[The pain resource nurse in a cancer unit]. / L'infirmière ressource douleur dans un centre de lutte contre le cancer.

The pain resource nurse in oncology works on the wards, upon the teams' request, in situations of complex pain in the context of serious and chronic diseases. She supports and cares for patients providing specific pain relief, in collaboration with an algologist, and is involved in the continuous training of caregivers.

The rapid sequence spinal for category 1 caesarean section: anaesthetic trainee knowledge and practice.

Rapid sequence induction of general anaesthesia (GA) is the fastest anaesthetic technique in a category-1 caesarean section (C1CS) for foetal distress. Recently rapid sequence spinal anaesthesia (RSS) has been explored as a technique to avoid the potential risks of GA in such cases. Out of hours, trainee anaesthetists are often required to provide anaesthesia for these emergencies. We surveyed their practices when performing a RSS. The aim of a RSS is to rapidly and safely achieve anaesthesia for C1CS, while optimising foetal oxygenation and preparing for possible GA. It requires anaesthetic skill, team work and communication. Many trainees understood the principles of the RSS, however, a significant number did not. Practice varied widely and no trainee had received any formal RSS training. Training for junior anaesthetists and those working in obstetric theatres, in the conduct of the RSS is crucial, to ensure safe practice, avoid delays in delivery and safely avoid the risks associated with GA in the C1CS.

Spinal anesthesia for orthopedic surgery: a detailed video assessment of quality.

BACKGROUND: Subarachnoid blocks are considered routine anesthetic procedures important in the daily practices of most anesthesiologists. However, few data exist regarding modern failure rates or quality-compromising behaviors. METHODS: Sixty adult patients having orthopedic surgery under spinal anesthesia were enrolled in this prospective and observational video study. Through a detailed high definition video review, we aimed to define our subarachnoid block failure rate and identify associated quality-compromising behaviors. RESULTS: An intrathecal injection either failed to generate a surgical block or was aborted secondary to difficulty in 7 patients (11.6%). A procedurally difficult subarachnoid block occurred in 17 patients (29%). Eight patients required greater than 10 mins of needling to complete the subarachnoid block. Body mass index represented an independent risk factor for long procedure times. There were 27 incidences of quality-compromising behaviors that included likely violation of aseptic technique, hemorrhage, poor positioning, damaged needles, thecal sac transfixation, high-lumbar needle placement, repetition of previously failed maneuvers, failure to provide skin anesthesia, and prolonged procedure times. Certified registered nurse anesthetist status predicted a greater-than-4-fold risk of subarachnoid block failure. DISCUSSION: The failure rate and quality-compromising behaviors identified in this study challenge the generalized assumption that performing a subarachnoid block in the orthopedic population is a simple procedure. The number and nature of the combined failed and difficult subarachnoid blocks suggest the need for quality improvement. Further research is needed to assess whether the use of image guidance may be a possible solution to navigate difficult anatomical pathology and confirm correct needle and drug placement.

Combined spinal/general anesthesia with postoperative femoral nerve block for total knee replacement in a patient with familial hyperkalemic periodic paralysis: a case report.

Familial hyperkalemic periodic paralysis (HYPP) is a rare genetic disorder in which the sodium channels in skeletal muscle cells have altered structure and function. Small elevations in serum potassium lead to inactivation of sodium channels, causing episodic weakness or paralysis. Exposure to cold, anesthesia, fasting, emotional stress, potassium ingestion, and rest after exercise can stimulate an attack. This case report describes a 65-year-old man with HYPP who was admitted for a right total knee arthroplasty. He had a history of arteriosclerotic heart disease and stenting 8 years earlier, previous inferior wall myocardial infarction with ejection fraction of 65%, anxiety, degenerative joint disease, well-controlled type 2 diabetes mellitus, and a body mass index of 53.3 kg/m2. A combined spinal/general anesthetic with a femoral nerve block for postoperative pain control was chosen. Careful attention was given to monitoring and maintenance of core temperature, use of insulin and glucose to maintain normokalemia, and carbohydrate loading the night before surgery. The patient recovered from the anesthetic without complication and had pain relief for approximately 22 hours postoperatively because of the femoral nerve block. The patient was without weakness or paralysis related to HYPP in the postanesthesia care unit or throughout his hospitalization.

