AANA journal
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Review Comparative Study
Transesophageal echocardiography as an alternative for the assessment of the trauma and critical care patient.
Transesophageal echocardiography was first described and used to monitor cardiac function in 1976. Initially adopted by cardiac anesthesiologists and cardiologists, it has gained acceptance as an important diagnostic tool in the monitoring and assessment of cardiac status in the critically ill and trauma patient population. ⋯ In addition, transesophageal echocardiography affords the practitioner reliable cardiac filling volumes based on direct left ventricular assessment compared to pressure data that are based on indirect right ventricular and pulmonary occlusive pressures. In a healthcare environment that seeks optimum patient assessment while requiring an approach that encourages cost-effective, noninvasive, and minimal patient risk, those nurse anesthetists who work in institutions that have transesophageal echocardiographic capabilities should learn this newer technology and begin to incorporate it into their practice.
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In this Journal course, the manifestations, etiologic and pathophysiologic factors, and incidence of Parkinson disease are reviewed along with current medical management. Medications and other factors that have an impact on the course of Parkinson disease are discussed. Suggested preanesthetic, intraoperative, and postoperative interventions are provided.
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Postoperative nausea and vomiting (PONV), a common problem with complex causes, may result in substantial complications. This Journal course discusses the pathogenesis of PONV and reviews antiemetic pharmacology. ⋯ State-of-the-art anesthetic techniques for prevention of PONV are described. Multimodal therapy with combined low-dose antiemetics affecting multiple receptors is suggested to prevent PONV in high-risk patients such as nonsmokers, females with a previous history of nausea, and patients with high postoperative narcotic requirements.
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Hypothermia has long been common in anesthesia and has largely been seen as an inconvenience. For many years, it was viewed as inevitable. But hypothermia is much more than an inconvenience, and it is no longer inevitable. ⋯ Hypothermia may begin in the preoperative holding area, so efforts to prevent it should begin there as well. Effective intraoperative and postoperative warming methods are known and commonly available, but they remain underused. Understanding how and why core temperature declines in association with anesthesia and surgery and safe, effective methods to prevent that decline will enable nurse anesthetists and perioperative nurses to increase both the comfort and safety of their patients while reducing costs to the institution.
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In the administration of anesthesia, clinicians have traditionally relied on a variety of autonomic signs to assess the pharmacologic effects of anesthetic agents on the central nervous system. As any experienced clinician knows, these signs can be misleading and lead to overdosing or underdosing of anesthetic drugs. The development of a monitor to measure the bispectral index (BIS) provides anesthetists with the first clinically tested and US Food and Drug Administration-approved monitor to assess the effects of anesthesia on the cerebral cortex. This article reviews the development of the BIS monitor, compares the BIS monitor with other commonly used clinical monitors, assesses the cost-benefit from the use of this monitor, and explores some of the possible uses for this monitor outside of the operating suite.