AANA journal
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This article provides an update on residual neuromuscular blockade for nurse anesthetists. The neuromuscular junction, pharmacology for producing and reversing neuromuscular blockade, monitoring sites and methods, and patient implications relating to incomplete reversal of neuromuscular blockade are reviewed. Overall recommendations include using multiple settings when employing a peripheral nerve stimulator for monitoring return of neuromuscular function and administering pharmacologic reversal when the train-of-four ratio is below 0.9.
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Opioids have been administered intrathecally with subarachnoid block for postoperative pain relief in parturients undergoing elective cesarean deliveries. This case report presents the uncommon occurrence of intrathecal opioid-induced hypothermia in the latent phase of recovery following elective cesarean delivery. There are few case reports on the occurrence of latent-phase postanesthesia care hypothermia in patients receiving subarachnoid block with morphine sulfate injection (Duramorph). ⋯ Further assessment determined that the morphine injection might have been a contributing factor. Naloxone at 40-μg increments was administered intravenously and corrected the hypothermia. Awareness of hypothermia postoperatively with associated morphine administration through subarachnoid block must be ruled out in cases of progressing hypothermia.
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Review Meta Analysis
Nonpharmacologic Neuraxial Interventions for Prophylaxis of Postdural Puncture Headache in the Obstetric Patient.
Postdural puncture headache due to accidental dural puncture during epidural catheter placement is a source of morbidity for new mothers. It can interfere with maternal-newborn bonding and increase the length of hospitalization. This evidence-based article examined the question: For obstetric patients experiencing an accidental dural puncture during epidural placement, which nonpharmacologic prophylactic neuraxial interventions safely and effectively decrease the incidence of postdural puncture headache? A search of online databases revealed 4 systematic reviews with meta-analysis and a randomized controlled trial meeting the inclusion criteria. ⋯ The evidence suggested there may be value in performing a prophylactic blood patch or placing an intrathecal catheter. The risk of the intervention must be carefully weighed with the benefits. Further rigorous studies are needed to help determine the best methods to decrease the incidence of postdural puncture headache in obstetric patients experiencing an accidental dural puncture during epidural placement.
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Occasionally intubation of patients is difficult using a video laryngoscope (GlideScope, Verathon Medical) because of an inability to guide the endotracheal tube to the glottis or pass the tube into the trachea despite an adequate view of the glottis. We examined methods to improve success when this difficulty occurs. A literature search revealed 253 potential sources, with 25 meeting search criteria: 7 randomized controlled trials, 4 descriptive studies, 8 case series, and 6 case reports. ⋯ Evidence from lower-level sources suggested that several interventions were helpful, including using a controllable stylet, a fiberoptic bronchoscope in conjunction with the GlideScope, or an intubation guide, and twisting the endotracheal tube to facilitate passage into the trachea. Providers must consider the risks and benefits of any technique, particularly if the device manufacturer does not recommend the technique. Further rigorous investigations should be conducted examining methods to increase success.
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The objective of this study was to investigate whether patients' sense of coherence (SOC)--ability to comprehend their whole situation and their capacity to use available resources--influences acute postoperative complications in the postanesthesia care unit (PACU). We hypothesized that patients' SOC would be negatively related to their experience of pain and nausea, consumption of opioids, and length of stay in the PACU--the higher the SOC, the lower the experience of pain and nausea, less consumption of opioids, and shorter PACU stay. Data were collected from the anesthesia and electronic medical records, and combined with a questionnaire. ⋯ Patients with a stronger SOC experienced significantly less pain (P < .01) and consumed significantly less opioids (P < .01) than those with a lower SOC. Patients' SOC influences their experience of pain and opioid consumption in the PACU. Therefore, patients' SOC could be one of many factors that nurse anesthetists consider in their efforts to predict, prevent, and decrease patients' experience of pain in the PACU.