Audio-visual distraction during spinal anaesthesia for orthopaedic surgery.

Spinal anaesthesia is an effective method of delivering anaesthesia for primary total knee replacement. A regional technique has several benefits over an opioid based general anaesthetic (Fischer 2009) (Figure 1). Pre-medication and sedation is commonly used as an adjunct to create anxiolysis and reduce stress which could be provoked by being awake in the theatre environment. However, sedation is not without its disadvantages (Absalom & Adapa 2007) (Figure 2).

Anesthetic management of an obstetric patient with Charcot-Marie-Tooth disease: a case study.

Additional documentation of regional anesthesia in patients with Charcot-Marie-Tooth disease (CMT) is needed to guide practitioners and patients in exploring appropriate options for anesthesia and analgesia management. This case report describes the successful use of a combined spinal-epidural technique for labor progressing to cesarean delivery in a patient with CMT. Previous similar case reports were reviewed and an extensive literature search was conducted to organize the limited body of research regarding use of regional anesthesia in patients with CMT. Opinions regarding regional anesthesia in patients with neuromuscular diseases such as CMT are often contradictory and based on theory rather than documented practice. This case report confirms what seems to be the developing consensus in anesthesia that regional management is a safe alternative to general anesthesia in these patients. Considering that CMT is among the most common of hereditary neuromuscular diseases, it seems valid to establish a more research-driven recommendation for practice.

Spinal anesthesia in preterm infant undergoing herniorrhaphy.

Inguinal hernias are the most common diagnosis requiring surgical repair in children of all ages. Anesthetic management of premature infants is often difficult due to their comorbidities and propensity for apnea and bradycardia. General anesthesia has been shown to be associated with an increased incidence of postoperative adverse events. The purpose of this review is to determine the benefits and risks of spinal anesthesia in preterm infants undergoing herniorrhaphy. The use of spinal anesthesia in this population has been shown to decrease the incidence of postoperative adverse events.

[Thoracic paravertebral block]. / Thorakale Paravertebralblockade.

Thoracic paravertebral block for postoperative pain control has been introduced more than a century ago. It is currently gaining increasing popularity. This simple and safe technique can be used for postoperative analgesia, as well as sole anesthetic technique. When compared to epidural analgesia for postthoracotomy pain control, thoracic paravertebral analgesia provides comparable analgesic efficacy, but less side-effects. Regarding concomitant use of anticoagulants and antiplatelet drugs, paravertebral blockade is considered a central nerve block.

Spinal opioids in postoperative pain relief. 2: Adverse effects.

This is a two-part unit on using spinal opioids to manage postoperative pain. Part 1 outlined the pharmacology of spinal opioids. Part 2 discusses the selection of patients and their nursing care. It also focuses on the incidence of and response to adverse effects. For further information on contraindications, nursing care and patients' clinical requirements, see Portfolio Pages on nursingtimes.net.

The influence of spinal needle orientation during administration of subarachnoid blocks on discharge criteria in same-day surgical patients.

Cost containment is a critical factor in today's healthcare industry, so finding ways to decrease length of stay is essential in anesthesia practice. We rely on rapid induction, recovery, and discharge to control cost in outpatient surgery. Subarachnoid block (SAB) is an acceptable anesthetic choice for many outpatient procedures. It is often underused because it may result in delayed discharge. The purpose of this study was to determine if orientation of the spinal needle during administration of SAB affects the time required to meet discharge criteria in a same-day surgical unit. Patients undergoing surgical procedures deemed appropriate for short-acting lidocaine spinal anesthetic were recruited for this randomized, posttest, prospective study. All patients received a hyperbaric lidocaine spinal administered using a 25-gauge Whitacre needle. The needle was oriented in a cephalad (group A) or a lateral (group B) direction. Time to discharge was determined by calculating time elapsed between administration of the SAB and the time when the patient met discharge criteria. The statistical analysis included 50 patients (group A, n = 30; group B, n = 20). Demographics (except weight) were not statistically different between the groups. Total hospital time did not differ between the groups. Regardless of needle orientation, patients in both study groups achieved discharge criteria in similar amounts of time.

