Abstract This paper discusses manipulation under anesthesia for a chiropractic doctoral candidate in fulfillment of sports medicine advanced licensing. This paper discusses the efficacy of the technique, applicability to sports medicine, issues with insurance coverage and how although the technique has been in use for over 70 years, insurance companies still refuse coverage stating it is experimental. This paper also talks about learning the technique from a CCE accredited chiropractic college.
From the Paper "Manipulation Under Anesthesia (MUA) is a common technique for providing more rigorous manipulations in a pain free manner to effect muscular and spinal subluxation corrective treatments when all other modes aimed at effective pain management and or the revitalization of structural integrity have failed. MUA is particularly relevant to the field of Sports Medicine. Most athletes are conditioned to accept a high level of pain and develop a high pain threshold. When this high pain threshold is pitted against what a chiropractor, osteopath or other medical professional can do during the performance of manipulative therapy, unless the surrounding musculature is relaxed, although the athletic patient might not complain, his physiological constrictive musculature will give him away; causing even more difficulty in achieving the goals that the practitioner is trying to achieve. "
Abstract It is the goal of this paper to define anesthesia, describe its uses and origin; and, finally describe its effects on the auditory system. This paper will describe in detail such effects and studies proving amnesia or the existence of surgery memory in spite of the use of anesthesia.
This paper discusses the effects of spinal vs. general anesthesia on the projected outcome for patients undergoing transurethral resection of the prostate (TURP).
Abstract This paper explains that the majority of research indicates that anesthetic choice has little impact on the outcome of surgery for patients undergoing TURP and related procedures. The author points out that physicians should instead take into consideration the likelihood for increased overall morbidity and mortality rates in patients due to the nature of the surgery and increased likelihood that patients are coming into a procedure with increased complications prior to surgery. The paper states that general and spinal anesthesia both carry risks, and both carry adverse side effects; which side effects a patient is best equipped to handle should be the determining factor for the majority of patients undergoing TURP.
Table of Contents
Introduction
Literature Review
Implications to Practice
From the Paper "There is research indicating that adverse effects may result from anesthetic choice during prostatectomy, or at least evidence indicating that in general this procedure is more risky and likely to result in a greater likelihood for poor outcome. The Department of Urology at Freeman Hospital in Newcastle, UK conducted a study that examined complications and morbidity resulting from prostatectomy in 1400 men. The patients were examined for a period of 8 months, with patients undergoing TURP examined from 12 separate institutions. Data was collected related to "factors potentially affecting mortality and morbidity" which included the American Society of Anesthesiologists co-
morbidity scores. Complications post-surgery included 8% of patients developing sepsis, with a large percentage of patients having a "significantly increased rate of deaths and complications" and emergent situations requiring re-admission to the hospital . The study concluded that due to the increased likelihood of complications, which were seen across population groups of varying ages, it is essential that care providers further examine potential increased causes for morbidity rates after prostatectomy. The increased likelihood of complications was not directly tied to anesthetic technique, but this possibility was also not ruled out."
Abstract This paper examines how the field of nurse anesthesia would not be as advanced today but for the achievements of certain women in the field. One of these women was Alice McGaw, who worked tirelessly to perfect the specialty of nurse anesthetist. It looks at how it was her advancements in the application of open drop inhalation anesthetic that paved the way for others to follow. It also looks at how it was the showcasing of her methods to others that encouraged them to use what she had learned in their own practices.
From the Paper "Alice McGaw went on to publish five papers total on the subject of nurse anesthesia. The paper in 1906 published in Surgery, Gynecology and Obstetrics was titled "A Review of 14,000 Surgical Anesthetics". It noted that in the 14,000 surgical procedures for which she had been the anesthetist, there had been no complications or deaths attributed to problems with the anesthetic or its application. This was a milestone in the field of nursing anesthesia."
Abstract This paper explains that, in the early years, until the use of certified specialty nurse anesthetists, many patients died or had severe complications during and after surgery because the person administering the anesthesia had little training and the physician had to divide his attention between the anesthesia and the actual surgery. The author points out that Agatha Hodgins did much more than teach nurses how to administer anesthesia under combat conditions because she also looked to the future of the profession and where it could go. The paper relates that, in 1939, Agatha Hodgins established the American Association of Nurse Anesthetists, which lead to the first national certification exam in 1945 and continues today as Certified Registered Nurse Anesthetists (CRNA), professional licensed nurses who have extensive training in nurse anesthesia required after obtaining a Registered Nurse (RN) degree.
From the Paper "During World War I, Agatha Hodgins served in France from 1914 to 1915. It was during this time that she helped train physicians and nurses from France and England in the administration of anesthesia. At this time the United States had not yet entered the war. Thank to the efforts of Agatha Hodgins and those she trained, nurse anesthetists have been the primary anesthesia administrators in combat areas. This has been the case in every war the United States has fought since World War I."
