CRNA : the clinical forum for nurse anesthetists
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Outpatient surgery has become increasingly popular. Technical advances in both surgery and anesthesia have made the practice of ambulatory surgery safe and attractive. ⋯ The valid patient complaint of postoperative nausea and vomiting has been shown to significantly delay discharge from the recovery area after ambulatory surgery. This article reviews the numerous factors that have been identified as fostering the postoperative complication of nausea and vomiting.
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In the United States, trauma continues to be the leading cause of death in children between the ages of 1 and 15 years of age. Children die from trauma at a rate five times greater than from leukemia which is the next leading cause of death in this age group. The acutely injured child is brought to community hospitals as well as university hospitals. ⋯ Only with this knowledge will there be a decrease in the morbidity of the traumatized pediatric patient. The CRNA should be able to rapidly assess and gain control of the pediatric airway and assure adequate respiration. Initial assessment of the pediatric trauma patient also includes the restoration or maintenance of hemodynamic stability.
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The 21st century will bring a new era of cost containment to the arena of ambulatory surgery force practitioners of anesthesia to reevaluate practice patterns. Along with the current increased interest in cost containment and optimal use of limited resources, growing concerns about patient outcome result in controversial issues in adult and pediatric outpatient anesthesia that must be addressed in the areas of preoperative evaluation, patient preparation and selection, laboratory screening, and practical discharge criteria. The future challenge for all practitioners is to provide high-quality anesthesia care at a reduced cost.
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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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Randomized Controlled Trial Clinical Trial
Effects of tourniquet time in knee arthroscopy patients receiving intraarticular morphine combined with bupivacaine.
The purpose of the study was to compare the duration of analgesia and the amount of supplemental postoperative analgesics required when morphine combined with bupivacaine was injected into the knee joint at the end of knee arthroscopy surgery. Varying tourniquet times of 0, 8, or 16 minutes were used after the injection. The variables examined were the duration of analgesia, and the amount of supplemental postoperative analgesics required in each subgroup. ⋯ No statistical differences were found between groups. All patients received analgesia with no reported side effects. Increasing the tourniquet time had no effect on the duration of analgesia or the amount of supplemental narcotics required in the postoperative period.