Anesthesia Essay
argumentative Essay
2071 words
A. Type of Anesthesia Although the comorbidities and type of surgery dictate certain decisions in managing patient care, anesthesiologists maintain various modalities for the perioperative period. These consist of anything from local to regional anesthesia, including neuraxial techniques and peripheral nerve blocks, as well as monitored anesthesia care with sedation to general anesthesia. Overlapping of different anesthetic types and combinations of regional analgesics to supplement general anesthesia occur frequently. Debate on the superiority of regional anesthesia to general anesthesia continues to date. Current literature does not support any difference in mortality between regional and general anesthesia. The largest randomized study to date highlighting this issue, the General Anesthesia Local Anesthesia (GALA) study group, demonstrated no significant difference amongst patients receiving local versus general anesthesia for carotid endarterectomy surgery45. Following that randomized clinical trial, a retrospective review of the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) reported similar results46. In another report from the ACS-NSQIP focusing on endovascular aortic repair, a lack of difference in mortality amongst local anesthesia, spinal anesthesia or general anesthesia emerged47. Moreover, meta-analyses of regional anesthesia versus general anesthesia for total hip arthroplasty and total knee arthroplasty revealed no difference in mortality.48, 49 Although there may be no difference in mortality, regional and local anesthesia offer other advantages compared to. sole general anesthesia. Such advantages may decrease morbidity associated with surgery and the patient’s existing medical st... ... middle of paper ... ... glucose measurements. Continuation into the immediate postoperative period remains important as well. Once in a steady state, treatment ought to be converted to a subcutaneous BBI regimen. For conversion from intravenous to subcutaneous insulin, a transition protocol should be employed 124. Many diabetic patients undergo minor surgery in an ambulatory care setting. Basal insulin management must occur as outlined above. However, no evidence exists that perioperative blood glucose control improves outcomes after one-day surgery. Thus, it is not advisable to use a perioperative insulin drip, even if blood glucose values exceed the recommended goal. In the event of an excessively high blood glucose level, deliberation for postponement of elective surgery should be given. The definition of a cutoff point for cancellation should be in consensus with a hospital policy.
In this essay, the author
- Explains that anesthesiologists maintain various modalities for the perioperative period, from local to regional anesthesia, including neuraxial techniques and peripheral nerve blocks, as well as monitored and sedated anesthetic care.
- Explains that current literature does not support any difference in mortality between regional and general anesthesia. the largest randomized study, the american college of surgeons national quality improvement program, reported similar results.
- Explains that regional and local anesthesia offer other advantages compared to sole general and may decrease morbidity associated with surgery and the patient’s existing medical status.
- Explains the controversy surrounding cancer recurrence rates and regional anesthesia. retrospective reviews determined that supplementation of general anesthetics with epidural or paravertebral blocks decreased cancer
- Explains that sqip considers normothermia a priority in the perioperative period.
- Explains that hypothermia leads to an increased rate of ssi through multiple mechanisms. it weakens the immune system through impaired leukocyte migration, neutrophil phagocytosis, and by reducing reactive oxygen intermediates.
- Explains that hypothermia results in coagulopathy, which leads to transfusion of blood products. platelets undergo morphologic changes that decrease the capacity to activate clot formation.
- Explains that perioperative hypothermia increases the risk of cardiac morbidity through increased catecholamine release, systemic vasoconstriction, shivering, and increased blood pressure. this effect is expected to be exaggerated in elderly patients.
- Explains that preventing hypothermia to less than 36°c decreases the risks of ssis, coagulopathy, prolonged recovery periods, and cardiac morbidity.
- Explains that the critical role of fluid management is another challenge for perioperative team members. multiple factors, including type and duration of surgery and anesthesia, impact the decisions in guiding fluid therapy.
- Argues that the debate on colloid versus crystalloid fluid therapy remains unresolved. the recent cochrane database reviews demonstrated no difference in the treatment of critically ill, trauma, burn and surgical patients.
- Explains that while the debate regarding fluid type continues, increased controversy surrounds the amount of fluids to be given within the perioperative period.
- Explains that some randomized controlled trials have been conducted to assess the benefit of perioperative supplemental oxygen therapy. the jury is still out about beneficial effects of hyperoxia.
