CRNA : the clinical forum for nurse anesthetists
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Local anesthetic drugs interrupt nerve transmission by inhibiting the passage of sodium ions (Na+) across neuronal membranes. Signal propagation and transmission along central and peripheral nerve pathways are impeded after the injection of these drugs near or on neuronal tissue. This article briefly reviews the basic pharmacology and toxicology of local anesthetic agents as well as recent studies of regional anesthesia performed with ropivacaine, a versatile new amide local anesthetic with a duration of action similar to bupivacaine, but with less systemic toxicity.
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Malignant hyperthermia (MH) is an uncommon and potentially fatal pharmacogenetic complication of anesthesia. It is commonly triggered by administration of halothane and succinylcholine. The treatment of choice is to administer dantrolene sodium while simultaneously discontinuing the triggering agent. ⋯ Anesthesia can be safely administered to MH-susceptible patients. Nontriggering agents are used, and meticulous monitoring of the patient is performed. All anesthesia providers should be familiar with MH.
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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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Children with craniofacial anomalies, in particular those with facial clefts and the associated syndromes of Treacher Collins, Pierre Robin, and Klippel-Fiel and craniosynostosis and its related syndromes, present some of the most hazardous and difficult challenges that anesthetists may encounter within the entire practice of pediatric anesthesia. Through this review of the embryological development of the above-listed anomalies, the specific concerns of the airway and coexisting congenital defects, the reader will develop a better understanding of each anomaly in order to create a safe anesthetic plan for the management of children with these types of craniofacial conditions.
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Review Case Reports
Laryngeal mask airway in anesthetic care: clinical cases and discussion.
The laryngeal mask airway (LMA) is rapidly becoming an essential tool in the anesthetist's armamentarium for airway management. Approved for use in the United States in 1992, the LMA has several uses, notably anesthesia traditionally administered by mask. ⋯ Techniques are described for the use and maintenance of the LMA. Two illustrative clinical cases are presented.