Journal of post anesthesia nursing
-
Trauma in children claims more lives than any other childhood disease; (8,000 deaths were reported in the United States in 1989). The peculiar anatomy and physiology of the young body is responsible for the different pattern and distribution of injuries in children than in adults. For instance, 75% of multiply injured children suffer from head trauma. ⋯ Recent research indicates that care delivered by specially trained teams results in decreased morbidity associated with prehospital care and transport of these patients. Inpatient care of injured children ranges from highly sophisticated resuscitation and life support to postoperative pain control and tactful communication with distressed families. Physicians and nurses involved in trauma care must direct their efforts to further the education of medical personnel and the lay public regarding management of accident victims.
-
Comparative Study Clinical Trial Controlled Clinical Trial
A comparison of tympanic and pulmonary artery measures of core temperatures.
The most accurate method of obtaining body temperature is the core temperature. Traditionally, esophageal measurements have been used in anesthetic settings. A method to assure similar accuracy for conscious patients was needed. ⋯ Mean temperature measured was 37.2 degrees C in the control group (pulmonary artery temperatures) and 37.3 degrees C in the experimental group (tympanic membrane temperatures). Using the descriptive statistic and analysis of variance, the F statistic indicated that there was no significant difference between the two groups. The null hypothesis that there is no significant difference between temperatures measured with a tympanic membrane thermometer and pulmonary artery catheter was accepted.
-
New methods of postoperative pain control offer alternatives to traditional intramuscular injections of narcotic. One such method is patient-controlled analgesia (PCA), in which patients self-administer predetermined, controlled doses of intravenous narcotic "on demand." The PACU is a desirable unit in which to initiate PCA since pain is often acute in the immediate postanesthesia period. ⋯ PCA is often initiated and controlled by the anesthesia department in large institutions. However, at The Medical Center of Central Massachusetts-Memorial, the program was successfully implemented under the direction of the Nursing Department.
-
Butorphanol tartrate (Stadol; Anaquest, Madison, WI/Bristol-Meyers Squibb, Evansville, IN) is an analgesic possessing mixed agonist-antagonist activity at opiate receptors. Receptor specificity has been used to limit respiratory depression, gastrointestinal side effects, and reduce the risk of dependency. Theoretically it offers an advantage over traditional opiates such as morphine and meperidine in the treatment of moderate pain. ⋯ Its lack of euphoric effects may be useful in emergency medicine for clinical populations prone to drug-seeking behavior. Butorphanol has been used more recently for epidural analgesia or for intravenous patient-controlled analgesia when allergies to opiates exist. Since butorphanol is not a controlled substance, its use can reduce administrative liability for abuse and can lower the number of distribution records associated with Schedule II narcotics.
-
Opiates remain the choice of analgesia for severe pain despite numerous side effects. They possess the unique ability to alter the interpretation of noxious sensations normally sensed as pain, while leaving the sensations of touch, temperature, and proprioception essentially unchanged. Opiates act by mimicking naturally occurring endogenous peptides at a variety of receptors in the central nervous system (CNS). ⋯ A brief description of nociceptive (pain) pathway anatomy is also presented. Application of knowledge has allowed the development of mixed agonist-antagonist drugs such as butorphanol (Stadol; Anaquest, Madison, WI/Bristol Meyers Squibb, Evansville, IN) that capitalize on specific opiate receptor activation or antagonism to decrease adverse side effects and abuse-dependence potential. Future research areas are discussed.