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CRNA : the clinical forum for nurse anesthetists最新文献

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Intrathecal opioids for the control of pain experienced during labor and in the post-cesarean section period. 鞘内阿片类药物用于控制分娩期间和剖宫产后的疼痛。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-08-01
J E Pellegrini
{"title":"Intrathecal opioids for the control of pain experienced during labor and in the post-cesarean section period.","authors":"J E Pellegrini","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Since the discovery of opiate receptors in the brain and spinal cord, considerable research has been performed to include intrathecal opioids for the control of pain. No area has used this knowledge more than the practice of obstetrical anesthesia. Intrathecal opioids have been shown to be very effective in controlling the pain experienced in the first stage of labor but have been ineffective in controlling second-stage labor pain. Intrathecal opioids, especially morphine sulfate, provide long-term analgesia but are associated with a high number of side effects. Research studies have attempted to determine the optimal dose of intrathecal opioids to provide the greatest amount of analgesia with the lowest incidence of side effects. Intrathecal morphine sulfate has been shown to be effective in controlling first-stage labor pain but has been shown to be the most efficacious in controlling the pain experienced in the post-cesarean section period. This article reviews the current literature and provides background of information to understand these developments.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 3","pages":"99-105"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20774847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Alpha 2-agonist agents: a review for CRNAs. α 2激动剂:对crna的综述。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-08-01
H E Holman, R E Haas
{"title":"Alpha 2-agonist agents: a review for CRNAs.","authors":"H E Holman,&nbsp;R E Haas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Over 300 clonidine-related research articles have been prominently featured in anesthesia journals over the last 4 to 5 years. Nurse anesthetists may already find themselves administering alpha 2-adrenergic agents to help control hypertension; however, in the future their use as anesthetic adjuncts to control pain may also become important. This article reviews the alpha 2-adrenergic (A2) receptor and one of its agonist agents, clonidine.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 3","pages":"86-92"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20775608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Nitric oxide: a primer for the practicing anesthetist. 一氧化氮:麻醉师的入门品。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-08-01
M W Kervin, K R Wren, R E Haas, D Farrer
{"title":"Nitric oxide: a primer for the practicing anesthetist.","authors":"M W Kervin,&nbsp;K R Wren,&nbsp;R E Haas,&nbsp;D Farrer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Nitric oxide (NO) is receiving interest because of its use in patients with acute respiratory distress syndrome. Because more studies are being conducted, researchers are discovering a vast array of physiological effects attributable to NO. NO has been implicated as having a role in the endogenous regulation of blood pressure; smooth, skeletal, and cardiac muscle relaxation; renal and immune system functioning; and selective pulmonary vasodilation. This article looks at the pharmacological and physiological effects of NO and its current use in the clinical setting.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 3","pages":"93-8"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20775609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Issues and perspectives affecting CRNA practice. 影响CRNA实践的问题和观点。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-08-01
I P Gunn
{"title":"Issues and perspectives affecting CRNA practice.","authors":"I P Gunn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 3","pages":"123-6"},"PeriodicalIF":0.0,"publicationDate":"1998-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20774851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Awareness during general anesthesia: new technology for an old problem. 全身麻醉中的意识:新技术解决老问题。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-05-01
J R Halliburton
{"title":"Awareness during general anesthesia: new technology for an old problem.","authors":"J R Halliburton","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The possibility of awareness during general anesthesia causes apprehension for the patient and the Certified Registered Nurse Anesthetist (CRNA). The goals of general anesthesia are to prevent the sensation of pain and produce a state of sedation, hypnosis, and unconsciousness so the patient will not remember the surgical procedure. An inadequate level of anesthesia can result in patient awareness during surgery. The current practice of anesthesia relies on indirect hemodynamic measurements such as blood pressure and heart rate to monitor the sedative hypnotic state of the patient's brain during general anesthesia. Hemodynamic responses are not reliable for predicting awareness just as blood pressure and heart rate are not indicative of consciousness. Electroencephalogram (EEG) waveforms are known to be affected by anesthetics. Characteristic EEG waveforms are a direct indication of the patient's level of consciousness. Unprocessed and computer-processed EEG recordings have been used in an attempt to monitor the patient's level of consciousness during general anesthesia. A raw or unprocessed EEG recording to monitor the level of consciousness during general anesthesia is problematic. The EEG signal is complex, affected by artifact, and it requires a dedicated interpreter. Conventional processed EEG monitoring systems are problematic because of the complexity of the equipment and technical difficulty of reading the EEG recording. The purpose of this article is to describe the history of awareness during anesthesia and introduce a new processed EEG monitor, the Bispectral Index (BIS) (Aspect Medical Systems, Inc., Natick, MA) with implications for future clinical use and research.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 2","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20641317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Anesthesia for an achondroplastic dwarf with bilateral vocal cord granuloma: use of a Xomed Hunsaker Mon-Jet ventilation tube. 软骨发育不全侏儒伴双侧声带肉芽肿的麻醉:Xomed Hunsaker无喷射通气管的应用。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-05-01
J O'Donnell, C J Williams, C A Rosen, N Sonbolian
