AANA journal
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Transversus abdominis plane (TAP) blocks are a relatively new regional anesthetic technique used in a multimodal approach to provide postoperative analgesia of the anterolateral abdominal wall. The technique for placing TAP blocks has evolved from a landmark technique to an ultrasound-guided technique. There are 3 common approaches for accessing the TAP: subcostal, midaxillary, and ilioinguinal-iliohypogastric. ⋯ The approach used is contingent on the type and location of the surgical procedure. Overall, TAP blocks reduce postoperative pain and opioid requirements, resulting in fewer side effects such as nausea and vomiting, respiratory depression, and sedation. Future studies should examine which type, concentration, and volume of local anesthetics are most effective.
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Trauma is a leading cause of morbidity and mortality. Uncontrolled hemorrhage related to the traumatic event is often the major cause of complications and death. The use of hemostatic agents may be one of the easiest and most effective methods of treating hemorrhage. ⋯ The evidence does not describe serious side effects, exothermic reaction, and thromboemboli formation associated with other hemostatic agents. Further investigation to determine the effectiveness of hemostatic agents, specifically QuikClot Combat Gauze, in the management of trauma casualties in the prehospital setting is required. These should include large-scale, multicenter, prehospital randomized controlled trials.
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The AANA determines the scope of nurse anesthesia practice. It is important for all members to understand the scope of practice that governs their work to better practice their profession and mentorship. In January 2013, the AANA Board of Directors charged the Practice Committee to revise the Scope of Nurse Anesthesia Practice. ⋯ Focus group themes include: (1) elements of nurse anesthesia practice; (2) future practice opportunities; (3) interprofessional collaboration; (4) full scope of practice; (5) autonomous practice; and (6) barriers to practice and recommendations. Of the 4,200 CRNA survey respondents, 44.6% are not permitted to practice to their full scope of practice. The revised Scope of Nurse Anesthesia Practice embodies the comprehensive span of nurse anesthesia practice.
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The purposes of this integrative literature review were to (1) present a synopsis of current literature describing posttraumatic stress disorder (PTSD), the amygdalocentric neurocircuitry, emergence delirium, reactive aggression, and the interaction of general anesthetics and the amygdalocentric neurocircuitry; (2) synthesize this evidence; and (3) develop a new theoretical model that can be tested in future research studies. Over the past decade, a dramatic rise in PTSD among veterans has been reported because of recent combat deployments. Modern anesthetics alter the function of the amygdalocentric neurocircuitry to produce amnesia and sedation. ⋯ To date, there have been no scientific studies conducted to identify the cause of emergence delirium in combat veterans with PTSD. This new theoretical model may explain why noxious stimuli at the time of emergence may stimulate the thalamus, leading to activation of an uninhibited amygdalocentric neurocircuitry. Because of the loss of top-down inhibition, the hyperactive amygdala then stimulates the hypothalamus, which is responsible for creating an increase in excitatory activity in the unconscious patient, resulting in emergence delirium.
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Review
A review of the evidence for active preoperative warming of adults undergoing general anesthesia.
Inadvertent perioperative hypothermia, a common occurrence in the operating suite, is associated with many adverse outcomes. It is the nurse anesthetist's goal to attenuate the incidence of this problem. Although active intraoperative warming is a widely accepted practice, active preoperative warming may be a less explored option for temperature maintenance. ⋯ Most of the studies support the implementation of active preoperative warming by demonstrating that subjects were warmer during the perioperative period. Overall, these differences were statistically significant and likely clinically significant. Future clinical trials should examine shorter warming times and lower warming unit settings, should include appropriate sample sizes, and should consistently employ trained staff using calibrated biometric instruments to measure temperature.