AANA journal
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Randomized Controlled Trial
Dexmedetomidine as a pediatric anesthetic premedication to reduce anxiety and to deter emergence delirium.
Presurgery anxiety in children may result in preoperative and postoperative complications. Emergence delirium (ED) is a mental disturbance common in children during recovery from general anesthesia. This study investigated the role of preoperative dexmedetomidine on parental separation anxiety and acceptance of wearing an anesthesia mask, and its effectiveness in reducing the incidence and severity of ED. ⋯ There were also no significant differences in ED occurrence. In this study, dexmedetomidine produced no common side effects (blood pressure and heart rate fluctuation), which may indicate that oral administration with a 76% bioavailability versus 82% in buccal preparations results in fewer side effects but requires higher dosing to gain therapeutic effects. Future studies should examine the use of higher doses of oral dexmedetomidine in reducing presurgical anxiety and postsurgical ED.
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This study examined whether combining lipid emulsion and advanced cardiac life support (ACLS) improves survival in an unanesthetized swine model of bupivacaine- and hypoxia-induced cardiovascular collapse. Arterial and venous catheters and a tracheostomy were surgically placed in 26 swine receiving inhalation anesthesia. After a 1-hour recovery period, bupivacaine (5 mg/kg) was administered intravenously over 15 seconds. ⋯ There was no significant difference in survival between the saline group (4/12, 33%) and lipid emulsion group (6/12, 50%; P > .05). Additionally, there was no significant difference between groups of surviving animals in the time to ROSC (P > .05). The combination of lipid emulsion and ACLS did not improve survival from bupivacaine- and hypoxia-induced cardiovascular collapse in unanesthetized swine.
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Recent research reaffirms that Certified Registered Nurse Anesthetists (CRNAs) are critical to the delivery of anesthesia in the United States and argues persuasively for the removal of barriers-including supervision requirements--that prevent CRNAs and other advanced practice registered nurses (APRNs) from practicing to the full extent of their education and training. As we as a nation strive to make healthcare accessible, ever safer, and affordable, the health system must use anesthesia professionals as efficiently as possible. Repealing the federal Medicare physician supervision requirement for nurse anesthetists is an important step toward achieving this goal.
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Postoperative visual loss (POVL) is a rare but catastrophic complication after nonocular surgery. Previously POVL has been reported in lengthy, prone, lateral, or cardiopulmonary cases, with extreme blood loss, hemodilution, and hypotension. The author's index case of POVL following a lengthy operation in steep Trendelenburg position (ST) prompted study of the relationship between intraocular pressure (IOP), mean arterial pressure (MAP), and time spent in ST. ⋯ The OPP ranged from 50 to 82 mm Hg at start of surgery and from 21 to 75 mm Hg after 120 minutes. Increased IOP and reductions in OPP in relationship to position change were statistically significant (P < .001), with OPP falling below IOP in 10 cases. Findings suggest a relationship between prolonged ST and reduced OPP, challenging the accepted view that cerebral and ophthalmic circulatory autoregulation prevents elevated compartment pressures and reductions in perfusion.