AANA journal
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Case Reports
Accidental carotid artery catheterization during attempted central venous catheter placement: a case report.
More than 2.1 million central venous catheters are placed annually. While carotid artery cannulation is rare, its effects can be devastating. Anesthesia providers frequently work with central venous catheters in the perioperative setting. ⋯ This case report details a case of accidental carotid artery catheterization during attempted right internal jugular vein catheterization and the steps taken to treat the patient following its recognition. A discussion of technique for central venous catheterization, indications for suspicion of arterial puncture, methods for confirming venous or arterial placement, appropriate methods for management of carotid artery cannulation, and the benefit of ultrasound in central venous cannulation follow. Through the appropriate use of equipment, early detection and management of carotid artery injury, and proper training, patient outcomes may be improved.
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Despite compelling evidence for the safety and efficacy of intrathecal hydromorphone, the use of this opioid intrathecally for the pain management of patients undergoing cesarean delivery has not been widely accepted. The purpose of this retrospective study was to compare the reported efficacy and safety of pain management in women who received intrathecal hydromorphone (100 microg) vs in women who received intrathecal fentanyl (25 microg) or a local anesthetic for their cesarean delivery. The author hypothesized that intrathecal hydromorphone because of its known pharmacodynamics would provide better postoperative analgesia within the first 24 hours after cesarean delivery. ⋯ Traditionally, intrathecal morphine was the opioid of choice for prolonged pain management during cesarean deliveries in which spinal anesthesia was selected. However, intrathecal hydromorphone was shown to be an effective and possibly even better substitute. Further research on intrathecal hydromorphone is needed.
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Clinical Trial
Implementation of an evidence-based extubation checklist to reduce extubation failure in patients with trauma: a pilot study.
This prospective, case-controlled observational study assessed whether an evidence-based extubation checklist would increase anesthesia providers' documentation of standardized extubation criteria and reduce the occurrence of preventable extubation failures in the early postoperative period. The sample consisted of 622 ASA Physical Status I to IV patients, aged 10 to 100 years but primarily adults, who underwent elective and emergency surgeries at a university-based adult trauma teaching hospital. Before the study, all anesthesia and postanesthesia care unit staff received an in-service on adherence to an evidence-based extubation checklist, followed by implementation of the checklist for 12 weeks. ⋯ Following use of the extubation checklist, documentation of patient readiness for extubation increased from 54% to 92.5%, and extubation failures decreased from 2.5 per month to 7.2 per month. This study confirmed that extubation failure occurred less frequently when the extubation checklist was used (P = .001, Fisher exact test). Study results indicate that an extubation checklist may positively influence provider documentation of evidence-based criteria for extubation and can reduce the occurrence of preventable extubation failures.
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Peripheral nerve blocks are common and effective means for anesthesia for limb surgery. The evaluation of the success of a peripheral blockade is based on the loss of sensation, with no objective means of detecting a successful block. The autonomic innervation to the upper extremity, which controls both the vascular tone and the activity of sweat glands, is supplied by nerve fibers accompanying the somatic nerve fibers. ⋯ The electrical resistance of the skin on the palmar aspect of the forearm was continuously recorded on the block arm and on the contralateral arm using a commercial skin resistance monitor. No statistically significant change in the electrical resistance of the skin was observed during 20 minutes after placement of the block. These results strongly suggest that the electrical resistance of the skin cannot be used to predict a successful infraclavicular block.
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Case Reports
Utilization of a massive transfusion protocol during liver lobe resection: a case report.
The literature shows substantial data that acute coagulopathy and hemorrhage without rigorous resuscitative efforts has a high morbidity and mortality. The utilization of protocols for a massive transfusion and resuscitation can lead to improved outcomes in morbidity and mortality. ⋯ Research and evidence from the armed services has shown remarkable improvements in morbidity and mortality when a massive transfusion protocol is implemented in the care of traumatically injured soldiers. The use and continued review of these military data appear to have a substantial impact on how the civilian healthcare system addresses massive transfusion and resuscitation in the critically injured and hemorrhagic patient.