- Explains that diabetes mellitus increases morbidity and mortality through multiple complications, including myocardial ischemia, retinopathy, autonomic and peripheral neuropathy, and nephropathy.
- Explains that long-term improvement of glycemic control reduces and delays the onset of diabetic complications.
- Recommends setting a target goal of 140 mg/dl in non-icu patients and between 140-180 mg in icu. all diabetic patients who are admitted to the hospital should receive bbi therapy.
- Recommends a transition protocol for diabetic patients undergoing major surgery, such as cardiac, vascular, or major abdominal surgery.
- Opines that perioperative blood glucose control does not improve outcomes after one-day surgery. deliberation for postponement of elective surgery should be given.
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- Regional Anaesthesia- Should We Be Keeping More Patients Awake?opinionated essayHu P, Harmon D, Frizelle H. Patient comfort during regional anesthesia. Journal of clinical anesthesia. 2007;19(1):67-74.
In this essay, the author
- Explains that the literature has shown that each to have their benefits but also disadvantages. several considerations should be taken into account, such as the co-morbidities of the patient.
- Explains regional anaesthesia (ra) is the loss of sensation of part of the body by the use of local anesthetics. ra is also indicated for analgesia or combined with a ga.
- Explains that the popularity of ra has varied since its discovery. indigenous south americans discovered the numbing effects of chewing coca leaves long before cocaine was isolated.
- Explains that regional anaesthesia can be provided by several techniques and requires extensive training in its provision. neuroaxial ra can also be used on peripheral nerves.
- Explains that ra has been proposed to reduce the risks of post-operative complications for many surgical procedures when compared to ga.
- Explains that ra avoids intubation and mechanical ventilation and the associated pneumonia risk is reduced. the benefits of having the patient awake can be exploited in procedures like carotid endarterectomy.
- Explains that ra has increased dramatically in recent years, but barriers exist to its widespread use, such as perceived delays to the surgery and an unpredictable success rate.
- Explains that rara is not without its own complications. post-dural puncture headaches are approximately 1% after epidural or spinal anaesthesia.
- Explains that hypotension is a recognised complication of ra. in spinal anaesthesia, the sympathetic nerves are blocked and vasodilation and venous pooling can result.
- Explains that permanent neurological injury is rare, but temporary injuries are more common. backache is also associated with neuroxial ra but the duration of the surgery irrespective of anaesthesia has been cited as the most important factor.
- Explains that adhesion arachnoiditis may occur several weeks or months safer the ra procedure. the spinal cord vasculature constricts over time due to the proliferation of the meninges.
- Explains that intraspinal haematoma is a rare adverse event associated with neuraxial blockade techniques. guidelines have been published to reduce this risk.
- Opines that patient preferences need to be considered in the choice between ra and ga. anaesthetists have a crucial role to play in educating patients.
- Recommends that the concerns of the patient be elicited prior to the procedure and appropriate terminology be used to explain.
- Recommends keeping medical remarks and conversations at a minimum, especially if could be open to misinterpretation by the patient. music has been shown to reduce sedative requirements.
- Opines that ra is standard practice in areas such as obstetrics and orthopaedics, but ga is still the normal practice. the evidence is mounting that it should be routine for more procedures.
- Explains the history and development of local anaesthesia oxford, uk: oxford university press. national office of clinical audit.
- Describes the recommendations of the american society of regional anesthesia and pain medicine and the european society. neuraxial blockade for the prevention of postoperative mortality
- Explains that dental injury associated with anesthesia: a report of 161,687 anesthetics given over 14 years.
- Explains that regional anesthesia improves outcome after total knee arthroplasty.
- Describes the costs of spinal versus general anaesthesia for fractured neck of femur surgery.
- Explains that evolving compartment syndrome not masked by a continuous peripheral nerve block: evidence-based case management. regional anesthesia and pain medicine.
- Explains the association of anaesthetists of great britain & ireland, regional anaesthesia uk, and webster f, bremner s, mccartney cjl.
1383 wordsRead More - Economic Analysis of Outpatient Care Centers vs. Hospitalsanalytical essayJohn B. Pollard, Ann L. Zboray, Richard I Mazze. The International Anesthesia Research Society. (1996).
In this essay, the author
- Analyzes the burgeoning of outpatient healthcare centers in the health services industry, stating that critics question whether the real benefits are for patients or simply as a mechanism to stuff physicians' wallets.