Abstract This paper relates the accomplishments of Helen Lamb Frost, who revolutionized anesthesiology by establishing the School of Anesthesia in St. Louis, Missouri in 1921 (AANA, 2005). The author points out that School of Anesthesia (1) introduced a new organization to anesthesiology's medical and academic significance in the field of medicine, (2) assisted the emergence professional organization such as the American Association of Nurse Anesthetists or AANA and (3) developed the standards for using anesthesiology in the field of medicine. The paper stresses that Lamb 'humanized' anesthesiology as a science by Lamb, in order making it patients safer thus making them more receptive to the use of anesthesia before undergoing a crucial medical procedure or operation.
From the Paper "AANA's study on patient safety in the office setting is one such example. Hornsby, in his article entitled, "Anesthesia's New Frontier: Ensuring Patient Safety in the Office Setting," focused on introducing the new method of conducting "office-based surgery." This new concept is presented as a new way in which medical practitioners adapt to the changing lifestyles and environments that people find themselves in everyday. As in the case of most people who work inside offices, Hornsby and the AANA delved on the possibility of promoting safe "surgical and anesthesia care" in the office setting to people who find themselves unable to commit themselves to caring for their health and illnesses for fear of missing out on work."
Abstract The paper examines a case study article called "Dexmedetomidine As A Sole Sedating Agent With Local Anesthesia In A High-Risk Patient For Axillofemoral Bypass Graft: A Case Report" by J.M. Rich. The writer of this paper examines the key elements of the case study and discusses the findings. The paper explains how the use of Dexmedetomidine as a sedation agent with local anesthesia has gained popularity in recent years, particularity for high risk patients. The paper shows how the article illustrates the success of using it as an agent in conjunction with local anesthesia for intensive care patients. The paper is of the opinion that the article provides valuable, time sensitive and helpful information on a topic that is addressed frequently in hospitals today.
From the Paper "There are inherent risks of sedating patients, using mechanical ventilators. When those patients are facing major surgery that normally uses mechanical ventilators it is important to locate an effective sedating agent that can be used alone in conjunction with local anesthesia so the risk to the patient will be reduced.
"One common issue in conducting major surgery on a high risk patient using a mechanical ventilator is the fact that most sedating agents depress the respiratory system. With a high risk patient a ventilator, which depresses the respiratory system can create complications."
Abstract This paper contends that childbirth is a powerful rite of passage and that it has the potential to transform women in very deep ways when experienced fully, without the deadening effects of anesthesia, lack of privacy and misuse of medical technology. It describes the negative affects of epidural anesthesia and suggests alternative pain relief methods.
From the Paper "It may take a little of researching to reconcile own attitudes toward pain and your philosophy as to what type of birth experience you want. Epidural anesthesia uses some doses of a local anesthetic in the epidural space of the spinal area. It numbs the nerves from the uterus and birth passage without stopping labor. A successful epidural once administered gives you no-pain awake state throughout the entire labor and birth of your baby. Epidurals provide complete relief in 85% of women, partial relief in 12%, and 3%of women will get no relief at all from an epidural."
This paper analyzes the function, structure, environment and culture of the American Society of Perianesthesia Nurses (ASPAN), which was developed to assist the nursing specialty of anesthesia.
Abstract This paper explains that one growing nurse specialty is that specialty, which surrounds the use of anesthesia care, before during and after surgical procedures requiring anesthetization. The paper states that the American Society of Perianesthesia Nurses (ASPAN), affects the medical and medical consumer society through education and information. The author relates that the structure of ASPAN is relatively complex and consists of paid and unpaid members/employees.
Table of Contents
Introduction
Why Organization Exists
Community Interaction
Effect on Society
Organization's Effect on Social Change
Body
Type
Structure
Power and Outcomes
Leadership
Decision Making
Communications
Change
Environments and Relationship
Conclusion
Effectiveness
Theory
From the Paper "Though in general the profession of nursing and especially the focus on specialized nursing professions has increased its validity through a lengthy professional proving ground over the past century, there are still environmental challenges to the field. One challenge that is paramount at this time is the overall shortage of qualified nurses to fulfill staffing shortages all over the country. Some fears arise through the shortages about burnout, ethical dilemmas associated to poor patient care in understaffed conditions, all of which affect the general legal environment of the industry as it attempts to make ends meet safely."
Tags: care, surgery, education, information, members
Abstract The paper analyzes the article "Preventable Adverse Patient Outcomes", which states that since 1995 Certified Registered Nurse Anesthetists (CRNA) have been doing closed claim analyses on adverse anesthesia outcomes from cases supplied to them by insurance companies. The paper examines how, by doing this analysis, a board of eight certified nurse anesthetists found that of the cases they studied thirty-eight percent of CRNA-related claims involved a respiratory incident as the primary cause of the negative patient outcome. The paper discusses how, by attaining this information, the research assists in ensuring that hospitals, clinics and surgical centers are made safer.
From the Paper "The article also states that errors in clinical judgment and failure to adhere to standards of practice and/or recommended protocols also were identified as patterns in practitioner behavior that contributed to the negative outcomes. Also stated was the importance of identifying patients before the procedure, who might have a higher risk of aspiration."
