AANA journal
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Opioids are the mainstay of intraoperative pain control, but they have several deleterious effects. Alternative medications and strategies to opioids, while effective in producing intraoperative analgesia, are underutilized by anesthesia providers. The purpose of this study was to examine and describe Certified Registered Nurse Anesthetists' perspectives and practices on administering opioids vs nonopioid or opioid-sparing strategies ("opioid alternatives") to treat intraoperative pain. ⋯ Barriers expressed by study participants included opioid superiority, inconsistent analgesic effects of intraoperative opioid alternatives, limited experience with opioid alternatives, limited resources on opioid alternatives, negative experiences with intraoperative opioid-alternative administration, and patient comorbidities. Facilitators expressed by study participants included the adverse effects of opioids, institutional policy and procedures, positive experiences with opioid-alternative administration, and regional anesthesia superiority. This study highlights the importance of improving education, training, and institutional policies in support of opioid-alternative medications and strategies to treat intraoperative pain and better prevent opioid addiction and abuse.
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Review Historical Article
Marijuana Use in the Anesthetized Patient: History, Pharmacology, and Anesthetic Considerations.
Marijuana consumption is growing in the United States because of state legalization for recreational and medical use. However, many anesthesia practitioners are unaware of the potential adverse effects that may occur if marijuana is taken before the administration of an anesthetic. This review provides a history of marijuana use, the current laws and regulations, the pharmacology of marijuana, and best evidence-based practices related to anesthetic care of the marijuana user.
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Medical errors are among the top 3 causes of patient deaths in the United States, with up to 400,000 preventable deaths occurring in hospitalized patients each year. Although improvements have been made in anesthesia patient safety, adverse outcomes continue to occur. ⋯ Investigators determined that 123 closed malpractice claims files from the American Association of Nurse Anesthetists (AANA) Foundation closed claims database involved events that the involved Certified Registered Nurse Anesthetist could have prevented. Factors that were associated with preventable closed claims included communication failures, violations of the AANA Standards for Nurse Anesthesia Practice, and errors in judgment.
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This article provides a systematic review of pediatric emergence agitation, also known as emergence delirium. Major topics of this review include the incidence, risk factors, and impact of the phenomenon, in addition to current evidence-based strategies for prevention of pediatric emergence agitation. ⋯ In an attempt to prevent this problem, anesthesia providers should consider these factors and possible interventions when implementing an anesthetic plan. Evidence-based interventions that may decrease the incidence of pediatric emergence agitation include technology, familial involvement, pharmacologic adjuncts, and alternative methods of general anesthesia.
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Clavicle fractures are common, and there has been a recent increase in surgical fixation of displaced fractures. General anesthesia is traditionally preferred for these operations because regional anesthesia can be challenging. This is partly due to a complex nerve innervation in this region, which makes the correct choice of nerve block difficult. ⋯ All patients underwent surgery successfully using regional anesthesia with light sedation, without the need for rescue opioids or rescue local anesthesia. No adverse events were recorded. This case series describes a successful peripheral nerve block combination that can be used for clavicle surgery.