CRNA : the clinical forum for nurse anesthetists
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Combined spinal epidural anesthesia offers the advantages of each method while minimizing their respective disadvantages. First described in 1937, this technique has risen in popularity over the last 15 years and is being used successfully in orthopedic, urologic, and gynecologic surgeries and for anesthesia/analgesia for labor and delivery as well as cesarean section. The history and development of combined spinal epidural anesthesia/analgesia, the different techniques, and controversies and problems associated with its use are discussed. The use of the technique of obstetric anesthesia/analgesia is also examined.
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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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Randomized Controlled Trial Clinical Trial
Comparison of ondansetron, metoclopramide, and placebo in the prevention of postoperative emesis in children undergoing ophthalmic surgery.
A common and distressing adverse effect following general anesthesia is nausea and vomiting. Pediatric ophthalmic surgery is associated with a high (50%-80%) incidence of postoperative emesis. Vomiting postoperatively may cause a prolonged hospital stay, and if it is persistent, may lead to unanticipated hospital admission after ambulatory surgery. ⋯ The incidence of emesis and adverse effects were observed in the postanesthesia care unit and documented for 24 hours postoperatively. Analysis of variance showed that ondansetron significantly decreased (P = .05) the incidence of emesis in the postanesthesia care unit and during the first 24 hours postoperatively (P = .049). Additionally, parents of children in the ondansetron group reported a high degree (94%) of satisfaction with the experience.
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This article addresses the use of peripheral nerve blocks as a primary or adjunctive technique of anesthesia for selective operative procedures. The use of these blocks can reduce the amount of inhalational and narcotic agents used during an anesthetic and facilitate a pain-free postoperative period.
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The inability to objectively evaluate the amnesic status of an anesthetized patient has been a perplexing problem for the anesthesia provider. One approach thought to be effective in evaluating the amnesic status of the anesthetized patient is the auditory midlatency response (AMLR). The AMLR is an electrophysiological response that is recorded from scalp electrodes 10 to 80 ms after the auditory pathways begin to process acoustic stimuli. ⋯ Recent results have noted that the Pa waveform, the first positive deflection of the AMLR, may be the component that may serve as an intraoperative indicator of the anesthetized patient's ability to potentially consolidate an intraoperative acoustic stimuli into a memory. With the establishment of the Pa waveform of the AMLR as a reliable indicator of intraoperative memory formation, the AMLR can then be used to significantly decrease the occurrences of traumatic neurosis in the surgical patient and subsequent medicolegal consequences for the health care team. Thus, the use of the AMLR strives to promote a safer intraoperative environment for both the patient and the anesthesia provider.