- Compares the costs of outpatient and inpatient clinics in palo alto, ca, and explains the economics behind the findings.
- Explains the benefits of shorter hospitalizations and outpatient clinics in a cost-benefit analysis conducted by the va palo alto health care system.
- Explains that the department for human and health services (hhs) has been monitoring the actions of doctors at outpatient clinics to curb unnecessary procedures and tests.
- Argues that the logical choice is to support the growth of outpatient clinics, as they allow for lower costs to patients, insurance companies, and medicare, while maintaining the profit motive for physicians and the centers.
- Analyzes the health aspect of outpatient clinics as a viable alternative to inpatient centers. outpatient visits rose by 27% in the first five years of the decade.
- Cites hearle, koenig, rudowitz, siegel, dobson, & ho, s., 2003, and martin, a.
- Explains that treatment programs in the department of veterans affairs. medical care research and review, vol.
- Cites harvey jay cohen, john r. feussner, morris weinberger, molly carnes, frank hsieh, philip lavori and john b. pollard.
1695 wordsRead More - Cardiovascular Deathexplanatory essay...mproved dramatically. Due to an aging population, increasing prevalence of cardiovascular disease, and expanding indications for AICD therapy, the number of patients with AICDs presenting for surgery will continue to rise. Areas of concern for the anesthesia provider with this patient population include preoperative device interrogation, perioperative reprogramming, disabling of the antitachydardia function, and post operative device interrogation. While there are currently no set standards in providing anesthesia care for this patient population, the result of this evidence based project demonstrate that patients with AICDs presenting for surgery can be safely cared for during the operative period. It is the responsibility of the anesthesia provider to be aware of the best evidence with regard to patients with AICDs in place that require anesthetic management.
In this essay, the author
- Explains that an automated implantable cardioverter defibrillator (aicd) in patients with lv systolic dysfunction significantly reduces overall mortality.
- Explains that the use of aicds in managing a diverse population of cardiac patients is increasing and that anesthesia providers are more likely to encounter these patients presenting for elective or emergency surgical procedures.
- Describes the pico format as an evidence-based approach to formulating clinical questions in a structured, specific way. the population of interest for the project included surgical patients with an aicd.
- Describes how the modified reader tool was used to conduct a rapid critical appraisal of the selected articles based on five main criteria: (1) relevance to the pico question; (2) relevant to general practice; (3) influence on behavior change; and (4) usefulness in practice.
- Explains that 8 articles were selected for further analysis and synthesis. six of them were single case reports, while two reported on multiple cases.
- Explains that two multiple case studies described cases in which the aicd was inadvertently deactivated after being exposed to magnetic fields in health care settings.
- Opines that due to an aging population, increasing prevalence of cardiovascular disease, and expanding indications for aicd therapy, the number of patients presenting for surgery will continue to rise.
- Explains that the pico question was categorized as a "prognosis/prediction" type of question.
- Explains that there are no published trials demonstrating the safest and most effective management principles for patients with aicds undergoing surgery.
1960 wordsRead More - Modifier 22 Research Paperexplanatory essayThis could be due to the particular patient's situation or to the type of medical procedure being done. If the surgeon uses a local anesthetic, no modifier is required. If the surgeon uses a general or regional anesthetic, Modifier 47 is used to distinguish this difference.
In this essay, the author
- Explains medical billing codes are used to communicate diagnosis and treatment of a patient to the patient's payer. they help the payer determine how much to pay the provider for services rendered.
- Explains that when a procedure takes longer than it should, the medical coder can use modifier 22 to indicate the extra work involved.
- Explains how modifier 26 allows the medical coder to separate the technician's work and use of testing equipment, from the services rendered by the physician interpreting the test results.
- Explains that some procedures require general or regional anesthetic, instead of a local, due to the patient's situation or the type of medical procedure being done.
- Explains that some patients get multiple medical procedures done during the same visit with a healthcare provider.
- Explains that if a patient experiences life-threatening situations, the surgeon or physician will likely terminate the procedure early. the medical coder can use modifier 53 to indicate the situation to the payer.
- Explains that some medical procedures require the services of two or more doctors. modifier 62 tells the payer that two different doctors will be billing for their services.
