Reexamining traditional intraoperative fluid administration: evolving views in the age of goal-directed therapy.

Intraoperative volume administration has long been a topic of debate in the field of anesthesia. Only recently, however, has the conversation shifted to a discussion of appropriate intraoperative volume. A thorough review of the literature explores the history of today's widely accepted fluid administration equation and discusses possible explanations and consequences of iatrogenically induced hypervolemia. Current studies exploring various volume administration techniques are reviewed, as are emerging technologies available to help guide anesthesia providers with intraoperative fluid management.

Musicoterapia y anestesia locorregional en cirugía ortopédica / Therapy and regional anesthesia in orthopedic surgery

Objetivo. Valorar los efectos sedantes, intraoperatorios, de la musicoterapia en pacientes intervenidos de cirugía ortopédica con anestesia locorregional, en el Hospital Clínic i Provincial de Barcelona. Material y métodos. Estudio comparativo prospectivo sobre una muestra aleatoria de 110 pacientes, sometidos o no a musicoterapia. El grado de ansiedad se valoró con el Cuestionario STAIC (State-Trait Anxiety Inventory for Children). La aplicación de la música se hizo con un reproductor de MP3 y auriculares. Los datos recogidos se analizaron con el programa Excel. Para el estudio estadístico se ha utilizado el programa SPSS-18 y la prueba de Chi-cuadrado para verificar la hipótesis de si hay relación entre el nivel de tranquilidad y la musicoterapia. Resultados. Tras el análisis, los resultados de Chi-cuadrado fueron en el grupo de no sedación con/sin música de X2 = 2.01, p = 0.35, siendo el nivel de significación estadística de p < 0.05. Conclusiones. No se ha encontrado relación entre la audición o no de música y el nivel de tranquilidad del paciente. La mayoría de los pacientes recomiendan oír música en el quirófano a pesar de que no les molestan los sonidos del entorno (AU)

Objective. To evaluate the sedative effects, intra-operation, of music therapy in orthopedic surgery patients with locoregional anesthesia in the Hospital Clínic i Provincial of Barcelona. Equipment and methods. Prospective comparative study on a random sample of 110 patients undergoing or not music therapy. The degree of anxiety was assessed with the Questionnaire STAIC. The application of the music was done with a MP3 player and head-phones. The collected data were analyzed with Excel. For the statistical analysis we used the SPSS-18 software and Chi-square test to test the hypothesis of whether there was relationship between the level of peace and music therapy. Results. After the analysis, the results of Chi-square were in the group of no sedation with/without music X2 = 2.01, P = 0.35. The statistical significance level was p < 0.05. Conclusions. No relationship was found between hearing music or not and the patient’s comfort level. Most patients recommend listening to music in the operating room despite the sounds around do not bother them (AU)

The differences of anaesthetic care in paediatrics compared to adults.

In the study of holistic perspectives in perioperative care the following article focuses on the care required for paediatric patients through the perioperative period. This incorporates an understanding of the anatomical, physiological and pharmacological differences from adult practice, acknowledging the most important principles of patient safety. The planning, implementation, equipment adaptations and psychological challenges associated with this group will be discussed in relation to improving the overall perioperative experience.

Oxygen: the two-faced elixir of life.

Take a moment and consider our planet without oxygen. Imagine the earth some 2.5 billion years ago when oxygen first appeared as a waste product of early anaerobes. Oxygen, as we know it today, is essential for life. Abundant and relatively inexpensive to manufacture, oxygen has widespread use in industry and healthcare. Anesthesia providers routinely administer oxygen in concentrations exceeding that in ambient air to ensure clinical safety and to offset the predictable sequelae associated with patient, drug-related, and procedural factors. Understanding the history of this unique element is critical in evaluating the often contentious body of contemporary research that has illuminated its efficacy (as elixir) and its attendant complications (its "two-faced" nature). Of particular interest is its role in free radical formation as etiogenic in developing complications. Oxygen is a mainstay in the perioperative management of patients, but its administration should be guided by thoughtful and rational goal-directed outcomes to maximize efficacy and minimize complications associated with its use.

Healing pathways through energy work in the perianesthesia care setting.

Energy-medicine therapy such as healing touch is a powerful way to promote relaxation and enhance the healing process. Healing touch is a sacred healing art and a way of caring in which practitioners use their hands as channels to assess and balance the energy field that encircles the body in order to promote the innate ability to heal. A collection of energy-based treatment modalities are used to assess and treat the human energy system. The energy system that is life is influenced by healing touch, which is used extensively in the nursing profession. This energy-medicine therapy is used in all areas of nursing. This article discusses the concepts of healing touch, the human energy field, and applications of healing touch in professional practice in the perianesthesia setting.

Surgery, pain, and immune function.

Research findings have demonstrated that surgery negatively affects immune function. Pain also has deleterious effects on immune function. Most research in this area has been conducted on animals. Psychoneuroimmunology provides the framework for this article. Psychoneurological phenomena, such as stress, depression, and pain, can influence immune system functioning through neuroendocrine pathways. Biological and behavioral processes appear to be closely related and need to be jointly considered when planning and providing anesthesia care. The anesthesia planning process increasingly involves aggressive assessment and treatment of postoperative pain, which may benefit immune function.

The Arab Muslim client: implications for anesthesia.

The Arab Muslim client has unique cultural characteristics that should be incorporated into anesthetic care. In obtaining a preoperative assessment and consent, issues such as privacy, family roles, body language, group decision making, communication distances, and use of translators should be addressed. Intraoperatively, the need for modesty and the client's possible adherence to folk beliefs should also be recognized. Postoperatively, pain and overall needs assessments are a continuing challenge. The anesthetist must also understand the underlying family roles, the high correlation between fear and pain, and the possible coexisting folk beliefs when working within the labor and delivery setting. By addressing these unique issues, the anesthetist can provide appropriate and safe anesthetic care.

Hypnosis principles and applications: an adjunct to health care.

Hypnosis has existed since the beginning of humankind, and is a part of everyday life. It is a valuable addition to the methods and techniques available to all health care providers, as well as a safe and uncomplicated method used to enhance patient health care. It is simply a state of complete physical and mental relaxation which produces an altered state of consciousness acceptable to suggestions. It is characterized by an increased ability to produce desirable changes in habit patterns, motivation, self-image, lifestyle, and personal health.

Anesthesia alternatives for ophthalmic surgery.

1. Traditionally, local anesthesia has only been used in patients with coexisting diseases that jeopardize the safety of general anesthesia. Local anesthesia, however, provides a number of advantages that make it suitable for ophthalmic surgery of both the anterior and posterior segment. 2. Preoperative emotional and physical assessment and patient counseling is essential to the successful use of local anesthesia. 3. Anxiety that exists intraoperatively can be relieved by sedentary social diversions such as listening to music, handholding, and other holistic approaches. 4. Discomfort caused by draping can be eliminated by using a drapeholder that lifts the drapes away, providing the patient with a high flow of air.