AANA journal
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Review
Alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events.
Alpha2-adrenergic agonists have been shown to reduce the incidence of perioperative myocardial morbidity and mortality. The purpose of this review article is to summarize the current data pertaining to alpha2-adrenergic agonists and their role in the prevention of perioperative adverse cardiac events. ⋯ The currently published randomized controlled trials indicate that alpha2-agonists reduce the incidence of myocardial ischemic episodes in patients with known or suspected coronary artery disease undergoing noncardiac surgery, and clonidine was shown to reduce mortality in noncardiac surgical patients. The authors of the studies concluded that while alpha2-agonists exert beneficial effects on hemodynamics and myocardial protection, large-scale, prospective, controlled trials are still needed.
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Patients having surgical procedures are at risk for anoxia that may cause cognitive impairment. Continuous monitoring of cerebral oxygenation and perfusion with an instrument such as a cerebral oximeter is desirable. ⋯ This critical review of the literature on the efficacy, mechanics, and usefulness of the cerebral oximeter will be helpful to anesthesia providers in evaluating the controversy surrounding its use. A comprehensive understanding of the factors involved in cerebral perfusion and available equipment, such as the cerebral oximeter to monitor cerebral oxygenation, allows anesthetists to provide the best protection for the brain.
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Review Case Reports
Anesthetic considerations for the patient with hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome).
Hereditary hemorrhagic telangiectasia (HHT), Osler-Weber-Rendu Syndrome, is an uncommon disease but may be present in many people who remain undiagnosed. It is an autosomal dominant disorder characterized by multiple arteriovenous malformations (AVMs) and telangiectases that affect multiple organ systems. Hereditary hemorrhagic telangiectasia patients have a propensity for bleeding, especially from the oropharynx, nasopharynx and gastrointestinal tract, as well as from rupture of AVMs of other organ systems. Anesthetic care of patients with HHT involves very specific interventions with regard to control of bleeding, maintaining adequate oxygenation, and balancing hemodynamic values to optimize perfusion without compromising anesthetic depth.
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Patients are admitted for surgery while taking a wide array of medications, and nurse anesthetists must evaluate their effectiveness and compatibility with anesthesia. Anesthetists must be familiar with the basic pharmacology of each drug and the potential adverse effects and possible drug interactions that may occur when anesthetic drugs are administered. If a medication requires discontinuation, we must ensure that the patient's disease remains controlled throughout the perioperative period. ⋯ Most medications taken for minor disorders that do not have systemic effects can be safely continued without incident. Some medications may require discontinuation or temporary alteration of the dosing schedule to avoid problems in the perioperative period. This course reviews the current literature regarding the anesthetic management of several commonly encountered drug classes.
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Review Case Reports
Anesthetic management of a pregnant patient with an automatic implantable cardioverter-defibrillator: a case report.
There is little data currently available for the obstetric anesthetist to use as a reference for the anesthetic management of laboring women with automatic implantable cardioverter-defibrillators (AICDs). This case report involves a parturient with an AICD and a history of serious cardiac events. ⋯ The choice of anesthetics used to provide her with analgesia for labor is described, including the rationale for this anesthetic plan. A review of the literature that contains information on safe and effective anesthesia used for laboring women with AICDs is described.