AANA journal
-
Randomized Controlled Trial Clinical Trial
The effect of pH-adjusted 2-chloroprocaine on the duration and quality of pain relief with a subsequent continuous epidural bupivacaine infusion.
A randomized, double-blind true experimental design with a post-test only was chosen to determine if the addition of sodium bicarbonate to 2-chloroprocaine would result in a longer duration of epidural analgesia, as well as increase the quality of pain relief in stage I parturients receiving a continuous bupivacaine epidural infusion. The experimental group (number (N) = 16) received sodium bicarbonate and 2-chloroprocaine followed by a continuous bupivacaine epidural infusion. The control group (N = 15) received normal saline and 2-chloroprocaine followed by a continuous bupivacaine epidural infusion. ⋯ Additional bolus injections occurred nine times in the control group and six times in the experimental group. The differences were not found to be significant (P > .106). The differences in time and amount of local anesthetic delivered were also found to be trivial (P > .80).(ABSTRACT TRUNCATED AT 250 WORDS)
-
A 28-year-old female with a diagnosis of multiparity was scheduled for laparoscopic tubal ligation. The patient had an unremarkable medical history, except that she had been a pack-a-day smoker for the past 10 years and had experienced a recent upper respiratory infection. General anesthesia was accomplished without incident, and insufflation of the abdomen with carbon dioxide (CO2) gas was begun. ⋯ The effect of CO2 insufflation on the patient should be given special consideration in these cases. Although serious complications associated with the use of CO2 gas are rare, such procedures must not be viewed with complacency. A protocol for the management of emergency situations should be developed and reviewed.
-
Contemporary advancements in cardiothoracic and abdominal surgical procedures have been historically dependent on the development and adoption of controlled airway management, specifically endotracheal intubation, controlled positive-pressure ventilation, and the use of automatic positive-pressure mechanical ventilators. More than 400 years elapsed before the 16th Century theories of Paracelsus and the demonstrations of Vesalius were routinely adopted to solve the "pneumothorax problem" that prevented complicated or prolonged surgical procedures within the pleural cavity. ⋯ The introduction of curare into European anesthesia practice and the adoption of protective airway practices during the poliomyelitis epidemics led to routine use of controlled positive-pressure ventilation and construction of dependable machinery. Laboratory investigations, exploring complications from cardiothoracic surgery, brought about American acceptance and established controlled positive-pressure mechanical ventilation as an indispensable part of conventional intraoperative management.
-
A prospective study was undertaken in an effort to determine the usefulness of the end-tidal carbon dioxide monitor in detecting anesthesia-related critical incidents. The critical incident technique was employed in the evaluation of 2,334 anesthetics. Anesthesia providers completed a critical incident questionnaire following each anesthetic. ⋯ Monitoring of end-tidal carbon dioxide was found to be useful in confirming the occurrence of already suspected critical incidents 58% of the time. The end-tidal carbon dioxide monitor was also found to be the initial detector of 27% of the reported anesthesia-related critical incidents. Monitoring of end-tidal carbon dioxide proved to be beneficial in detecting and confirming critical incidents during anesthetic management.
-
The medical director of a nurse anesthesia educational program in a Veteran's Administration medical center relates his experiences in creating an educational and practice environment where, through cooperation with the CRNA director, the capabilities of all anesthesia providers are respected and utilized.