Only a whisper away. A philosophical view of the awake patient's situation during regional anaesthetics and surgery.

In this study the awake patient's intraoperative situation and experiences during regional anaesthetics and surgery are reflected upon by using the work of the French philosopher Maurice Merleau-Ponty. Merleau-Ponty's phenomenological idea of the body as being at the centre of the world highlights the patient's embodied position and bestows significance onto the body as a whole, as a lived body. A case, based on the findings from a previous interview study, is presented as a contextual starting point where a patient goes from having a familiar body recognized as her own to having a partially anaesthetized body experienced as an unknown object. The intraoperative caring space is described in this context as the mutual ground where the awake patient and the nurse anaesthetist (NA) can interact to create meaning. The NA can act as the patient's bodily extension to bridge the gap between the patient's experiences and the situation. This calls for the NA's proximity and genuine presence in order to meet and understand the patient's awake experiences. Learning from the patient's situatedness gives information that is valuable for NAs to share with patients who are less experienced with this contextual situation. The challenge for the NA is not to perform routine-based care, but to acknowledge every patient's lifeworld and uniqueness thus enabling the patient to move easily along the mind-body-world continuum. The core of intraoperative care is to provide support and promote well-being of awake patients in the intraoperative environment. The use of a philosophical perspective is relevant for nurses who work in an intraoperative setting where patients undergo regional anaesthetics. This study shows how nursing research using phenomenological philosophy can help uncover new meanings known only to the patients living the experience.

Regional anaesthesia: back to basics.

Regional anaesthesia has become more popular in recent years with an emphasis on cost effectiveness, bed occupancy, and reduction in hospital acquired infections (HAls). Anaesthesia is a worrying time for any patient, but now the emphasis is to encourage patient empowerment by involving patients in their own care throughout their holistic journey. This article explores patient selection for regional anaesthesia, and the different types of central and peripheral blocks in line with national policies. The equipment required, pharmacology, toxicity of local anaesthetics, and their physiological effects on the cardiovascular, respiratory, and gastrointestinal systems of the body will also be discussed.

[Nursing basics in anesthesia: material to carry out regional anesthesia technics]. / Material para la anestesia regional.

Nursing career tend to specialize more each time in the different specialties, for this reason the introduction of the specialist nurse in anaesthesia required a specific knowledge on this medical discipline. The evolution of technologies applied to the design of new needles, echography machines and other equipment for regional anaesthesia techniques make essential to update of our knowledge in this area. This piece of work pretend to show the readers (nurses working in anaesthesia and others practitioners involved in surgical areas or pain management) a current view about the material and other instruments, mostly used in the different types of nerve blocks in regional anaesthesia. The aim of this, is provided an easy introduction of the regional anaesthesia to the junior practitioners, and updated evidence to the senior practitioner. The work is structured in a classic way: introduction, central blocks (subarachnoid and epidural), peripheral blocks, regional intravenous anaesthesia, eye block, asepsis and conclusions.

Material para la anestesia regional / Nursing basics in anesthesia: material to carry out. Regional anesthesia technics

Enfermería tiende a una gran especialización en las distintas áreas asistenciales; por este motivo, la introducción de la figura de la enfermera de anestesia obliga a un conocimiento específico de todo cuanto influya en esta disciplina. La continua evolución de la tecnología aplicada al diseño de nuevas agujas, ecógrafos u otro tipo de aparataje para la realización de técnicas anestésicas regionales, hace imprescindible la actualización de nuestros conocimientos en este campo. Este artículo pretende mostrar al lector interesado (enfermeras que se dedican al campo de la anestesiología y profesionales que pueden verse vinculados en áreas quirúrgicas o de dolor) una visión actual sobre el material y otro aparataje que más se utiliza en la realización de los distintos tipos de bloqueos nerviosos en anestesia regional; siendo su objetivo proporcionar a quien se inicia en esta disciplina una herramienta útil y rápida de introducción a la anestesia regional, y a los profesionales más expertos una actualización contrastada. El trabajo se estructura de forma clásica: introducción, bloqueos centrales (subaracnoideo y epidural), blo-queos periféricos, anestesia regional intravenosa, bloqueo del ojo, asepsia y conclusiones(AU)

Nursing career tend to specialize more each time in the different specialties, for this reason the introduction of the specialist nurse in anaesthesia required a specific knowledge on this medical discipline. The evolution of technologies applied to the design of new needles, echography machines and other equipment for regional anaesthesia techniques make essential to update of our knowledge in this area. This piece of work pretend to show the readers (nurses working in anaesthesia and others practitioners involved in surgical areas or pain management) a current view about the material and other instruments, mostly used in the different types of nerve blocks in regional anaesthesia. The aim of this, is provided an easy introduction of the regional anaesthesia to the junior practitioners, and updated evidence to the senior practitioner. The work is structured in a classic way: introduction, central blocks (subarachnoid and epidural), peripheral blocks, regional intravenous anaesthesia, eye block, asepsis and conclusions(AU)

Evidence-based anesthesia: fever of unknown origin in parturients and neuraxial anesthesia.