{"title":"Anesthesia for an achondroplastic dwarf with bilateral vocal cord granuloma: use of a Xomed Hunsaker Mon-Jet ventilation tube.","authors":"J O'Donnell,&nbsp;C J Williams,&nbsp;C A Rosen,&nbsp;N Sonbolian","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Technological advances have greatly improved the management of the patient undergoing microlaryngeal surgery. The use of a laser, high frequency jet ventilation (HFJV), total intravenous anesthetic techniques (TIVA), and specially designed endotracheal tubes (Xomed Hunsaker Mon-Jet ventilation tube [Xomed Surgical Products, Jacksonville, FL]) are recognized as cutting edge approaches to the management of these cases. The use of high technology adjuncts requires considerable skill and knowledge from the perspective of the anesthesia provider. This case report describes an approach to anesthetic management for a patient with a history of achondroplastic dwarfism having laser excision of bilateral vocal cord granulomas. Further increasing the complexity of the case was the surgical use of an autogenous tissue glue, which required a period of 'airway silence' during the application process.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 2","pages":"67-76"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20641321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The evolution of the auditory midlatency response in evaluating unconscious memory formation during general anesthesia. 听觉中潜伏期反应在评估全身麻醉下无意识记忆形成中的演变。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-05-01
T L Smith, D Zapala
{"title":"The evolution of the auditory midlatency response in evaluating unconscious memory formation during general anesthesia.","authors":"T L Smith,&nbsp;D Zapala","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The inability to objectively evaluate the amnesic status of an anesthetized patient has been a perplexing problem for the anesthesia provider. One approach thought to be effective in evaluating the amnesic status of the anesthetized patient is the auditory midlatency response (AMLR). The AMLR is an electrophysiological response that is recorded from scalp electrodes 10 to 80 ms after the auditory pathways begin to process acoustic stimuli. The response is thought to reflect the anesthetized patient's ability to consolidate an acoustic stimuli into an explicit or implicit memory. This article defines the amnesic state, describes the various components of AMLR, discusses clinical uses of the AMLR as an indicator of memory formation during the anesthetized state, and explains the clinical implications of using the AMLR in the surgical suite. Recent results have noted that the Pa waveform, the first positive deflection of the AMLR, may be the component that may serve as an intraoperative indicator of the anesthetized patient's ability to potentially consolidate an intraoperative acoustic stimuli into a memory. With the establishment of the Pa waveform of the AMLR as a reliable indicator of intraoperative memory formation, the AMLR can then be used to significantly decrease the occurrences of traumatic neurosis in the surgical patient and subsequent medicolegal consequences for the health care team. Thus, the use of the AMLR strives to promote a safer intraoperative environment for both the patient and the anesthesia provider.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 2","pages":"44-9"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20641318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Planning and implementing an anesthesia crisis resource management course for student nurse anesthetists. 为实习麻醉师护士策划并实施麻醉危机资源管理课程。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-05-01
J O'Donnell, J Fletcher, B Dixon, L Palmer
{"title":"Planning and implementing an anesthesia crisis resource management course for student nurse anesthetists.","authors":"J O'Donnell,&nbsp;J Fletcher,&nbsp;B Dixon,&nbsp;L Palmer","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Development of Anesthesia Crisis Resource Management (ACRM) skills is a highly desirable outcome of a nurse anesthesia educational program. Access to an ACRM course is limited by a variety of factors including cost, availability of a center, time constraints, and the lack of adequately prepared CRNA faculty. The authors describe a Nurse Anesthesia Program's planning and implementation of an ACRM course by using a high fidelity human simulator. Key supportive and logistical elements necessary to implement an ACRM course are described. The authors address administrative concerns, faculty preparation needs, and explain the process of course design. Strengths of the course and problems encountered during the implementation of the experience are described. Feedback from participating students, faculty perceptions, and lessons learned from the experience are shared.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 2","pages":"50-8"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20641319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The use of an anesthesia simulator in graduate and undergraduate education. 麻醉模拟器在研究生和本科生教学中的应用。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-05-01
E J Monti, K Wren, R Haas, A E Lupien
{"title":"The use of an anesthesia simulator in graduate and undergraduate education.","authors":"E J Monti,&nbsp;K Wren,&nbsp;R Haas,&nbsp;A E Lupien","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The use of simulation for educational training is common in many industries but is a new advancement in student instruction in anesthesia, medicine, or allied health. The Human Patient Simulator (HPS) allows students and clinicians to learn and practice a variety of technical skills as well as manage basic and complex clinical situations in a modifiable and reproducible environment. The HPS has been extensively integrated in many graduate and undergraduate Nursing and Allied Health courses at the Medical College of Georgia. Use of the HPS stems from the theory of situated cognition, which states that students best learn \"what to do\" and \"how to do\" in a real world environment. The HPS provides a real world environment for student learning in various fields. The theory of situated cognition is discussed in conjunction with the implementation of the HPS into various classes.</p>","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 2","pages":"59-66"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20641320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quarterly update. Anesthetic drug interactions. 每季度更新。麻醉药物的相互作用。
CRNA : the clinical forum for nurse anesthetists Pub Date : 1998-05-01
M S McAuliffe, E A Hartshorn
{"title":"Quarterly update. Anesthetic drug interactions.","authors":"M S McAuliffe,&nbsp;E A Hartshorn","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":77087,"journal":{"name":"CRNA : the clinical forum for nurse anesthetists","volume":"9 2","pages":"77-83"},"PeriodicalIF":0.0,"publicationDate":"1998-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20641322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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