AANA journal
-
Randomized Controlled Trial Comparative Study
The influence of spinal needle orientation during administration of subarachnoid blocks on discharge criteria in same-day surgical patients.
Cost containment is a critical factor in today's healthcare industry, so finding ways to decrease length of stay is essential in anesthesia practice. We rely on rapid induction, recovery, and discharge to control cost in outpatient surgery. Subarachnoid block (SAB) is an acceptable anesthetic choice for many outpatient procedures. ⋯ Demographics (except weight) were not statistically different between the groups. Total hospital time did not differ between the groups. Regardless of needle orientation, patients in both study groups achieved discharge criteria in similar amounts of time.
-
Randomized Controlled Trial
The effectiveness of 4% intracuff lidocaine in reducing coughing during emergence from general anesthesia in smokers undergoing procedures lasting less than 1.5 hours.
Coughing commonly occurs in patients emerging from general endotracheal anesthesia and is prominent in smokers due to underlying airway irritation. Clinical techniques used to mitigate emergence coughing include intravenous narcotics, intravenous or topical lidocaine, and deep extubation. Reduction of coughing by instilling lidocaine into the endotracheal tube cuff has been shown to be effective in long cases. ⋯ The control group received 5 mL of saline, and the experimental group received 5 mL of 4% lidocaine. On emergence, the anesthesia provider counted and recorded the number of coughs before awake extubation. This study did not show a correlation between use of intracuff lidocaine and a decrease in emergence coughing in procedures lasting less than 1.5 hours in patients who smoke.
-
Randomized Controlled Trial
CRNA performance using a handheld, computerized, decision-making aid during critical events in a simulated environment: a methodologic inquiry.
Directives to improve patient outcomes and enhance safety within the healthcare system have led to development of technologies to assist practitioners in a variety of activities. The purpose of this study was to explore and evaluate a method for examining the effect of computer-assisted decision making (CADM) using a handheld device on the accuracy (ie, correct diagnosis and treatment) and speed of problem solving by Certified Registered Nurse Anesthetists (CRNAs) during simulated critical patient-care events. A randomized crossover design with matched-pair sampling was used. ⋯ Time to correct diagnosis and treatment varied by scenario, taking less time with CADM for one but more with CADM for the other, likely due to differences in pace, intensity, and conduct of the 2 scenarios. We believe this study supports further exploration and application of CADM in complex patient scenarios involving anesthesia practitioners. Affirmation of environmental authenticity also validates the high-fidelity human simulation environment as an appropriate setting to conduct research in this area.
-
Randomized Controlled Trial Comparative Study
The effectiveness of inhalation isopropyl alcohol vs. granisetron for the prevention of postoperative nausea and vomiting.
We evaluated preemptive treatment for postoperative nausea and vomiting (PONV) with intravenous (IV) granisetron, 0.1 mg, introoperatively as compared with the use of 70% inhalation isopropyl alcohol and a control group for the prevention of PONV. We randomly assigned 57 women, 18 to 50 years old, undergoing laparoscopic procedures to 1 of 3 groups: (1) inhalation of 70% isopropyl alcohol, (2) 0.1 mg granisetron IV, and (3) no prophylactic treatment control. Participants were asked to rate their nausea and vomiting preoperatively, on arrival to postanesthesia care unit (PACU), at discharge from PACU, 6 hours after extubation, and 24 hours after extubation and any occurrence of nausea and vomiting using the numeric rating scale (NRS), 0 to 10. ⋯ There were no significant differences among the 3 groups in demographics, first episode of PONV, total number of episodes in 24 hours, NRS rating at rescue, and anesthetic duration. PONV and menstrual cycle phase had no positive correlation (P > .05). History of smoking, PONV, and motion sickness had no significant difference against any measure of PONV (P > .05).
-
Randomized Controlled Trial Comparative Study
The use of ultrasound for placement of intravenous catheters.
Ultrasound has been used to aid cannulation of veins of the neck, chest, antecubital fossa, and femoral vein. This investigation compared the traditional method of peripheral intravenous (IV) cannulation of veins of the hands and forearms with ultrasound-guided IV cannulation of these veins. After obtaining institutional review board approval and written informed consent, 35 adult subjects with a history or suspicion of difficult IV cannulation were prospectively enrolled with 16 subjects randomly assigned to the traditional group and 19 to the ultrasound group. ⋯ No significant differences were noted between groups in demographics, time to successful cannulation, number of attempts, and number of subjects in whom IV cannulation was successful on the first attempt. Ultrasound was as efficacious as the traditional method of IV cannulation in this subset of patients. Future investigations should examine the efficacy of the ultrasound-guided technique of IV cannulation of these veins in patients in whom the traditional method failed.