AANA journal
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The laryngeal mask airway (LMA) is a relatively new and innovative means to control the airway during anesthesia or in emergent situations. It is simply a small infatable mask that forms a low pressure seal around the laryngeal inlet that can be used in spontaneous or controlled breathing in adult and pediatric patients. The LMA is less invasive than the endotracheal tube, does not require laryngoscopy or the use of muscle relaxants, and has been used in the management of the difficult airway and with fiberoptic facilitated intubation. It does not protect against aspiration and is contraindicated in patients at risk for this complication.
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Safely operating life support equipment and evaluating new technology both require some basic understanding of measurement theory. Measurement errors fall into two main categories: systematic errors (predictable problems usually due to calibration) and random errors (unpredictable). These two types of errors can be quantified by experiments involving repeated measurements of standards or "true" values. ⋯ The third step is to calculate basic descriptive statistics, such as the mean and standard deviation. Finally, the data should be presented in graphic form with the differences plotted against the reference values and including numerical values for the calculated error intervals. The key idea to remember is that device evaluation and method agreement studies are based on the desire to know how much trust we should place in single measurements that may be used to make life support decisions.
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Review Comparative Study
Pain measurement tools for clinical practice and research.
An important component of effective postoperative pain management is a measure of the patient's pain intensity. This article examines three unidimensional pain measurement instruments and one multidimensional pain measurement instrument used in daily practice and clinical research. The strengths and weaknesses of the numerical rating scale, verbal descriptor scale, visual analogue scale, and the McGill Pain Questionnaire are discussed. Issues of validity and reliability, important in clinical research, are also presented.
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The Mayo block is an extremely efficacious regional anesthetic technique used to provide anesthesia of the forefoot. Patients requiring surgical correction of hallux deformity, bunionectomy, and first metatarsal surgery may benefit from this technique. The Mayo block is a field block that anesthetizes the specific nerves of the forefoot that innervate the surgical field. ⋯ This technique has been used at one military hospital on more than 275 patients. The failure rate of the block is less than 1%. Learning this technique adds to the anesthetist's armamentarium of regional anesthesia, aids in rapid case turnover, and avoids the risks associated with major conduction and general anesthesia.
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Pulmonary aspiration during anesthesia, although rare in most patients, remains a very real concern for anesthesia providers. Recently, an extensive collection of data has emerged demonstrating a seemingly benign effect of gastric pH and volume from clear liquids consumed 2 to 3 hours prior to surgery in select patients. This AANA Journal course will evaluate the risk of pulmonary aspiration and relate this to specific identifying characteristics described to influence risk. Gastric physiology will be reviewed and current research will be examined evaluating the impact of clear liquids on specific outcome variables.