Staff development special: spinal anesthesia and analgesia.

When caring for a patient who's received drugs intrathecally, teach staff how to assess his condition, anticipate and recognize problems, and intervene correctly.

Evaluation of orthostatic blood pressure testing as a discharge criterion from PACU after spinal anesthesia.

Discharge readiness from a Phase I PACU after spinal anesthesia is frequently determined by recovery of sensory/motor function. However, no data exist indicating that recovery of sensory/motor function adequately predicts hemodynamic stability after spinal anesthesia. The conservative practice of waiting until the sensory/motor effects of spinal anesthesia have completely worn off often requires patients to remain in PACU for prolonged periods of time. The purpose of this study was to determine the safety and efficacy of using orthostatic blood pressure (BP) testing as a discharge criterion from PACU after spinal anesthesia. This study used a prospective, descriptive design to measure changes in mean arterial pressure (MAP) during orthostatic BP testing at 30-minute intervals after admission to the PACU following spinal anesthesia. A convenience sample of 121 patients admitted through the Same Day Surgery (SDS) unit was used. Results show that orthostatic BP criterion was safe and effective as an alternative to sensory/motor criteria in assessing hemodynamic stability and reducing the amount of time patients spend in the PACU after spinal anesthesia. This is a U.S. government work. There are no restrictions on its use.

Influence of Whitacre spinal needle orifice direction on the level of sensory blockade.

The purposes of the present study were to determine if the direction of the needle orifice during injection of anesthetic into the subarachnoid space, using a 25-gauge Whitacre spinal needle (Becton Dickinson, Franklin Lakes, NJ) to deliver 15 mg of 0.75% hyperbaric bupivacaine, affected the level of sensory blockade achieved, and if there was a difference in time from injection to surgical anesthesia based on needle orifice direction. A convenience sample was selected from patients presenting for elective surgical procedures. All patients received a standard anesthetic solution using a standard technique and duration of injection. Mean maximum height of sensory blockade was compared between treatment groups using a Student t test. Progression of the sensory blockade was compared at each data collection point using a chi-square test. There was no statistically significant difference in the mean maximum height of block between the treatment groups. The mean maximum height of block for the cephalad group was T4 with an SD of 2.5 dermatomes, and T5 with an SD of 4.57 dermatomes for the caudad group. An incidental finding was that all failed blocks were from the caudad group. There was no statistically significant difference in time from injection to surgical anesthesia between the treatment groups. Although the data support no statistically significant difference between the treatment groups for either research question, the cephalad group provides for a more precise height of block.

AANA Journal course: transient neurologic symptoms and spinal anesthesia.

A universal goal of anesthesia providers is to provide the safest, most effective anesthesia and analgesia for their patients. When reports emerge showing problems or complications with an agent or technique that previously was thought safe, recommendations often are adopted in anesthesia departments to avoid or abandon the agent or technique, or alternatives are sought. Hyperbaric 5% lidocaine has been an effective and safe spinal anesthetic agent for short procedures for years. During the past decade, controversy arose over its use because it was implicated as the cause of transient neurologic symptoms and cauda equina syndrome. Use of bupivacaine or tetracaine results in a much lower incidence, but these agents are not as well suited to brief or outpatient procedures as is the shorter acting lidocaine. Substantial research has been conducted detailing the search for reasons these complications occur and how to prevent them. A sample of the findings is summarized in an attempt to present current knowledge about the apparent causes and prevention of transient neurologic symptoms. There is promising research showing that safe and effective short-acting intrathecal anesthesia can be accomplished with procaine, prilocaine, meperidine, and sufentanil.