AANA journal
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Case Reports
Elective laparoscopic fetal laser photocoagulation in twin-twin transfusion syndrome: a case report.
Twin-twin transfusion syndrome (TTTS) is a complication of multiple gestation in which arteriovenous vascular communications occur in a shared placenta. Due to these communications, there is an imbalance of blood flow between the developing fetuses. This results in 1 twin becoming the donor and the other becoming the recipient. ⋯ Therapeutic options available include decompression amniocentesis, amniotic septostomy, interruption of the placental vessel communications, and selective fetal reduction. Selective fetoscopic laser photocoagulation of abnormal vascular communications has shown to result in increasing survival rates and has become a definitive treatment option for severe TTTS. The case report presented involves a 32-year-old, gravida 5, para 2 patient at 19 weeks' estimated gestational age with a monochorionic diamniotic twin gestation with TTS diagnosed using ultrasonography presenting for an elective laparoscopic fetal laser photocoagulation.
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A retrospective analysis of the National Practitioner Data Bank (NPDB) Public Use Data File was performed on anesthesia-related malpractice payments from 2004 to 2010. Anesthesia-related allegations, malpractice act or omission codes, severity of injury, and cost were assessed. ⋯ When reviewing specific allegations of malpractice act or omission among the total number of CRNA malpractice payments, the most common allegations were improper performance,, failure to monitor, and problem with intubation. Patients between the ages of 40 and 59 years, inpatients, and female gender were independently more prevalent among CRNA malpractice claims leading to payment than other patient demographics.
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This article presents thromboelastography (TEG) as an important assay to incorporate into anesthesia practice for development of evidence-based therapy of trauma patients receiving blood transfusions. The leading cause of death worldwide results from trauma. Hemorrhage is responsible for 30% to 40% of trauma mortality and accounts for almost 50% of the deaths occurring in the initial 24 hours following the traumatic incident. ⋯ A potential solution is incorporating the use of the TEG assay into the care of trauma patients to render evidence-based therapy for patients requiring massive blood transfusions. Analysis with TEG provides a complete picture of hemostasis, which is far superior to isolated, static conventional tests. The result is a fast, well-designed, and precise diagnosis enabling more cost-effective treatment, improved clinical outcome, accurate use of blood products, and pharmaceutical therapies at the point of care.
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The purpose of this evidence-based project was to determine the perceptions of anesthesia providers regarding the use of disposable laryngoscope blades. Frequency of use, ease of use, and complications encountered when using the disposable blade were evaluated before and after an in-service program designed to increase the use of disposable blades. Participants completed an anonymous questionnaire about their knowledge and practice regarding disposable laryngoscope blades. ⋯ After the intervention, 25% of anesthesia providers described performance as their reason for not using the disposable laryngoscope blade, which was down from 60% at the project's start. Inventory showed a 23% increase in use of disposable laryngoscope blades after the intervention, which a single-proportion Z test showed was statistically significant (Z = 2.046, P = .041). This evidence-based project shows that a change in practice was evident after dissemination of the best and most recent clinical evidence regarding laryngoscope blades, which should translate to improved patient outcomes.