AANA journal
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Review Case Reports
Tympanic membrane rupture following general anesthesia with nitrous oxide: a case report.
Although rare, tympanic membrane rupture during general anesthesia with nitrous oxide has been reported previously in the literature. Nitrous oxide administration and the effects on closed body cavities will be reviewed. Key factors in patient assessment which can determine safe use of nitrous oxide in the clinical setting will also be discussed.
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The use of capnography during general anesthesia has become not only state of the art but also a recommended standard of care. In intubated patients, measurements of partial pressure of carbon dioxide in exhaled pulmonary gases approximate partial pressure of carbon dioxide in arterial blood under stable conditions. End-tidal carbon dioxide measurement has allowed anesthetists to continuously follow carbon dioxide concentration in exhaled gases; indirectly, it has enabled them to continuously monitor carbon dioxide concentration in arterial blood. ⋯ Recently, attention has focused on the utilization of capnography in sedated, nonintubated patients to follow carbon dioxide concentrations and access respiratory system function. This review of the current body of literature outlines development in capnography monitoring for sedated, nonintubated patients. Emphasis is placed on current techniques of measurement, the degree of correlation, and ramifications for clinical practice.
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Conscious awareness is an infrequent complication of general anesthesia. All methods of anesthesia have been implicated, and no method guarantees amnesia. This article examines implicit and explicit memory and discusses factors associated with awareness. ⋯ Strategies to block threatening auditory stimuli include use of earphones, music tapes, white noise, reassuring statements, or positive suggestion. Behavioral anesthesia decreases patient stress to enhance recovery. Evidence of patient benefit resulting from therapeutic suggestion is inconclusive.
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Advances in technology have provided the means to reduce the length of stay for some surgical patients while offering increased quality of care. Videoscopic surgery is a rapidly expanding technology with increasing applications. When used in place of open thoracotomy, thoracoscopy offers the patient a less traumatic treatment modality. This procedure presents challenges to the anesthetist in choosing anesthetic technique, patient monitoring, and maintenance of cardiorespiratory function in the presence of pneumothorax and a variety of coexisting disease states.
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Airway catastrophes have been identified as the leading cause of injury and death during anesthesia. Proper management of a patient with a technically difficult airway commences with problem recognition. Physical limitations to mask ventilation and endotracheal intubation may be accurately identified by thorough observation. ⋯ Prudent options may include awakening the patient, proceeding with mask ventilation, or performing semi-elective tracheostomy. Emergency airway access may be achieved with a tracheoesophageal airway, esophageal tracheal combitube, laryngeal mask airway, digital intubation, or obtained surgically by transtracheal jet ventilation or tracheostomy. Reduction of airway-related morbidity and mortality is best achieved with an understanding of airway anatomy, common causes and prompt recognition of compromise, and alternative techniques of establishing patency and ventilation.