AANA journal
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This article discusses the anesthetic management and implications of 2 pediatric patients with a diagnosis of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis. Anti-NMDA receptor encephalitis has been described as an immune-meditated syndrome that triggers the production of antibodies to the NMDA receptor: a site of action for many commonly used anesthetic agents. ⋯ This disease process can pose a challenge to the anesthesia provider during all stages of the anesthetic. Thus, the anesthesia provider must incorporate an understanding of the administered anesthetic agent's potential pharmacologic effect on the affected NMDA receptor when formulating the patient's anesthetic plan.
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Comparative Study
Perioperative glucose monitoring and treatment of patients undergoing vascular surgery in a community hospital setting.
This article discusses the glucose monitoring and treatment practices of a small community hospital and aims to determine how these practices relate to postoperative complications in patients undergoing vascular surgery. Previous studies in patients undergoing cardiovascular surgery have demonstrated that glucose control directly affects outcomes, including length of stay and incidence of infection, stroke, renal failure, myocardial infarction, and readmissions within 30 days of the initial surgery. A retrospective analysis of 101 patients who underwent vascular surgery was performed. ⋯ The threshold for treatment of preoperative hyperglycemia was a blood glucose level of 236 mg/dL. Increased vigilance of perioperative blood glucose levels is needed so that appropriate interventions can be instituted and outcomes improved. Glucometers must be readily available to anesthesia providers so that intraoperative monitoring of blood glucose levels can occur.
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Anesthesia is one of the few areas in healthcare with no secondary verification of medication administration, yet it also has the highest number of administered medications, most of which are high-alert medications. Anesthetists often prescribe, dispense, mix, relabel, administer, and document medications without secondary verification. ⋯ The Anesthesia Patient Safety Foundation recommends implementing standardizations, barcode medication administration, and the use of prefilled or premixed syringes to assist in the safe delivery of anesthesia. It has been shown that adhering to the principles outlined by the Anesthesia Patient Safety Foundation reduces the number of adverse drug events and results in safer care of patients.