CRNA : the clinical forum for nurse anesthetists
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Anesthesia providers are expected to provide information to the patient during the preanesthesia interview that enables the patient to make informed choices. Adequate disclosure during the informed consent process ensures the equalization of the practitioner/patient relationship and the decision-making rights of the patient. Both certified registered nurse anesthetists (CRNAs) and anesthesiologists are not only legally required to provide information that will allow a patient to make an informed judgment about how to proceed with various anesthetic modalities but are also obligated by their standards of practice. This article informs the CRNA about the principles of informed consent so that they can better understand their role in the informed consent process.
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Randomized Controlled Trial Clinical Trial
Comparison of sufentanil versus fentanyl with 0.125% bupivacaine for continuous labor epidural anesthesia.
The search for an ideal combination of agents for labor epidural anesthesia has become a focus of current research studies. This study was performed to determine if a combination of sufentanil with bupivacaine would show superior analgesia and fewer side effects when compared with an equipotent combination of fentanyl with bupivacaine in continuous labor epidurals. After the approval of the Human Investigations Committee and written consent from the subjects, 54 parturients were assigned to receive one of two epidural drug combinations in a randomized double-blind design. ⋯ There were no statistically significant differences found in VAS scores or requirement for epidural top-up injections between the two groups. Demographics, side effects, apgar scores, and maternal satisfaction scores were also comparable. Both sufentanil and fentanyl with bupivacaine provide comparably safe and satisfactory analgesia for labor epidural anesthesia.
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The purpose of this investigation was to determine, through current research in the literature, if a background basal infusion should routinely be used to improve the efficacy of traditional-demand patient-controlled analgesia (PCA) and would the safety of the PCA technique be maintained with the addition of a continuous infusion. Of the nine studies investigating PCA with and without continuous infusion, six found no improvement in pain control with the addition of a continuous infusion. ⋯ Many studies reported an increased incidence of side effects with the addition of a continuous infusion. This modality of PCA should be reserved for use in patients in whom traditional-demand PCA does not satisfy analgesic requirements.
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The increased use of continuous spinal anesthesia (CSA) in recent years has resulted in research efforts directed at reducing the complications associated with the technique. Complications of CSA are categorized as general, the same as those associated with single-shot spinal anesthesia, and specific, those associated solely with CSA. ⋯ The risk of developing the neurological complication of postdural puncture headache (PDPH) led to the use of microcatheters designed specifically for CSA. While the incidence of PDPH decreased with the use of microcatheters, the risk of developing the more serious complication of cauda equina syndrome increased, resulting in a Safety Alert being issued by the Food and Drug Administration.
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Review Comparative Study
Setting the record straight on nurse anesthesia and medical anesthesiology education.
The history, qualifications, capabilities, and legal status of nurse anesthetists in the United States have been perceived by organized anesthesiology as both a professional and economic threat to the medical specialty. Such threats often lead to turf battles in which groups try to seek public affirmation of their point of view through ongoing public and/or government relation debate and activism. Medicine, including anesthesiology, has used educational preparation of physician and nurse specialists as a favorite topic for such activism. ⋯ This article is aimed at setting right the facts in the current debate used by the American Society of Anesthesiologists in regards to the comparative analysis of CRNA and anesthesiologist education. Because medicine most often uses length of education as a quality measure of that education, regardless of the validity of such arguments, this comparison is set within that framework. Unfortunately, it will not be the last work on this subject.