CRNA : the clinical forum for nurse anesthetists
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Post dural puncture headache is a common sequelae of spinal and, sometimes, epidural anesthesia. Since 1960, the practice of placing autologous blood into the epidural space to treat spinal headache has been used with great success. The blood patch can provide immediate symptom relief from spinal headache and repair of the CSF leak, which is the basic mechanism of post dural puncture headache. ⋯ This is a procedure not without complications and requires caution. Contained herein are recommendations for safe and effective use of the epidural blood patch. Following these procedures, anesthetists will likely see an 85% to 98% immediate cure rate for post dural puncture headache with the fewest possible complications.
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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 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 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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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.