International Federation of Nurse Anesthetists.