CRNA : the clinical forum for nurse anesthetists
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Since the discovery of opiate receptors in the brain and spinal cord, considerable research has been performed to include intrathecal opioids for the control of pain. No area has used this knowledge more than the practice of obstetrical anesthesia. Intrathecal opioids have been shown to be very effective in controlling the pain experienced in the first stage of labor but have been ineffective in controlling second-stage labor pain. ⋯ Research studies have attempted to determine the optimal dose of intrathecal opioids to provide the greatest amount of analgesia with the lowest incidence of side effects. Intrathecal morphine sulfate has been shown to be effective in controlling first-stage labor pain but has been shown to be the most efficacious in controlling the pain experienced in the post-cesarean section period. This article reviews the current literature and provides background of information to understand these developments.
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The patient, as a health care consumer, has a fundamental right to determine what shall be done to his or her own body. The doctrine of informed consent has evolved to protect that right. ⋯ A brief history of informed consent is provided, as well as discussion of the controversies surrounding the topic. Several court cases are cited, and the opinions of various authors reflect the wide range of legal and ethical implications associated with informed consent.
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Pulmonary edema developing after the relief of upper airway obstruction has been reported in association with a variety of factors including laryngospasm, foreign bodies, and tumors. However, as the phrase "negative pressure pulmonary edema" suggests, markedly negative intrapleural pressure is the dominant mechanism for the genesis of pulmonary edema associated with upper airway obstruction. A review for anesthesia providers of this poorly recognized and often perplexing syndrome may help to reduce the occurrence of this potential complication and facilitate its treatment.
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In spite of the fact that nonphysician anesthesia providers are used in many areas of the world, some countries continue to have shortages in the anesthesia workforce. As a result of many requests from around the world for information on starting a nurse anesthesia program, the Education Committee of the International Federation of Nurse Anesthetists (IFNA) developed a document entitled "Guidelines for Starting A New Program and Sample Curriculum." It was hoped that this document, along with IFNA's "Educational Standards for Preparing Nurse Anesthetists," would be of assistance to individuals starting programs internationally. ⋯ In addition to beginning stages and organization of the school, it describes the challenges encountered. It highlights the importance of follow-up and continued assistance for success of new programs.
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Comparative Study
Accuracy of blood loss determination by health care professionals.
Patients undergoing surgery will likely experience some degree of blood loss. There is much literature examining effects of blood loss, but little was found that examined accuracy of estimation of blood loss. The research question for this study was: How accurate are surgical health care professionals in their estimations of blood loss? This study was a pre-experimental between-subject design that used a convenience sample of 85 volunteers who worked in the surgical and postsurgical units of a rural southern 450-bed hospital. ⋯ The variables that were examined and were compared included the professional group, years of experience in surgery or the postanesthesia care unit (PACU), and their estimation of blood loss. Their estimation of blood loss was compared with the actual amount of blood to determine whether one group was more accurate than another statistically and whether increasing years of experience improved accuracy. The statistical tests used were simple and multiple regressions.