AANA journal
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As university faculty, Certified Registered Nurse Anesthetists (CRNAs) are expected to meet the same obligations as other members of the academy. The purposes of this investigation were to describe the educational preparation and role expectations of nurse anesthesia faculty. Following institutional human assurance committee approval, an investigator-developed questionnaire was mailed to the directors of 85 nurse anesthesia programs recognized by the Council on Accreditation of Nurse Anesthesia Educational Programs. ⋯ Assistant directors allocated 75% of their time to classroom teaching, clinical teaching, and program administration. Among all program faculty, limited time was reserved for research and scholarly activities. Increasing the percentage of doctorally prepared faculty and the amount of time allocated to research and scholarship are essential for full integration of nurse anesthetists into the university and to continue the development of nurse anesthesia's specialty knowledge.
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Randomized Controlled Trial Comparative Study
Labor epidural anesthetics comparing loss of resistance with air versus saline: does the choice matter?
This study examined whether air or saline, used for the loss-of-resistance (LOR) technique, resulted in a difference in pain relief or adverse events for laboring parturients. Previous studies had mixed findings regarding the onset of analgesia and subsequent pain relief. Research questions were as follows: Is there difference in analgesic onset for patients receiving air vs saline during the LOR technique? Do women receiving the air method for LOR experience any difference in the quality of pain relief from that of women receiving saline? Is there any difference in the incidence of analgesic distribution or segmental pain relief in women receiving the air vs the saline method? Is there any difference in the incidence of adverse effects in women receiving air vs saline during the LOR technique? This was an experimental, prospective study with 50 women. ⋯ A dermatome level recorded the spread of analgesia. No significant differences were found between groups for onset or quality of analgesia. There was a significant increase in the number of subjects who experienced segmental blocks after receiving air during the LOR technique.
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This case study describes a 51-year-old, ASA physical status II Hispanic man who underwent liposuction to the anterior neck and resection of adipose tissue of the posterior neck. The patient was diagnosed with multiple symmetric lipomatosis, better known by its eponym, Madelung disease. This disease is characterized by abnormal adipose tissue growth primarily in the neck and shoulder regions. ⋯ In addition, flexion and extension of the neck was limited by a minimum of 20 degrees because of the pathology. The patient was deemed as having a difficult airway, and an awake fiberoptic intubation was planned and used successfully. The subsequent surgical procedure progressed without incident, and the patient was transferred to a stepdown unit for monitoring of his airway postoperatively.
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Preoperative cardiac assessment has become an integral part of contemporary anesthesia practice. Simple clinical markers can identify high-risk patients, but the question of how to reduce cardiac complications among high-risk patients has been controversial. Good quality randomized controlled trials have showed that neither preoperative coronary revascularization nor the placement of pulmonary artery catheters reduces perioperative cardiac complications. ⋯ The data supporting these conclusions are reviewed in an evidence-based manner. At present, it is prudent to treat moderate- to high-risk patients undergoing elective surgery with beta-blockers if possible. Because not all patients are candidates for beta-blocker therapy, data regarding the perioperative use of alternative medications to reduce perioperative cardiac complications have been explored and are reviewed.
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Review Case Reports
Unintended subdural injection: a complication of epidural anesthesia--a case report.
Epidural anesthesia is practiced in virtually every clinical setting. Its safety and versatility have supported increasing use for more and varied therapies. In a healthy patient in whom near-complete left hemiparesis developed following a routine continuous epidural anesthetic for labor, subdural deposit of the local anesthetic was suspected. The following case and discussion may help illustrate the mechanism behind this complication and how it can be detected, treated, and, possibly, avoided.