- Explains that if the patient is an infant weighing less than 9 pounds, the medical coder will use modifier 63 to indicate this situation.
- Explains that highly complex medical procedures may require the services of a surgical team, made up of doctors from multiple disciplines and the use of highly technical equipment.
- Explains that billing coders can use modifier 77 to indicate if a doctor has to repeat procedures done by another physician.
- Explains that if a patient is sent back to the operating room due to complications, the medical billing professional will indicate this with modifier 78. understanding the full set of modifiers is required for any coding professional.
590 wordsRead More - Paresthesiacomparative essayOne of several complications that may occur when giving a local anesthetic in the dental office is paresthesia. Paresthesia happens when there is a lingering sensation of tingling or feeling of numbness around the injection site after local anesthetic has been administered, metabolized, and should have worn off. It is caused by trauma to the nerve from the needle or the solution that is used. Most cases of paresthesia end within eight weeks but some can be permanent depending on the nerve damage (Malamed, 2004, pg.289). The purpose of this paper is to determine which anesthetic is safer to use in regards to causing mandibular paresthesia. Our PICO question is, in a patient receiving a mandibular block, will administering the local anesthetic septocaine compared to lidocaine increase the incidence of paresthesia?
In this essay, the author
- Explains that paresthesia occurs when there is a lingering sensation of tingling around the injection site after local anesthetic has been administered, metabolized, and should have worn off.
- Describes septocaine as a new local anesthetic in the dental field. it contains epinephrine and was first used in dentistry in 1976 in germany.
- Explains that the local anesthetic has a thiophene ring that allows septocaine to enter neurons when given in greater doses.
- Explains that lidocaine is a two percent formula with one to one hundred thousand epinephrine. nils löfgren synthesized it in 1943 and it began being marketed in 1948.
- Explains that there was no significant evidence of septociane having a higher rate of paresthesia when compared to lidocaine.
- Explains that septocaine has a higher numbing rate than lidocaine in areas that would normally be difficult to number. articaine anesthetizes the pulp, but it is not certain if its ability to diffuse or from the higher concentration.
- Explains that there are not many reports of septocaine overdose because the dentist is overly cautious because of its higher concentration or follows the strict protocol of using local anesthetic.
- Explains that there are not many sources that acknowledge septocaine having a higher rate for paresthesia, but there were studies done evaluating the frequency.
- Explains that paresthesia is an uncommon condition caused by injections. it usually involves a mandibular block or lingual nerve block.
- Concludes that the local anesthetic septocaine has the same incidence of causing paresthesia when a patient receieves mandibular block.
- Explains the efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial.
- States hawkins, j. m. (n.d.). articaine: efficacy and paresthesia in dental local anesthesia.
- Compares the injection pain of articaine and lidocaine in a primary intraligamentary injection administered with computer-controlled local anesthetic delivery system.
- Explains that articaine, a new local anesthetic for american dentists, will supercede lidocaine.
1231 wordsRead More - An Anesthetic Issueopinionated essayAnesthesiologists face many issues, one of the most important being drug shortages. These drug shortages are on some of the most vital anesthetics, those used on a daily basis. These shortages result in numerous problems not only for the physicians, but also for the patients because it creates different side effects and creates hazards in the hospitals. Although still developing, some solutions have risen that might help alleviate the drug shortages even though they are not as effective as expected.
In this essay, the author
- Explains that anesthesiologists face many issues, including drug shortages, which creates different side effects and hazards in the hospitals.
- Analyzes how the drug shortage has become so widespread that even the federal government is interested now.
- Explains that the biggest cause of drug shortages is difficulty in manufacturing, which can include the loss of staff or resources.
- Opines that drug shortages are harmful for physicians, patients, and hospitals.
- Explains that drug shortages cause delays or cancellations of surgeries, which are harmful to the patient. they also explain that different companies use different sizes and colors for their vials.
- Opines that the fda is making companies report with at least six months advance notice of a shortage. better communication between the manufacturers of the drugs, fda and the hospitals is another possible solution.
- Explains that the american association of nurse anesthetists (aana) is trying to get the fda to set up better regulations for the companies to adhere to.
