AANA journal
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Comparative Study
A comparison of endotracheal tube cuff pressures using estimation techniques and direct intracuff measurement.
Cuffed endotracheal tubes are one aspect of airway management designed to ensure safety, yet patients can be at risk for injury from underinflated and overinflated endotracheal cuffs. Tracheal pressures exceeding approximately 48 cm H2O impede capillary blood flow, potentially causing tracheal damage, and pressures below approximately 18 mm Hg may increase the risk of aspiration. There is no standard identified in the literature describing the method of cuff inflation, and nurse anesthetists use various cuff inflation techniques. ⋯ Analysis revealed that fewer than one third of the anesthesia providers inflated the cuff within an ideal range. No differences were found between level of anesthesia provider and cuff inflation pressures. We conclude that estimation techniques for cuff inflation are inadequate and suggest that direct measurements be used.
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Review Comparative Study
Epidural analgesia using loss of resistance with air versus saline: does it make a difference? Should we reevaluate our practice?
The choice of using air or saline in epidural syringes during the loss-of-resistance technique, for identifying the epidural space, has been based largely on personal preference of the anesthesia provider. A survey of practice in the United Kingdom, thought to be similar to practice in the United States, revealed that the majority of anesthesia providers use air. Case reports have appeared in the literature suggesting that air may be harmful to patients or, at the very least, impede the onset and quality of epidural analgesia. ⋯ Current anesthesia literature suggests using saline with an air bubble in the loss-of-resistance syringe. Many anesthesia training programs continue to teach the use of air, saline, and saline with an air bubble. Further studies may help to determine whether there is a scientific or safety basis for using air vs saline.
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In the United States today, as many as one third of the population suffers from chronic pain conditions. These syndromes cost an estimated $80 billion and are a major source of burden to the healthcare system as well as to the suffering patients. According to a study by Harvard Medical School in 1997, visits to alternative medicine providers had reached 629 million, mostly for these pain conditions. ⋯ Many now believe that acupuncture should be considered a valuable asset in the specialty of pain, and that it can be of value in comprehensive pain clinics as well as physical therapy practice. Acupuncture is certainly not a cure-all; however, researchers and experienced clinicians both attest to its benefits. This article is a review of the literature with regard to acupuncture as a modality for pain management.
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Preeclampsia developed in this patient 4 days' postpartum. Visual changes, headache, and elevated blood pressures were present on arrival to the emergency department. Coincident with the preeclampsia was a postdural puncture headache complicating the diagnosis of late postpartum preeclampsia. ⋯ Blood pressures continued to increase, however, and late postpartum eclampsia developed. We conclude that symptoms of a postdural puncture headache can mimic those of postpartum preeclampsia. Early recognition and treatment of postpartum preeclampsia may decrease patient mortality and morbidity by preventing late postpartum eclampsia.
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Anesthesia-associated nerve injury is a common cause of patient morbidity and litigation. To identify factors associated with perioperative nerve injuries and rationalize preventive strategies, 44 cases from the American Association of Nurse Anesthetists (AANA) Foundation Closed Malpractice Claims Database pertaining to nerve injuries in which nurse anesthetists provided care were analyzed. Emerging patterns and themes related to the development of injury were identified. ⋯ Documentation on the anesthesia record of the use of intraoperative protective padding and patient position was lacking or inadequate in a majority of the claims. Effective strategies for the prevention of nerve injury during anesthesia are reviewed. Abnormal body habitus, several disease states, anesthesia technique, improper positioning, lack of adequate padding, and tourniquet use have been implicated as risk factors.