Opioid-Based Anesthesia and Analgesia for Adult Cardiac Surgery: History and Narrative Review of the Literature.

Opioids have played in a key role in cardiac anesthesia and analgesia since the early years of cardiac surgery. Today, opioids continue to be the primary mode for analgesia in cardiac surgery, yet there is considerable variability in the choice, dose and route of used. A history of the use of opioids in cardiothoracic anesthesia is presented, followed by an examination of the differences among current opioids in use and of outcome variables important in cardiac anesthesia, such as postoperative analgesia, extubation times, fast-track cardiac anesthesia, chronic neuropathic pain, and cardioprotection. Topical issues such as the role of perioperative opioid use in the global opioid crisis, opioid-sparing techniques and novel opioids in development are also discussed.

Repair of atrioventricular disruption after mitral valve replacement utilizing commando procedure principles.

Atrioventricular rupture is a life-threatening complication of mitral valve replacement. We present how incising the intervalvular fibrosa critically improves exposure. The aortic valve sacrifice allows access to a large atrioventricular dissociation defect and reliable repair of the anterolateral aspect of mitral valve annulus.

Supraglottic airway devices: current and future uses.

Supraglottic airway devices have increasingly been used in anaesthesia since their invention in 1982. Now over half of general anaesthetic cases in the UK use them, and they have vital roles in difficult airway algorithms, pre-hospital use and emergency medicine. This article presents the current evidence regarding the complications of these devices, and compares these devices and endotracheal intubation. The technology of the newer generation devices has improved the safety profile, and they may be considered a better choice than endotracheal tubes in some cases. There may be a case for using these devices in a wider range of surgical and non-surgical cases.

New graduate nurses adaptation to shift work: can we help?

Shift work's desynchronisation of physiologically determined circadian rhythms has a major effect on the psychobiology of every shift worker. It is also commonly perceived that the effects of shift work contribute to the current New Graduate Nurses (NGNs) attrition rate. NGNs must also adjust to work within the health care system as they adapt to shift work, but do the initial effects of shift work as experienced by NGNs get better with time? This study aimed to describe the adaptation of NGNs to shiftwork. Levels of general health, sleep, fatigue, circadian type, job satisfaction, levels of burnout and the coping processes of 150 final year undergraduate students were investigated in a questionnaire based longitudinal study conducted over their initial twelve months of clinical practice as NGNs. Correlational analysis indicates that whilst shift work initially seriously disturbs sleep and other variables associated with individual and situational differences some adaptation was evident by twelve months. Social dysfunction scores (GHQ28) remained significantly related with variables associated with burnout, job satisfaction, sleep disturbance and life disruption at the twelve month point. The presence of depression on pre-shift work scales was also significantly related to continuing experience of sleep disruption and increased levels of emotional exhaustion throughout the twelve month period. Further investigation is required to establish the effect of shiftwork on outcome measures such as levels of burnout and job satisfaction for NGNs. However, although it is possible that improved preparation for shift work may assist the adaptation of NGNs to shift work during their first year of practice it is clear that attention to the organisation of nursing shift work would also be timely.