The safety of neuraxial analgesia in febrile patients is controversial. We performed an evidenced-based project in an effort to establish a guideline for our active obstetric clinical practice. Neuraxial anesthesia is generally safe for parturients, and complications are rare; however, serious adverse outcomes can result. Because of the devastating nature of the morbidity, the decision to proceed with a neuraxial anesthetic in the face of infection may be contentious. Fever and sepsis are considered relative contraindications to regional anesthesia; however, epidural anesthesia is a superior method of management of pain during labor. One must also consider that 30% to 40% of patients with chorioamnionitis require cesarean delivery. Because of the increased morbidity and mortality of general anesthesia in this population, it may be reasonable to proceed with regional anesthesia. Based on a review of the literature, it is difficult to estimate the risk of an infrequently occurring event. We recommend evaluation of each individual to determine the risks and benefits of the anesthetic. However, it is prudent to administer antibiotics before the regional anesthetic and adhere to strict aseptic technique. Postprocedure monitoring is essential for early detection and treatment of complications.

Obstetric anesthesia: changes and choices.

This article is a review of analgesics and anesthetics offered to laboring women, including intravenous drugs, epidural and spinal agents, and inhalational anesthetics. An overview of the uses, risks, and benefits is provided for each anesthetic alternative. To provide the most effective care to women in labor, clinicians have a responsibility to have current knowledge of the best evidence for safety and efficacy of these pharmacologic agents and techniques and be able to effectively communicate this information to clients.

Evaluation of ASPAN's preoperative patient teaching videos on general, regional, and minimum alveolar concentration/conscious sedation anesthesia.

This descriptive study was undertaken as part of a clinical improvement effort by the ASPAN Research and Education Committees to evaluate adult patients' perception of and satisfaction with the ASPAN Preoperative Patient Teaching videotape on general, regional, and minimum alveolar concentration (MAC)/conscious sedation anesthesia. Research findings on the use of videotapes for preoperative education are mixed. Some studies have reported that the use of videotapes increases knowledge and decreases anxiety, whereas other studies have shown a minimal effect on knowledge and anxiety. A convenience sample of 96 adult patients was chosen from those who were scheduled for surgeries with the above anesthesia techniques in 11 US hospitals and/or surgical centers within 4 ASPAN regional boundaries. Patients viewed the videotape the day(s) before surgery and then completed ASPAN's Preoperative Anesthesia Patient Teaching Questionnaire to measure patient perception and satisfaction. Sixty percent of the patients were women, and 50% had a college degree or higher. The average age of the patients was 51 (+/-17.2). Overall satisfaction scores had a potential range of 10 to 40, with higher scores indicating greater satisfaction. The mean satisfaction score for this study was 35 (+/-6.6). No significant relationships were found between satisfaction with the videotape and age, gender, or educational level. Patients were asked to rank each of 4 teaching methods. Among the choices of individualized instruction, written materials, Internet-based instruction, and videotape, the videotape method was ranked as most preferred. The information obtained from this study will be used to modify and improve the content of the patient education videotape produced by ASPAN.

A qualitative study of the perceptions of Hong Kong Chinese women during caesarean section under regional anaesthesia.

AIM: to explore Hong Kong Chinese women's experiences and perceptions of elective caesarean section performed under regional anaesthesia. DESIGN: an exploratory study using a qualitative approach. Data were collected by tape-recorded in-depth interviews two to five days after caesarean section. PARTICIPANTS: a purposive sample of 18 Hong Kong Chinese women having an uncomplicated, elective caesarean section under successful regional anaesthesia. SETTING: a post-caesarean ward of a University affiliated District General Hospital in Hong Kong. KEY FINDINGS: the three categories relating to the overall theme of Consciousness during Surgery were: Interacting with others, Experience of birthing, and Awareness of the environment. IMPLICATIONS FOR PRACTICE: the experiences of women, related to the general theme and categories cited above, affected their feelings of security and fulfillment. On the whole, women were satisfied with the regional anaesthesia, preferring to remain conscious throughout the surgery. They appreciated being able to interact with others and listening to music, but needed information regarding what was happening. Many were distressed by the sight and noise of surgical instruments, the narrowness of the operating table, the operating theatre lamps and the coldness of the theatre. Recommendations for practice are made relating to these issues.

Back to basics in anaesthesia.

This is the last in the Back to Basics series of articles--for now at least. I would like to thank all the authors for their pieces. I've learnt and relearnt from each of them. The completed set of articles will be available as one document in October, and will be launched at Congress--yet another reason to attend! Bye for now.