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."
Abstract In this article, the writer notes that the roots of modern anesthetics may be traced back to the 19th century, with the successful isolation of cocaine from coca leaves. The writer points out that one type of amino amide that is far less toxic than cocaine is bupivacaine, which was eventually synthesized in 1963. The writer maintains that the long-lasting anesthetic effects provided by bupivacaine have been shown to cause cardiovascular toxicity at relatively low serum levels that are approximately the same as levels that cause toxicity in the central nervous system. The writer then discusses issues related to toxicity caused by the bupivacaine including reactions, prevention and resuscitation techniques. The writer concludes that the research supports possible clinical interventions using lipid infusion in the treatment of cardiac toxicity due to exposure to bupivacaine.
Outline:
The Development and Use of Bupivacaine
Toxic Reactions Associated with Bupivacaine
Case Studies Detailing Toxicity Associated with Bupivacaine
The Prevention of Bupivacaine-induced Toxicity
Bupivacaine and Positive Cardiovascular Effects?
Resuscitation Techniques Following Bupivacaine Intoxication
Lipid Infusion as Resuscitation for Bupivacaine Toxicity
From the Paper "Overall, bupivacaine is considered to be among anesthetic agents that are more likely to cause states of cardiotoxicity. In animal studies, bupivacaine was demonstrated to be four to sixteen times more likely to cause cadiovacular toxicity than lidocaine. However, bupivacaine will continue to remain as a primary local anesthetic agent used by clinicians, which indicates a need for knowledge and awareness as to how to most effectively treat toxicity when it arises."
"Clinicians must adhere to proper dosages of anesthetics and correct sites of administration in order to reduce chances of the occurrence of toxicity. More recently, research has yielded the development of anesthetic agents that have reduced toxicity in comparison to bupivacaine."
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 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 Cocaine is an effective topical anesthetic and it provides significant blood flow stimulation. Cocaine hydrochloride is a fine white powder derived from the leaves of the plant Erythroxylon coca. "Coca" comes from the Aymara word "khoka" meaning "the tree". The Spaniard's adopted the practice of chewing coca leaves after conquering Peru in the 16th century. There are many different nations that continue to use coca and cocaine actively within the indigenous medical cultures. Cocaine provides benefit to the body and the spirit.
Abstract This paper explains that most people know Dr. Sigmund Freud as the "father of psychiatry" and associate him with the famous "Oedipus Complex", but very few know that, before making his discoveries about the workings of the human mind and personality, he was a physical scientist, who first used cocaine as an anesthetic during eye surgery. The author points out that Freud, believing one's gender played a very large role in the development of one's personality and mind, was the first physician to treat mentally and emotionally disturbed patients humanely. The paper states that, although Freud's methodology seems to have gone out of style, Freud's granddaughter, also a psychiatrist, believes that the core of Freud's thinking reflects, in many ways, pioneering postmodern insights compatible with current cognitive and constructivist ideas and neurophysiological brain research.
Table of Contents
Early Life
From Fear to Modernity
Same Stuff, Different Day
A Man for our Times?
Time's Up
From the Paper "There were other components to his belief system, of course, often connected to boys? fears concerning their private parts. Girls were supposed to envy their brothers and fathers, something Freud connected to their differing gender-specific physical equipment, but which"looking back at how badly society in Victorian times oppressed women"might well have been a rational reaction on the part of those girls and women. They saw that they could not achieve what men did. Freud attributed that to anatomy; these days, we would attribute it to the expectations of society."
Abstract The history of surgery involves the discovery and evolution of medical technology, concepts, and systems, which have their origins dating back thousands of years. This paper shows that while the early considerations of supernatural methods of healing were the standard for the time, work by Hippocrates, Galen, Louis Pasteur, and Joseph Lister helped transform medicine into an implementable science. The course of surgical history involved little change for many centuries, but with the industrial revolutions following the Renaissance, significant developments in aseptic technique for surgical sterility, methods of anesthetic administration, the instruments and computerized technology used in surgery, and the surgical methods themselves have provided modern day patients with innovative systems of surgical treatments that optimize safety and comfort. The paper comments that considering how far medicine and surgical advancements have come, it is unfathomable what the future of surgery holds in store for us.
From the Paper "In 1867, Joseph Lister, a medical doctor and professor of surgery at Edinburgh in London, determined that methods of scrupulous cleanliness should be followed during a surgical procedure. He employed the use of carbolic or phenic acid in a dressing to destroy the "floating particles" discovered by Pasteur. Carbolic acid is a volatile organic compound with destructive properties, capable of eliminating lower microbes, which, at the time, was the most powerful form of antiseptic known. Previous to the use of antiseptics it was thought that the inflammatory influences on tissue, coupled with blood decomposition at the site, were the factors motivating tissue decomposition. Thus, eliminating bacteria at the wound or surgical site through the use of antiseptics proved to rule out both the air-exposure theory and the inflammatory tissue consideration."
