AANA journal
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This review assessed the utility of vasopressin and vasopressin analogues for the treatment of refractory hypotension associated with angiotensin-converting enzyme (ACE) inhibitors in the perioperative setting. A systematic review of the literature was conducted using MEDLINE, Embase, and ProQuest. Six randomized controlled trials met eligibility criteria. ⋯ All of the patients receiving vasopressin demonstrated improved hemodynamic stability with small, intermittent doses, without profound ischemic changes. For management (prevention and treatment) of ACE inhibitor-associated hypotension in the perioperative setting, all studies showed statistically significant success with vasopressin or vasopressin analogues for improvement of systemic blood pressures. Before vasopressin is widely accepted as a standard of care, further studies are needed to confirm these findings and assess the general utility of vasopressin in surgical populations for management of ACE inhibitor-associated refractory hypotension.
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Case Reports
Laryngospasm as a Cause of Unsuccessful Placement of Laryngeal Mask Airway ProSeal: A Case Report.
Laryngospasm is a potential complication encountered during anesthesia using a laryngeal mask airway (LMA). We report a case in which laryngospasm resulted in unsuccessful placement of an LMA ProSeal Airway (Teleflex Inc), and we discuss the various causes of unsuccessful placement of this type of airway device. ⋯ In this case report, the laryngospasm-induced increased resistance to gas flow was manifested by exaggerated outward movement of the LMA ProSeal following its connection to gas flows and thus resulted in failed airway placement. The possibility of laryngospasm as a cause of failed placement of an LMA ProSeal must be considered in clinical practice.
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A difficult intubation poses one of the most challenging tasks for anesthesia professionals, representing 27% of all adverse respiratory events, 93% of which are unanticipated. Unanticipated difficult mask ventilation and intubation may result in serious complications. Safe airway management requires a proper and thorough preoperative airway evaluation and a plan to secure the airway, with alternate plans available when the initial plan fails. ⋯ Nine articles were selected for appraisal in this literature review: 6 randomized control trials, 2 prospective studies, and 1 retrospective study. Multiple apneic oxygenation techniques, including nasopharyngeal catheter, nasal prongs, endotracheal tube, intratracheal catheter, and high-flow transnasal humidified oxygen, demonstrated effectiveness at delaying the onset of hypoxemia during the apnea period. Prolonging the apneic window changes the nature of airway management in patients at high risk of desaturation and when an unanticipated difficult airway arises.
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The purpose of this evidence-based, quality improvement practice project was to increase anesthesia providers’ knowledge and awareness of the taping practice for securing the endotracheal (ET) tube that increases the patient’s exposure to pathogens and the risk of nosocomial infections. A change in the taping practice by anesthesia providers was the desired outcome. Participants completed an anonymous questionnaire about their knowledge and use of a taping practice to secure the ET tube. ⋯ A Mann-Whitney U test demonstrated statistical significance (U = 55, P = .003). Additionally, anesthesia providers gave a strong indication that they would not use adhesive tape that had fallen to the floor (U = 78, P = .04, Mann-Whitney U test). This project demonstrated that a change in practice occurred after an intervention regarding securing the ET tube with adhesive tape.
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This article provides a systematic review of awareness with recall, also called intraoperative awareness. Major topics of this review include the incidence and causes of this phenomenon, in addition to an examination of current strategies for prevention of intraoperative awareness. ⋯ This Journal course explores evidence related to the utility and limitations of this monitor in clinical practice. It also reviews evidence-based practices that may decrease the incidence of awareness with recall, including avoidance of muscle relaxants and protocol-driven approaches to awareness prevention.