CRNA : the clinical forum for nurse anesthetists
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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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Preemptive analgesia has recently been the subject of much discussion in the literature including a recent editorial which describes some of the difficulties surrounding the subject. The concept of preemptive analgesia is frequently misunderstood by anesthesia providers especially relative to the use of regional anesthesia. This confusion hampers anesthetists in their practice when they seek to provide optimal pain care for their patients, and especially when regional block is not an option in their particular practice or is inappropriate either for the individual patient or for the surgery being undertaken. This article attempts to differentiate preemptive analgesia from regional anesthetic blockade, and discusses other interventions which may also play a role in producing some measure of preemptive effect.
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The anesthetist must be aware of anesthesia implications for the surgical patient who is taking prescribed psychotropic medications. The number of patients taking psychotropic medications who present for surgery is increasing. Psychotropic medications combined with anesthesia can produce serious complications. This article reviews commonly known psychotropic medications and introduces the anesthetic implications of two new drugs, fluoxetine and buspirone.
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The possibility of awareness during general anesthesia causes apprehension for the patient and the Certified Registered Nurse Anesthetist (CRNA). The goals of general anesthesia are to prevent the sensation of pain and produce a state of sedation, hypnosis, and unconsciousness so the patient will not remember the surgical procedure. An inadequate level of anesthesia can result in patient awareness during surgery. ⋯ The EEG signal is complex, affected by artifact, and it requires a dedicated interpreter. Conventional processed EEG monitoring systems are problematic because of the complexity of the equipment and technical difficulty of reading the EEG recording. The purpose of this article is to describe the history of awareness during anesthesia and introduce a new processed EEG monitor, the Bispectral Index (BIS) (Aspect Medical Systems, Inc., Natick, MA) with implications for future clinical use and research.
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A large, retrospective chart review was conducted to analyze the length of stage II labor and instrumental and cesarean-section delivery rates in nulliparous women who received either 0.0625% bupivacaine with 2 mu/mL fentanyl or 0.125% bupivacaine with 2 mu/mL fentanyl. Data collected included length of stage II labor, incidence of operative or instrumental delivery rates, concentration of bupivacaine used, and demographic data. Demographics obtained included maternal age, weight, and height, as well as neonatal gestational age, weight, and Apgar scores. ⋯ Cesarean delivery rate was 17% in the 0.125% bupivacaine group versus a 21% ratio in the 0.0625% bupivacaine group. Duration of stage II labor was noted to be prolonged in the 0.125% bupivacaine group but was not statistically significant. Based on this data, it can be concluded that the use of 0.125% bupivacaine with 2 mu/mL fentanyl does not cause a statistically significant increase in instrumental or cesarean delivery rates, nor does it have a detrimental effect on length of stage II labor.