Assessing the force generated with application of cricoid pressure.

The application of cricoid pressure is a common technique used to decrease the risk of aspiration during anesthetic induction. Research recommends that 3 to 4 kg of cricoid force be applied to achieve effective esophageal occlusion. The purpose of this study was to assess perioperative nurses' knowledge regarding the recommended amount of cricoid force that should be applied to the cricoid cartilage and to assess the amount of force generated when cricoid pressure was applied to a scale-mounted model. A convenience sample of 102 perioperative nurses participated in the study. Five percent of participants identified the correct amount of force necessary. Applied force was significantly less than the recommended amount. Findings of this study suggest perioperative nurses lack both knowledge and clinical skill for generating effective amounts of cricoid force.

AANA Journal Course: update for nurse anesthetists--femoral nerve block and 3-in-1 block in anesthesia.

Femoral nerve blocks and 3-in-1 blocks are simple and useful alternatives to other regional or general anesthetic techniques for selected surgeries. These blocks also may provide postoperative analgesia that may be a useful alternative to epidural or parenteral analgesia. Understanding the techniques of blockade, its appropriate applications, and the relevant anatomy may provide the anesthetist with a valuable alternative.

Comparison of intubating conditions related to timed dosages and a nerve stimulator based on the measurement of acceleration using mivacurium.

A quantitative method of monitoring neuromuscular blockade has been recently introduced. It has been suggested, when using mivacurium, that a standardized passage of time be used for induction. The purpose of this study was to determine whether a difference existed in intubating conditions when using mivacurium between a timed-dose technique and the ParaGraph (Vital Signs, Inc., Totowa, New Jersey). In this prospective, experimental, clinical trial, 40 patients were randomized into two groups. Standardized induction sequences were used for both groups. A standardized rating tool was used to grade each intubation. Intubation commenced in the ParaGraph group when the monitor read one twitch. Intubation in the timed-dose group occurred 90 seconds after the first dose of mivacurium. The difference in intubating conditions score and time to intubation was tested by the Mann-Whitney-Wilcoxon lest. The ParaGraph group had superior intubating conditions when compared with the timed dose group (P = .0001). Of the ParaGraph group, 100% had good to excellent intubating conditions, and 85% of the timed-dose group had fair to excellent intubating conditions. Time to intubation was longer in the ParaGraph group, with a mean of 216 seconds compared with 121 seconds in the timed-dose group. The variable time to onset of mivacurium indicates that a timed-dose technique may yield less than optimal intubating conditions despite manufacturer recommendations.