AANA journal
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An exciting revolution in pediatric pain control has evolved in anesthesia during the past 2 decades. The creative use of systemic analgesic techniques has dramatically improved the quality of postoperative pain management. The postsurgical pediatric population is reaping the benefits of such advancements in acute pain management, as there is an increasing use of patient-controlled analgesia (PCA). ⋯ This review of the literature addresses safety issues, indications, contraindications, complications, and dosing regimens related to pediatric PCA. Recommendations for continuous pulse oximetry and sedation monitoring, along with individualized dosage requirements, are presented to decrease the incidence of complications. Overall, the literature shows that PCA provides adequate pain control and high levels of satisfaction for the pediatric postsurgical population and their families.
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The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace. The U. S. ⋯ Human tissue is also an important factor in ultrasound imaging. The different densities of soft tissues, bone, fluid, and air all interact with sound, creating distinctive images that can aid and potentially hinder accuracy. Comprehension of basic ultrasound principles and how it is affected by tissue will enable anesthetists to better understand what is being seen and reduce the potential for errors.
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Organs needed for transplantation far outweigh their availability. There is minimal research regarding perioperative care of the brain-dead organ donor during the procurement procedure. Current research attributes a great deal of organ damage to autonomic or sympathetic storm that occurs during brain death. ⋯ No studies have been published evaluating the effect of preconditioning with inhalational agents (administering 1.3 minimal alveolar concentration of an inhalational agent for the 20 minutes before periods of ischemia) in the brain-dead organ donor population. Further studies are required to determine if administration of inhalational anesthetics reduces catecholamine release occurring with surgical stimulation during the organ procurement procedure and whether this technique increases viability of transplanted organs. Anesthetic preconditioning before the ischemic period may reduce ischemia-reperfusion injury in transplanted organs, further increasing viability of transplanted organs.
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Current fashion in body art includes low back tattoos of varying designs and colors, a trend that presents unique concerns for anesthesia providers. Does the placement of epidural catheters risk the introduction of tattoo pigment dyes into the epidural space through the process of coring? Are there specific risks associated with tattoo dyes and epidural needle placement? We performed a comprehensive review of the literature using multiple search databases with the intent to form guidelines for practice using a level of evidence taxonomy. ⋯ Continued investigation is necessary before comprehensive practice guidelines regarding the practice of placing epidural needles and catheters through lumbar tattoos can be developed. We suggest avoidance of piercing tattoos when performing epidural punctures until there is sound evidence of short-term and long-term safety.
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Visual loss is a traumatic occurrence that has been reported after prone spine surgical procedures performed under general anesthesia. The most common cause of postoperative visual loss is ischemic optic neuropathy. Although the incidence of postoperative visual loss is rare, this devastating injury has been reported more frequently. ⋯ Ischemic optic neuropathy usually presents with painless visual loss and visual field deficits during the immediate postoperative period. There is no definitive treatment. Prevention is the key.