Nurse anesthesia
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Historically, pain in ill and injured pediatric patients has not been recognized or attended to. Subsequently, children often suffer in silence. Caretakers are often fearful to intervene aggressively to alleviate pain. ⋯ One of the most important is how to individualize the treatment of pain. We also need to learn more about children's natural coping styles and how parents and health care providers can enhance their effectiveness in contributing to the therapeutic team. It is hoped that readers will notice their patient's behaviors a little more closely, think about the extent of their private suffering, and become willing to offer a more studied, justifiable, and aggressive approach to pediatric pain management.
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Certified Registered Nurse Anesthetists (CRNAs) provide anesthesia to a wide spectrum of patients, including those undergoing various neurosurgical procedures. While some CRNAs specialize in neuroanesthesia, most are involved on a more episodic basis. Using a case study format, this article reviews the pathophysiology associated with six common neurologic conditions the general practice CRNA may encounter. Important anesthesia considerations for each condition are discussed.
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Case Reports
Ketorolac as a preoperative nonnarcotic analgesic to enhance anesthesia and postanesthesia recovery.
The benefits of using ketorolac as a preoperative intramuscular (IM) non-narcotic analgesic are described and illustrated by the presentation of two case reports. Case Summary--Patient 1: A 53-year-old female who had experienced refractory nausea and vomiting after six previous exposures to anesthesia presented for outpatient ureteroscopy and dilatation of strictures. ⋯ Case Summary--Patient 2: A 65-year-old male with mild chronic obstructive lung disease presented for extracorporeal shock wave lithotripsy (ESWL). To avoid the respiratory depression associated with opioid narcotics, ketorolac 60 mg IM was given as an analgesic 1 hour before the ESWL procedure.