AANA journal
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Historically, closed malpractice claims have been used to identify and examine potential causes for adverse anesthesia outcomes. In the United States, the American Association of Nurse Anesthetists and the American Society of Anesthesiologists have compiled and analyzed such data. ⋯ Although some researchers have cited closed claims studies as evidence of anesthesia risk trends, the nature of the data makes it inappropriate for calculation or comparison of risk. Further work is needed to elucidate some mechanisms of injury and to develop interventions to maximize patient safety.
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Review Case Reports
Impact of pseudotumor cerebri (idiopathic intracranial hypertension) in pregnancy: a case report.
This case report reviews anesthetic management and medical considerations for a pregnant patient with a history of pseudotumor cerebri (PTC). The 24-year-old woman, gravida 2, paragravida 0, spontaneous abortion 1, was in active labor at an estimated 38 weeks' gestation and had been given a diagnosis of PTC 4 years earlier. This patient first experienced global headaches and blurred vision at age 20 years. ⋯ The patient was free of PTC symptoms on admission for labor. A lumbar epidural was placed for labor analgesia. The patient delivered a healthy infant after approximately 10.5 hours of patient-controlled epidural analgesia.
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An extensive literature review was undertaken to evaluate the best anesthetic practice for carotid endarterectomy surgery. Two anesthetic techniques were evaluated: general anesthetic with an endotracheal tube and regional anesthetic block. Three variables were reviewed with respect to significant clinical outcomes based on anesthetic technique. ⋯ According to the literature, there is an advantage to performing regional anesthesia with respect to cost and neurologic status. Information analyzed was inconclusive with respect to hemodynamic stability and anesthetic technique. We conclude that regional anesthesia may have some slight advantages; however, more investigation is warranted.
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Review Case Reports
Risk, benefits and complications of epidural steroid injections: a case report.
Acute low back pain, radiculopathy, and associated disabilities have a prevalence of 2% in the United States, which represents a significant health problem and a major cause of workplace absence. The condition primarily affects 25- to 45-year-old men and women. Epidural steroid injections (ESIs) are commonly administered to relieve this pain and improve mobility without surgery. ⋯ It reviews the risks, benefits, side effects, complications, and contraindications to ESI and the American Society of Regional Anesthesia consensus recommendations for the performance of neuraxial procedures in patients receiving anticoagulant therapy. It is imperative that any provider who performs ESIs know the risks, benefits, complications, and contraindications for this procedure. Practitioners must also be able to recognize and manage or appropriately refer patients having immediate or delayed complications related to the placement of an ESI.
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Review Case Reports
Use of heliox for intraoperative bronchospasm: a case report.
Bronchospasm is an anesthetic emergency that can lead to disastrous outcomes if treatment is irresolvable. An anesthesia provider must immediately initiate treatment if bronchospasm is suspected in order to avoid negative sequelae. ⋯ Although heliox has been used foryears to treat patients with various respiratory complications, it is not currently a common treatment instituted by anesthesia practitioners for the treatment of bronchospasm. Consideration of the use of heliox may provide another option for the treatment of a patient suffering from refractory bronchospasm.