AANA journal
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The laryngeal mask airway (LMA) is an important new tool for managing the emergency airway. In a variety of emergency situations, the LMA may be considered instead of the face mask or the endotracheal tube. ⋯ The primary risk with the LMA is aspiration of gastric contents. Anesthetists should be familiar with its advantages, risks, indications, and uses.
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HELLP syndrome in the parturient (hemolysis, elevated liver enzymes, and low platelet count) is associated with poor maternal and fetal outcomes. Maternal mortality has been estimated to be as high as 24%. Patients with HELLP syndrome are also at greater risk of pulmonary edema, adult respiratory distress syndrome, abruptio placentae, disseminated intravascular coagulation, ruptured liver hematomas, and acute renal failure. ⋯ Obstetric anesthesia personnel should perform a thorough preanesthetic evaluation and be familiar with the pathophysiologic changes of this syndrome. Determining the anesthetic of choice depends on the patient's condition, fetal well-being, and the urgency of the situation. In the presence of severe coagulopathy, regional anesthesia is contraindicated.
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Inhaled nitric oxide (NO) is a selective pulmonary vasodilator in adult and pediatric patients. Inhaled NO diffuses into the pulmonary vascular smooth muscle where it results in vasodilation via stimulation of guanylyl cyclase. Systemic hemodynamics are not altered because inhaled NO is rapidly inactivated by hemoglobin. ⋯ The potential toxicity of inhaled NO, particularly on immature and developing lungs, must be considered. While inhaled NO exerts acute beneficial effects, it is unclear if there are long-term benefits. Multicenter trials are currently underway to determine if inhaled NO decreases mortality from PPHN or decreases morbidity associated with ARDS.
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Review
AANA Journal course: update for nurse anesthetists--genetic testing for malignant hyperthermia.
The "gold standard" for the determination of susceptibility to malignant hyperthermia has long been the caffeine-halothane-contracture test, which is costly and invasive. As the workings of molecular genetics are better understood, research is being applied to finding the causative gene for malignant hyperthermia. Once this gene is identified, genetic testing will involve a much simpler, less invasive test that uses blood samples to detect susceptibility. ⋯ Review of the literature reveals that malignant hyperthermia has been linked to the ryanodine receptor in swine and in some humans. It has also been linked to chromosome 19q12-13.1, which is where the gene encoding the ryanodine receptor lies. The literature further reveals that malignant hyperthermia may be a heterogeneous disorder, which means that more than one gene is responsible for its expression.
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The June 1996 article in Anesthesia and Analgesia by Abenstein and Warner entitled "Anesthesia Providers, Patient Outcomes, and Costs" presents important information about anesthesia services, but it contains a number of errors and questionable interpretations that could lead to inappropriate programs and policies. Among the most important points of fact we clarify in our paper are: 1. Three organizations that accredit, certify, and govern nurse anesthetists are organized in similar fashion to three comparable bodies governing anesthesiologists. ⋯ The use of a hypothetical example related to Medicare reimbursement in New York to justify the implication that CRNA-delivered services are more costly than anesthesiologist-delivered services is misleading and not borne out in the literature. We hope that planners and policy makers will read the article by Abenstein and Warner with extreme caution. Taking some of their statements and conclusions seriously could lead to policies and programs that are not focused in science.