1355 wordsRead More - Npo Status Case Summaryopinionated essay2. The patient has a history of Type 2 Diabetes that is controlled by 5 mg Metformin twice daily. Metformin should be stopped 24 hours before surgery and restarted only after kidney function is normal. Patient last dose was @ 1800 previous evening. Patient blood glucose level was 280 this morning. Surgeon needs to be notified of patients medical history and glucose reading.
In this essay, the author
- Opines that the patient should understand the surgical procedure explained by the surgeon. the nurse should clarify facts and expel myths.
- Opines that nurses should make sure the patient adhered to the npo after midnight order.
- Recommends that same-day surgery patients receive written and oral instructions about when to begin npo status. type 2 diabetes is controlled by 5 mg metformin twice daily.
- Recommends reducing stress and anxiety by teaching family members about procedures. patients with diabetes are at risk for venous thromboembolism due to age, obesity, hip fracture, and decreased mobility.
1065 wordsRead More - Personal Narrative: My Digestive Electrinal Ultrasoundexplanatory essayShe also knew that I was fully aware of my blood sugar being high again on the day of my surgery, (I think it was about 250). Just before surgery, one of the surgeons and the head anesthesiologist had even come to talk to me about it. They told me, they didn't want to delay surgery anymore, and that I would be given insulin intravenously during it, if thought necessary.
In this essay, the author
- Explains that an abdominal ultrasound detected a small amount of gallbladder sludge. in the months following that, my digestive symptoms increased and worsened, till they got to the point of being debilitating.
- Explains how they went to the er due to a ruptured eardrum, and their digestive symptoms increased and worsened, until they were debilitating.
- Explains that they got hypoglycemia every day of their hospital stay and was vigilant about testing. the nurses' delays in giving insulin were nothing but detrimental.
- Explains that they were not given the benicar because their blood pressure was not high. they were given intravenous levaquin for the liver infection.
2002 wordsRead More - Screen Diabetic Patientsopinionated essayThe insulin doses are separated into basal rates that keep the blood glucose level in a range between meals and overnight, bolus doses that cover meals high in carbohydrates and correction doses, it is important that patients know how often to change needles or catheters and that their injection site should be rotated. Controlling caloric and carbohydrate intake, management helps patients to learn to incorporate good dietary choices in their everyday life and oral antidiabetic medication to reduce the risk of hypoglycemic/ hyperglycemic in order to promote healthful weight loss and maintain glucose control.
In this essay, the author
- Explains that it is important to screen diabetic patients for neuropathic complications and refer them to specialists such as ophthalmology, podiatry, gastroenterology.
- Explains that untreated maternal diabetes can result in spontaneous abortion and increased neonatal mortality, and pregnant patients with type 1 diabetes mellitus have a higher rate of perinatal infant mortality and congenital anomalies.
- Explains that regular exercise and lifestyle changes help with diabetes management and lower blood glucose levels. physical activity also helps with other health conditions like blood pressure, high cholesterol, heart disease, sleep, stress, and the strengthening of bones and muscles.
- Explains the different types of injectable medications, including rapid-acting, intermediate acting, long acting and combination mixed insulins. the difference between these types is the onset or the length of time it takes before insulin reaches the bloodstream.
- Explains that insulin pumps deliver rapid or short-acting insulin daily through a catheter placed under the skin.
- Opines that patient education should include the relationships between nutrition, exercise, medications, and blood glucose levels, as well as the importance of foot, skin and dental care.
- Concludes diabetes mellitus is a complex disease that involves multifaceted therapies and treatments that begin with diagnosis and continue on throughout the lifetime of the disease.
782 wordsRead More - Nurse Anesthetist Ethical Issuesexplanatory essayWithout the care of the certified registered nurse anesthetist, the patient would not receive adequate anesthetic care during surgery. The importance of following policies, adhering to safety, and being aware of ethical issues are perspectives which contributes the quality care the certified registered nurse anesthetist can provide. There are many areas that can be explored further more in this role. Areas that could have been explored were patient satisfaction. Since anesthesia care is provided by the certified registered nurse anesthetist, how would the patients react knowing that the attending would not be with them throughout the entire procedure? What could have been explored further was whether or not the patients would be more receptive
In this essay, the author
- Explains the importance of following policies, adhering to safety, and being aware of ethical issues which contributes to the quality care the certified registered nurse anesthetist can provide.
401 wordsRead More