Nurse anesthesia
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This clinical review explores the efficacy of the nonsteroidal antiinflammatory agent, ketorolac tromethamine, added to an anesthetic regimen utilizing intravenous propofol. Both agents have been shown to reduce the incidence of nausea and vomiting postoperatively when administered to patients undergoing minor gynecologic surgery. Because the incidence of nausea and vomiting is significantly reduced when ketorolac is used in place of opioids to attenuate postoperative pain, it would appear to be an appropriate choice of agent to use following propofol anesthesia. The use of this combination of drugs may not only reduce the incidence of postoperative nausea and vomiting in patients undergoing minor gynecologic surgery, but could reduce the duration of hospitalization and enhance recovery from anesthesia.
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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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Over the last 15 years a rapid growth has occurred in the number of pediatric patients that are encountered in the operating room. A developing sophistication on the part of both children and parents, coupled with a rapidly expanding recognition of the need to minimize the amount of physical and psychological trauma that a child has to experience, has led to a growing use of premedication agents for children. A review of the premedication agents currently in use, their various routes of administration, as well as their associated benefits and risks, is presented.
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Pediatric regional anesthesia has been viewed less favorably in the past because it was often considered an extra and unnecessary procedure. Current anesthesia practice demonstrates that local anesthetic techniques are of great value either as the sole anesthetic or for postoperative analgesia in the pediatric population. ⋯ The advantages and special considerations of the pediatric population also are reviewed. Regional anesthesia in the pediatric patient population does have its benefits and should be considered as an option in the provision of anesthesia in the pediatric age group.
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Thrombelastography (TEG) has been used widely during hepatic transplantation procedures to detect intraoperative changes in blood coagulation and as a guide to determine appropriate treatment of these changes. The current literature identifies the use of TEG for intraoperative management of coagulation as a proven reliable and rapid monitoring system. The clinical applicability of TEG monitoring for the anesthesia provider will give better intraoperative management of hemostasis, optimizing patient care and minimizing blood component use.