CRNA : the clinical forum for nurse anesthetists
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The most common local anesthetics in clinical use today are of two classes: amino-esters and amino-amides. These two classes differ not only in their chemical structure but also in regard to their metabolism and allergic potential. ⋯ The effects of local anesthetics are primarily caused by the blockade of the sodium channels, thus affecting the slow and fast depolarization phase of the action potential. With the basic understanding of the chemistry and pharmacology of the different local anesthetic agents, the nurse anesthetist can more effectively integrate the use of these drugs into their clinical practice.
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This article provides an overview of the current status of general anesthesia and regional anesthesia techniques including complications occurring after using these techniques. The advantages, disadvantages, mortality, and morbidity are described for these two techniques.
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In the last 5 years, the number of nonoperating room procedures performed on the pediatric population requiring sedation has skyrocketed. Some of these procedures, such as bone marrow aspiration or dental restorations, may be painful, whereas others, such as magnetic resonance imaging, are not painful but require a motionless patient. Anesthesia departments are being tasked more and more frequently to provide the sedation and monitoring for these procedures. ⋯ Currently, there are several medications or combinations of medications that offer advantages over the commonly used chloral hydrate and "lytic" cocktail. Selection of medication(s) should be based on the type of procedure (painful v painless), the length of the procedure, the medical condition of the patient (current medications, fasting status, and disease processes or metabolic disorders), and the need for anxiolysis or amnesia. This article briefly reviews: (1) developmental changes and metabolic capacity in the pediatric patient; (2) the American Academy of Pediatrics guidelines for care of the pediatric patient undergoing sedation; (3) basic pharmacology of sedative-hypnotics and opioids; and (4) patient monitoring and discharge.
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The psoas compartment acts as a conduit for the nerve roots of the lumbar plexus. Originating at approximately the 12th thoracic vertebrae, this potential compartment continues on caudally, bordered posterolaterally by fascia of the quadratus lumborum and iliacus muscles, medially by the fascia of the psoas major muscle, and anteriorly by the transversalis fascia. ⋯ Spread of the anesthetic to all roots of the plexus occurs in 15 to 20 minutes. Profound sensory and motor blockade can be achieved providing surgical anesthesia as well as long duration postoperative pain relief.
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While under hypnosis, patients can be taught to alter their psychophysiological functions. With this ability to alter these functions, patients can overcome the anxiety associated with surgery. ⋯ The purpose of this article is to review the research literature related to the use of hypnosis in preparing the patient for surgery and to present 2 approaches used by the authors to prepare patients for surgery. The first approach is used when there is enough time to condition the patient, and the second approach is used when the anesthetist meets the patient shortly before the surgery is to begin and there is no time to induce formal trance.