CRNA : the clinical forum for nurse anesthetists
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Pain is the most common reason for the hospitalization of people with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS). The epidemiology of this disease and limitations of available therapies suggest that HIV/AIDS pain will be a treatment challenge within and beyond the perioperative realm for some time to come. ⋯ Suggestions are provided for pain assessment in HIV/AIDS patients. Both pharmacological and nonpharmacological treatment of pain in this complex population are described.
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Review Case Reports
Current perspectives on the perioperative management of the latex-allergic patient.
The increasing incidence of latex allergy necessitates thorough preanesthetic screening for risk factors, which will be delineated in this article, that are associated with latex allergy. The pathophysiology, epidemiology, and testing procedures for latex allergy will be reviewed. This case report will illustrate the management of a patient who was found to be latex-sensitive during surgery and the management of intraoperative anaphylaxis is provided. Safe perioperative care can be provided for latex-sensitive patients if latex avoidance techniques are used consistently.
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Postoperative nausea and vomiting are common and distressing postsurgical complications. Prevention or early treatment of this complication should be a goal of all anesthesia providers. ⋯ Pharmacological actions and side effects of commonly used antiemetics are addressed. The new serotonin antagonists and combined antiemetic therapy are highlighted.
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The 21st century will bring a new era of cost containment to the arena of ambulatory surgery force practitioners of anesthesia to reevaluate practice patterns. Along with the current increased interest in cost containment and optimal use of limited resources, growing concerns about patient outcome result in controversial issues in adult and pediatric outpatient anesthesia that must be addressed in the areas of preoperative evaluation, patient preparation and selection, laboratory screening, and practical discharge criteria. The future challenge for all practitioners is to provide high-quality anesthesia care at a reduced cost.
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Healthcare practitioners are the primary users of medical devices for direct patient care. As such, they are in the best position to recognize problems that result from the use of medical devices. The outcome of a device-related adverse event or product problem, as with any other medical product, can be serious and result in illness injury, or even death. ⋯ Healthcare practitioners are major contributors to the knowledge base related to device use and safety through astute monitoring, rapid identification of device-related problems, and reporting these problems. An understanding of the voluntary and mandatory mechanism of reporting will ensure that device problems are reported appropriately and in a timely manner. As the primary users of medical equipment for direct patient care, health care professionals have the training and expertise to improve patient care by reporting actual and suspected problems with medical devices.