AANA journal
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Femoral nerve blocks and 3-in-1 blocks are simple and useful alternatives to other regional or general anesthetic techniques for selected surgeries. These blocks also may provide postoperative analgesia that may be a useful alternative to epidural or parenteral analgesia. Understanding the techniques of blockade, its appropriate applications, and the relevant anatomy may provide the anesthetist with a valuable alternative.
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Nitrous oxide, a commonly used agent in the dental and anesthesia practice, carries serious risks to healthcare providers. Complications from its exposure can range from hematological abnormalities and neurological deficits to increased risk of spontaneous abortions in women. A concentrated effort by all anesthesia personnel is necessary to prevent the adverse effects associated with the use of this agent.
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The lungs can be separated by use of either a double-lumen tube (DLT) or a bronchial blocker (BB). Correct positioning of DLTs and BBs is often the most important determinant as to whether thoracic surgery cases (in particular one-lung ventilation cases) and differential lung ventilation in the intensive care unit proceed smoothly. If the method of lung separation is correct, the operative nondependent lung will collapse completely and easily, the surgeon will be able to work efficiently without damaging the operative lung, and the nonoperative lung will be unobstructed and easy to ventilate. For both DLTs and BBs, the key to precise positioning is to visualize, with a fiberoptic bronchoscope, through the tracheal lumen, the occluding endobronchial cuff/balloon just below the tracheal carina.
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The goal of mechanical ventilation is to maintain adequate gas exchange by opening and stabilizing alveolar units with minimal detriment to the pulmonary and circulatory systems. The optimal ventilatory strategy may be difficult to achieve, especially in patients with respiratory failure. Total liquid ventilation is a process whereby a liquid perfluorocarbon (PFC) replaces both the functional residual capacity and the tidal volume within the lung. ⋯ In PLV, a functional residual capacity of PFC liquid is maintained in the lung, and the patient is ventilated with a conventional gas mechanical ventilator. Studies of the acute respiratory distress syndrome in animal models and in human series have demonstrated encouraging results using PLV and PFC. The high density, low surface tension, and other qualities of PFC in the setting of PLV may offer a highly innovative approach that can be directed toward the management of patients in respiratory failure.
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Complex regional pain syndrome (CRPS) is a progressive, chronic illness that is enigmatic because the mechanisms for its pathogenesis have yet to be determined. Syndromes synonymous with CRPS are reflex sympathetic dystrophy, reflex neurovascular dystrophy, causalgia, algoneurodystrophy, sympathetically maintained pain, clenched fist syndrome, and Sudek's syndrome. The diagnosis of CRPS is categorized into three stages: acute, dystrophic, and atrophic. ⋯ Patients suffering from CRPS may be limited in their ability to function in a self-directed, independent fashion. A longitudinal study of CRPS on 1,348 patients revealed that 96% of the study subjects still suffer some pain and disability regardless of the duration of the disease or course of treatment. Although the primary etiology for CRPS is not clearly understood, key progress has been made in terms of establishing a psychological as well as therapeutic treatment plan once the diagnosis has been made.