Articles: postoperative.
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Case Reports
Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach.
The conventional ultrasound-guided interscalene block targets the C5 and C6 nerve roots at approximately the level of the cricoid cartilage where they lie in the groove between the anterior and middle scalene muscles. This technique, although effective at providing regional anesthesia of the shoulder, is associated with risks of phrenic nerve palsy, injury to the dorsal scapular and long thoracic nerves, and long-term postoperative neurologic symptoms. In this case report, we describe the ultrasound-guided superior trunk block. This procedure targets the C5 and C6 components of the brachial plexus more distally after they unite into the superior trunk but before the suprascapular nerve branches off. ⋯ The enhanced anatomical knowledge provided by ultrasound-guidance has allowed anesthesiologists to devise new block techniques and refine existing ones. The superior trunk block is an example of this refinement and is intended as an alternative to the conventional interscalene block for anesthesia of the shoulder. Further research is planned to confirm the efficacy and safety of the technique.
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The purpose of this Continuing Professional Development Module is to review the issues pertinent to one-lung ventilation (OLV) and to propose a management strategy for ventilation before, during, and after lung isolation. ⋯ Optimal perioperative care of the thoracic patient includes a protective ventilation strategy from intubation to extubation and into the immediate postoperative period. Anesthetic goals include the prevention of perioperative hypoxemia and postoperative ALI.
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Worldviews Evid Based Nurs · Dec 2014
Instituting best practice for monitoring for opioid-induced advancing sedation in hospitalized patients.
Adverse events related to opioid-induced unintended advancing sedation and respiratory depression in hospitalized patients are occurring with increased frequency, and these adverse events can have a negative impact on quality and cost outcomes. ⋯ Nurse executives and nurse managers assume accountability for ensuring that patient care is aligned with the best evidence, practices, and regulatory mandates. The framework presented in this paper can help prevent opioid-induced advancing sedation and respiratory depression, and assist nurse leaders in implementation strategies to guide policies and practice.