AANA journal
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Randomized Controlled Trial Comparative Study
Comparison of Second-Generation Supraglottic Airway Devices (i-gel versus LMA ProSeal) During Elective Surgery in Children.
Second-generation supraglottic airway devices i-gel (Intersurgical Ltd) and LMA ProSeal (Teleflex Inc) are designed for a superior airway seal with a high success rate in adults. This study compared the efficacy of i-gel and LMA ProSeal (sizes 1, 1.5, and 2) as an airway device in a pediatric population, especially infants. The study included 163 ASA class 1 and 2 children, aged up to 10 years and weighing 2 to 25 kg, undergoing elective surgeries lasting less than 1 hour under general anesthesia on spontaneous respiration. ⋯ Mann-Whitney U test and χ2 tests were used to compare collected data. Both devices were found to be comparable in effectively securing the airway in children, even in infants. The insertion time was significantly faster with i-gel.
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Comparative Study
Does Moral Distress Differ Between California Certified Registered Nurse Anesthetists in Independent Versus Medically Supervised Practice: An Exploratory Study.
The purpose of this exploratory, descriptive study was to determine if moral distress levels differed between certified registered nurse anesthetists (CRNAs) working in medically supervised versus independent practice in California. A 63-question survey was administered to 1,190 California CRNAs. Moral distress was measured by the included Ethics Stress Scale. ⋯ Lower scores on the ESS indicate higher moral distress. Qualitative data demonstrated that CRNAs experienced moral distress in the following situations: when pressured to give anesthesia to unoptimized patients, when differences of opinion regarding anesthetic plans occurred, in dealing with end-of-life issues, when working with incompetent providers, and during interprofessional struggles between CRNAs and anesthesiologists. In order to reduce moral distress among CRNAs, implications for practice include increased administrative support, increased communication and reciprocated collegial respect between anesthesiologists and CRNAs, and CRNA representation on ethics committees.
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Use of opioids to provide adequate perioperative analgesia often leads to respiratory depression, nausea, vomiting, urinary retention, pruritus, and opioid-induced hyperalgesia, with the potential to increase length of stay in the hospital. In an effort to reduce perioperative opioid administration yet provide appropriate pain relief, researchers began to study the use of esmolol beyond its well-known cardiovascular effects. Perioperative esmolol has been shown to reduce anesthetic requirements, decrease perioperative opioid use, decrease the incidence of postoperative nausea and vomiting, lead to an earlier discharge, and increase patient satisfaction. This article provides a review of the literature on the use of esmolol as an adjunct for perioperative analgesia and anesthesia.
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Identification and analysis of critical respiratory alarms during use of an advanced anesthesia workstation is essential in the intraoperative period. We present and discuss a scenario in which there was activation of a fresh gas flow alarm during low-flow anesthesia intraoperatively and use of oxygen flush to counteract it led to a diluted concentration of the inspired anesthetic agent.
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The most common complication due to intubation is a high cuff pressure. A high cuff pressure can cause postanesthetic tracheal mucosal injuries in patients undergoing surgery. The aim of this cross-sectional study was to describe whether anesthetic nurses and anesthesiologists identified a very high cuff pressure by manual palpation of the external cuff balloon on an endotracheal tube. ⋯ Among the participants who rated the cuff pressure as high, 44.8% rated the pressure as quite high and 60.6% rated the pressure as very high. There was no significant relationship between profession and skill in identifying a very high cuff pressure (P = .843) or between work experience and skill in terms of identifying a very high cuff pressure (P = .816). These findings indicate that 10% of patients are at risk of tracheal erosion because of a high cuff pressure.