AANA journal
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Knee arthroscopy is one of the most common orthopedic procedures done in the United States. It usually is performed as an outpatient procedure. This retrospective study was designed to assess the level of postoperative analgesia provided by the local knee block. ⋯ The severity of the knee pain was assessed using verbal pain rating scores during the anesthesia recovery period, before patients left the hospital, and again on the first postoperative day. Patients in group 2 had significantly lower pain scores compared with patients in group 1 during these periods. Results suggest that the local knee block provides superior postoperative analgesia for the knee arthroscopy patient.
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Review Case Reports
Use of the LMA classic to secure the airway of a premature neonate with Smith-Lemli-Opitz syndrome: a case report.
In addition to managing the most challenging of airways within the operating room environment, anesthesia providers are frequently consulted or requested to participate in emergency airway control in various areas of the hospital, often after other providers have failed. The following is a case report of a premature infant born with multiple and life threatening congenital anomalies in a rural facility. The current recommendations of the American Heart Association for neonatal resuscitation were followed; however, the resuscitating team was unable to secure the airway using standard intubating techniques. ⋯ The pediatrician involved in the care of the patient had minimal experience with using the LMA; however, with verbal instruction was able to successfully place the LMA. With a patent airway established, the patient stabilized and was transferred to a tertiary facility for aggressive care. Although currently not part of the American Heart Association neonatal resuscitation algorithm, consideration of the LMA as a tool to manage an airway after failed attempts at intubation may be appropriate.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesia and effectiveness of levobupivacaine compared with ropivacaine in patients undergoing an axillary brachial plexus block.
A common anesthetic technique for the upper extremity is local brachial plexus anesthesia using levobupivacaine and ropivacaine. To our knowledge, no study has been performed measuring differences in analgesic efficacy and latency when these local anesthetics are used for brachial plexus anesthesia. We enrolled 54 adults, assessed as ASA class I or II, into this double-blind, prospective investigation to receive 40 mL of 0.5% ropivacaine or levobupivacaine with 1:200,000 epinephrine. ⋯ Return of motor activity was significantly faster in the ropivacaine group (778 minutes) than in the levobupivacaine group (1,047 minutes; P = .001). No other significant differences were noted between the groups. When considering levobupivacaine and ropivacaine for brachial plexus anesthesia, levobupivacaine should be considered when postoperative analgesia is a concern but not when an early return of motor activity is required.
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The purpose of this article is to discuss the benefits, safety, and efficacy of the laryngeal mask airway (LMA) and identify the risks and misconceptions associated with LMAs when used with positive pressure ventilation (PPV). Despite the abundance of supporting evidence that LMAs may be used successfully in a variety of age groups and surgical procedures using PPV, many anesthesia providers are still reluctant to choose an LMA when PPV is needed. This reluctance emerges from the misconception that when using an LMA with mechanical ventilation, there is an increased incidence of gastric insufflation, failed ventilation, and pulmonary aspiration. When compared to other airway adjuncts, however, the LMA is a safe, effective means of delivering ventilation under anesthesia.
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Arterial catheterization for hemodynamic monitoring is used widely in clinical management. Complications of connulation have been recognized since introduction of the technique. This review examines radial, brachial, axillary, and femoral cannulation sites. ⋯ Axillary cannulation provides data closely approximating aortic pressure and poses minimal thrombotic risk but is associated with brachial plexus compression. Femoral cannulation provides a pulse contour approximating aortic with minimal thrombotic risk. There is little evidence to show increased incidence of catheter-related systemic infection at this site.