John Martin, CRNA, manages the anesthetic of a patient while he keeps track of blood loss and runs a cell salvage machine at Oklahoma Surgical Hospital in Tulsa, Oklahoma. The patient, located to the left and not visible in the photo, is undergoing back surgery with spinal fusion and instrumentation. “All of the CRNAs that I work with learn to operate the ‘cell saver,’ and we have all had several inservices to keep us up to date,” said Martin. (Photo taken by Janis Thomas, CST.)
Dexmedetomidine: A Useful Adjunct to Consider in Some High–Risk Situations Dexmedetomidine is a relatively selective α2 agonist with sympatholytic, sedative, amnestic, and analgesic properties. It is indicated for the short–term sedation of patients needing mechanical ventilation in the intensive care unit. This article provides a comprehensive review of the pharmacology, pharmacokinetics, and adverse effects of dexmedetomidine. A thorough understanding of this drug will enable the anesthesia provider to determine situations in which dexmedetomidine may be a useful drug to consider, whether as an adjunct or as a sole agent.
The Efficacy of Ketorolac as an Adjunct to the Bier Block for Controlling Postoperative Pain Following Nontraumatic Hand and Wrist SurgeryResearch indicates that using a combination of ketorolac and lidocaine in the administration of a Bier block results in significant postoperative analgesia and decreased inflammation; however, the optimal dose of ketorolac to coadminister with the local anesthetic has not been established. This study was performed to determine if a 20-mg dose of ketorolac is effective in providing prolonged postoperative analgesia without adverse effects. Based on the results of this study, the authors recommend that 20 mg ketorolac be considered in intravenous regional anesthesia.
Masseter Muscle Rigidity, Elevated Creatine Kinase, and Rhabdomyolysis Following Succinylcholine Administration: A Case ReportIn this case report, the author details the onset of masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis following a sevoflurane mask induction and succinylcholine administration in a 12-year-old boy. The patient had no family or personal history of neuromuscular disease or malignant hyperthermia. Hyperkalemia, metabolic acidosis, and rhabdomyolysis occurred within 75 minutes of masseter muscle rigidity. Masseter muscle rigidity, elevated creatine kinase levels, and rhabdomyolysis are discussed in this article.
AANA Journal Course: Update for Nurse Anesthetists—Part 4—Gender Differences in Pain: Does X = Y?Increasing evidence suggests that men and women differ in their responses to pain. The aims of this course are to update anesthesia providers about the differences between genders in pain sensitivity and treatment and to elucidate the complex aspects of the biology of such differences. Included are the history of female participation in pharmacological testing, psychological factors in pain, the role of gonadal hormones in pain, pregnancy, gender differences in opioid analgesia and postoperative pain, and gender influence on minimum alveolar concentration.
Keywords: Analgesia, gender, pain.
Version: 2008;76(5):355-359.Authors: Matthew Toomey, CRNA, MSNA