Journal of post anesthesia nursing
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The physiology of the neuromuscular junction has a significant impact on the pharmacology of neuromuscular blockade and associated reversal. Depolarizing and nondepolarizing agents for blockade and enzyme inhibitors for reversal of blockade are discussed. Clinical applications are also reviewed.
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Seventy percent of all postoperative patients--over 14 million cases annually- suffer from hypothermia, which is caused by the combination of the anesthetics preventing thermal homeostasis and the cold operating room environment. Therapeutic goals are to treat shivering, prevent the severe discomfort of hypothermia, maximize rewarming rate to shorten PACU time, and maximize patient safety. Traditional warming therapies do not actively heat the patient nor do they prevent the continued loss of endogenously produced heat. Convective warming therapy is a new technology that clinical studies have demonstrated to be effective in preventing intraoperative or treating postoperative hypothermia.
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This article pertains to malignant hyperthermia (MH). The disease and its physiologic aspects are described, and a general overall view of what takes place at the cellular level during an MH crisis is presented. Also described is the drug of choice, dantrolene sodium, and its functioning during an MH crisis. The care of an MH patient in the PACU is presented, correlating all the above mentioned aspects of MH.
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Laryngospasm during the emergent phase of anesthesia is a respected complication well known to any PACU nurse. One complication of laryngospasm is noncardiac pulmonary edema (NCPE). NCPE can be a catastrophic complication of anesthesia. ⋯ The mechanism of laryngospasm-induced pulmonary edema is described. The need for PACU nurses to comprehend the pathophysiology and implications of laryngospasm and hypoxemia is paramount when determining proper treatment. PACU nurses should be particularly alert to and aware of this complication.
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Patients receive maximum benefit from surgery with the fewest complications if they and the medical personnel involved in their care are well prepared for anesthesia. The importance of a thorough history and physical examination are discussed. ⋯ The importance of nothing-by-mouth status and the risk of acid aspiration are emphasized. A brief discussion of preoperative optimization of cardiopulmonary disease and the definition of American Society of Anesthesiologists Physical Status conclude the article.