AANA journal
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A young woman who sustained severe head trauma presented to the operating room for emergent surgical intervention. Her electrocardiogram (ECG) exhibited signs of myocardial ischemia, which resolved several days postoperatively. ECG changes suggestive of cardiac pathology can be associated with intracranial pathology, most notably subarachnoid hemorrhage. ⋯ Continuous ECG monitoring is essential. Ventricular dysrhythmias may prove resistant to conventional pharmaceutical management. Beta blockade may be indicated to prevent excessive cardiac stimulation by endogenous catecholamines, and, in addition, may prevent the formation of the microscopic cardiac lesions typical of this hyperstimulation.
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The high cost of nurse anesthesia education programs, brought about by the movement of such programs into a master's degree framework, can become a hindrance to the incorporation of such programs into the mainstream of nursing education. Strategies for coping with these costs are offered.
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Comparative Study
Neuromuscular blockade: electromyographic and mechanical versus visual interpretation.
Anesthetists frequently provide intraoperative muscle relaxation in addition to general anesthesia. However, visual interpretation of the effect of neuromuscular blocking drugs is not always possible. This study examined two alternative methods (electromyography/electrocardiography [EMG/ECG] and mechanical/ECG) of interpreting neuromuscular blockade and compared these methods to visual interpretation. ⋯ Both EMG/ECG and mechanical/ECG, when compared to visual interpretation, were found to be equally, and usually more, valid indicators of neuromuscular blockade. The clinical significance of this study is its contribution to quality care and patient safety. When visual monitoring of neuromuscular blockade is not feasible, either EMG/ECG or mechanical/ECG provide an alternative method of monitoring neuromuscular blockade.
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The intent of this research was to address the following question: Will an alteration in the drug aspiration technique cause a significant difference in the incidence of multidose vial contamination? The control group consisted of multidose vials collected at the end of each day from staff anesthetists. The use of these vials reflected the practice technique of a single needle and syringe for each vial. The vial, as well as needle and syringe, were used on all cases managed for the day. ⋯ Of the 369 multidose vials, one tested guaiac positive, 0.27%. A chi-square test on the cumulative data demonstrated a significant (p less than .05) difference between the two groups. The research demonstrated that occult blood may be contained within the used multidose vials suggesting that contaminated drug may then be injected into another patient.(ABSTRACT TRUNCATED AT 250 WORDS)