AANA journal
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Review Historical Article
AANA journal course: Update for nurse anesthetists--part 6--The long-term use of opiates for pain control: Laputa revisited?
Research seeking to resolve issues regarding the use of opiate analgesia in treating non-cancer-related chronic pain is confusing. In caring for a patient experiencing pain, the relief of pain is the primary objective. ⋯ Specifc and measurable outcomes of functionality are available to guide use; attention to these may help to significantly improve outcome of long-term opiate therapy. This course provides an evidence-based approach to selecting and using opiates in the management of chronic, non-cancer-related pain, critiquing the appropriateness of the associated intervention(s).
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Advanced airway practitioners in anesthesiology, emergency medicine, and prehospital care can suddenly and unexpectedly face difficult airway situations that can surface without warning during mask ventilation or tracheal intubation. Although tracheal intubation remains the "gold standard" in airway management, it is not always achievable, and, when it proves impossible, appropriate alternative interventions must be used rapidly to avoid serious morbidity or mortality. The SLAM Emergency Airway Flowchart (SEAF) is intended to prevent the 3 reported primary causes of adverse respiratory events (ie, inadequate ventilation, undetected esophageal intubation, and difficult intubation). ⋯ It is intended for use with adult patients by advanced airway practitioners competent in direct laryngoscopy, tracheal intubation, administration of airway drugs, rescue ventilation, and cricothyrotomy. The SEAF has limitations (eg, suitable only for use with adult patients, cannot be used by certain categories of rescue personnel, and depends heavily on assessment of Spo2). A unique benefit is provision of simple alternative techniques that can be used when another technique fails.
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Review Case Reports
Ruptured arteriovenous malformation and subarachnoid hemorrhage during emergent cesarean delivery: a case report.
Cerebral arteriovenous malformations (AVMs) are formed from a vascular plexus of direct arterial-venous connections that progressively dilate, making them prone to rupture. They are frequently asymptomatic and often remain undiagnosed until they present with associated symptoms of headaches, seizures, neurological deficits, or hemorrhages. Occurrence of headache during pregnancy and labor is associated with several diverse etiologies, making definitive diagnosis extremely difficult. This case report describes the anesthetic management of a 31-year-old laboring patient who first complained of headache, then suffered an acute subarachnoid hemorrhage secondary to rupture of a previously undiagnosed AVM during emergent cesarean delivery.
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Economic assumptions and other factors affecting the economics of nurse anesthesia education are presented in Part 2 of this 2-part column. In Part 1, published in the October 2004 issue of the AANA Journal, general economic principles and healthcare economic principles in particular were described, explained, and related to the current US healthcare system.