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 Around the globe, animals are utilized to test products ranging from shampoo to new cancer drugs. Each and every short of medication applied is first tested on the animals. Animals were also applied to develop anesthetics to alleviate human ailments and suffering during surgery. The paper shows that, currently, questions have been raised about the ethics of this usage. Several regulations have been devised and legislated to evaluate and control the application animals in all fields of studies, with the objective of ensuring that such research is carried out in a humanely and ethical manner. The paper show that acceptance of such experimentation is subject to heavy debate.
Paper Outline:
Introduction
Arguments for Testing
Arguments against Testing
My Stance (Author's Point of View)
Conclusion
Works Cited
From the Paper "Government and humanitarian agencies have financed researches into the substitutive strategies since the 1960s. (Animal Experiments) Revlon Cosmetics was considered premier in this line to finance research studies for substitutions with a grant of $750,000 to the Rockefeller University in 1979. Several agencies like the John Hopkins Center for the Alternatives to Animal testing - CAAT, the International Foundation for Ethical Research, the Cosmetic, Toiletry and Fragrance Association, and the Soap and Detergent Association followed the trend and initiated their own projects in justifying the alternatives. (Animal Testing Alternatives) During the last 15 years, Germany has granted about ?4.2 million per annum in research grants, while the annual expenditure of Netherlands in this regard is ?1.4 million."
Abstract This paper explains that advanced practice nurse are registered nurses including nurse practitioners, nurse-midwifes, nurse anesthetists and clinical nurse specialists, who hold authorization from a board to practice, based on the completion of a recognized advanced educational program. The author points out that core competency of advanced practice nurses include the application and adaptation of advanced skills in unstable and complex environments, the ability to apply advanced clinical reasoning including the use of advanced complete assessment, the acceptance of referrals and consultation from other health care professionals and team work with other health care providers. The paper relates that an advanced practice nurse is supposed to diagnose a patient and recognize the underlying problem and then provide adequate treatment, which includes the prescription of medicines as well as administering anesthetics.
Table of Contents
Introduction
Definition
Core Competencies
Scope of Practice
From the Paper "Further, their nature of practice further includes research work and the utilization of research within the scope of their practice. They are allowed to admit patients to hospitals and the authority to refer patients to other healthcare professionals like licensed physicians and dentists. Additionally an advanced practice nurse also gives consulting services to other healthcare providers. They have professional autonomy and independent practice which also includes management. Moreover they are to manage the physical and mental illness status of the patient with regard to nursing care."
Abstract This paper discusses the role of ketamine as a smooth muscle relaxant and antihistamine, which, along with its anesthetic effects proves useful in the treatment of asthma. The paper highlights case studies performed on effectivity along with commenting on the need to exercise caution with asthmatic patients who have co-morbid cardiac disorders.
From the Paper "Nosworthy (1999) states that Ketamine is the induction agent most likely to be chosen when an asthmatic patient requires endotrachial intubation, providing marked patient improvement, possibly due to Ketamine's smooth muscle relaxant and antihistamine effects. Long (2003) tells us that Ketamine is often used as a method of managing bronchial spasms associated with asthma. Galbis-Reig and Rasansky (2004) presented the case of a 47-year-old male asthmatic with co-morbid depression and chronic obstructive pulmonary disease (COPD) presenting to the Emergency Department (ED) with dyspnea and cough that was successfully treated with Ketamine. The patient had been using his albuterol inhaler without significant improvement prior to arriving at the ED, still smoked a pack of cigarettes a day and was taking azmacort, combivent, sertraline and methocarbamol as prescribed (Galbis-Reig & Rasansky, 2004)."
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 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 The paper discusses an unsuccessful product, a dissociative anesthetic referred to as phencyclidine or PCP, introduced by Parke Davis Laboratories, which has now been classified as an illegal drug. The paper discusses its addictive effect, how it is abused and it's mode of action. The paper follows by explaining the patterns used by drug abusers, starting with experimentation and leading to daily dependence. The paper concludes by discussing rehabilitation programs.
From the Paper "They consist of behavior modification methods, aimed at getting the user to recognize his behavior. They also include counseling for both the user and his family, held individually and as a group. The programs are usually long-standing and persist long after the user is released from the facility. These programs are also designed to provide peer support. Drug addiction must be understood as a serious and complicated condition, which calls for collaborative physiological and psychological treatment and support."