Abstract This paper explains that some surgeons have suggested that cardio pulmonary bypass surgery in and of itself activates an inflammatory response that results in a stress reaction. The author points out that the role of the anesthesiologist in cardiac surgery is, as much as possible, to reduce the stress response that results form cardiac surgery. The paper relates that the stress response can be mitigated by a variety of anesthetic techniques, including use of opioids and epidural anesthesia.
Table of Contents
Introduction
Synopsis
Stages of Anesthesia for Cardiac Patients
Implications for Practice
From the Paper "The job of an anesthesiologist during a CBS procedure includes minimizing the autoimmune and stress response. Studies have shown that "greater fear or distress prior to surgery" is typically associated with slower and more complex and complicated post-operative recovery (Glaser, et. al, 1998). Stress response in fact delays healings. The body naturally perceives surgery as a "threatening" experience, and thus a variety of stress factors are involved in the surgical process (Glaser, et. al, 1998). Among these stress concerns include worries related to survival and recovery, as well as separation from family (Glaser, et. al, 1998); these factors are especially prevalent among cardiovascular patients, who face at bets long postoperative periods and "delicate" recovery prognosis."
Abstract This paper addresses the role of nurse anesthetists in administering anesthesia to patients, looking at their education and training as well as the care that they give to their patients.
From the Paper "It may be useful to begin with a definition of a certified registered nurse anesthetist. A nurse anesthetist must complete two to three years of a post-graduate program in anesthesia and have graduated from an accredited nurse anesthesia program. In addition she or he must have passed the national certification exam for nurse anesthetists.
Nurse anesthetists are qualified to administer any type of anesthesia that a patient may need during the course of treatment, including general anesthesia as well as spinal, epidural, regional, or local anesthesia. Certified registered nurse anesthetists now administer between 65% and 70% of the 26 million anesthetics given each year in the United States today. "
Tags: anesthetic, nurse, medical, treatment, care, health, patient
This paper discusses that elective surgical intervention in the population over age 50, once considered to be a risk, is coming under new consideration.
Abstract This paper explains that, today, chronological age alone is not a limitation for undergoing any type of anesthesia due to a greater emphasis on the study of gerontology, as well as a population that is increasingly health-conscious; there is also a greater emphasis on the prevention of long-term disability and disease earlier in life. The author points out that older individuals have complex metabolic and physiological changes, which require special consideration in pre-, peri- and post-operative management. The paper stresses that it is important to remember that not only do these patients require close physical monitoring, but also psychological issues, fear, and pain must be addressed to improve long-term survival rates and improve outcomes for patients.
From the Paper "Interestingly enough, more and more studies are being started that primarily investigate anesthetic practices in the elderly population. An interesting study performed at the Mayo Clinic actually followed the postoperative course of a group of patients over 100 years old who underwent both elective and emergency surgeries. The post-operative mortality rate was compared to that of similar patients with similar socioeconomic and physical conditions of the same age. It was found that these patients were more and more demonstrating that they were living productive and independent lives before they developed the disease or injury, which required the surgical intervention. It was felt that the risk of the age was not as significant as the impact of the indication for the surgery."
Abstract This paper explains that, historically, many great medical advancements, such as anesthesia and heart transplantation, were fiercely rejected by many bio-conservative moralists, but now have gained acceptance. The author points out that people who disagree with human cloning believe the idea runs contradictory to the evolutionary need to retain a basic level of genetic variety and the variety in nature created by God. The paper stresses that human cloning could lead to situations where a completely new form of genetic and psychological counseling would become a necessity.
From the Paper "A significant advantage suggested out of cloning is that it is a therapy for childlessness. The reasons for sterility are by genetic defects, wounds to the reproductive organs, hereditary defects and contact to poisonous material and waves. Sterile people can have an advanced possibility of success by human cloning. Many people are not sterile, as they cannot produce feasible gametes. For cloning technology a feasible sperm or egg is not required, any body cell will do. This technology will be able to avoid faulty gametes and permits sterile people to have their own biological children. By cloning technology, suicide, separation, clinical gloominess among sterile people can be stopped. The ideal gene treatment is likely by cloning technology, the real alteration or substitution of flawed gene series."
Abstract This paper discusses the basic pharmacology of anesthetic agents. Commonly-used anesthetics are examined briefly in the paper. The paper focuses on the use of volatile anesthetics that enter the circulation via the lungs. The paper contends that, although the general mechanism of action is similar among all anesthetics, one may be indicated for a particular case, but not another. Considerations for use should include subject medical history and presentation, length and depth of desired sedation, and potential side effects.
From the Paper "A variety of anesthetic techniques are available in clinical practice today for different surgical situations. A trained anesthetist decides the most appropriate method for each case and has the necessary skills to use the technique of choice. Volatile anesthetic agents are commonly used and have an important safety feature in that agents that enter the circulation via the lungs may leave by the same route. Thus, the concentration of anesthetic at the brain can be rapidly reduced as long as the patient is breathing adequately. General anesthetics are used to produce unconsciousness during surgery. Unlike local anesthetics that are used in dentistry and minor surgery, general anesthetics circulate throughout the body, which results in a stronger action on the nervous system and a greater potential for side effects."
