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- Anesthesia (5)
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- Perioperative (2)
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- Anxiety (1)
- Aortic stenosis (1)
- BIS (1)
- BIS monitor (1)
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- Blood Glucose (1)
- Cardiac Surgery (1)
- Cardiac surgery (1)
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- Deep Vein Thrombosis (1)
- Dexmedetomidine (1)
- ERAS (1)
- Early Mobilization (1)
- Enhanced Recovery After Surgery (1)
- Erector spinae plane block (1)
- Evidence-based practice (1)
- Guidelines (1)
- Heart Rate (1)
- Hyperglycemia (1)
- Intraoperative management (1)
- Invasive Ventilation Time (1)
- Labor (1)
- Length of Stay (1)
- Major adverse cardiac event (1)
Articles 1 - 13 of 13
Full-Text Articles in Medicine and Health Sciences
Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda
Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda
Doctor of Nursing Practice Scholarly Projects
Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …
Final Scholarly Project: Evidence-Based Practice Guidelines For The Perioperative Management Of Blood Glucose Levels In The Cardiac Surgery Patient, Chelsey Benner
Doctor of Nursing Practice Scholarly Projects
Cardiovascular disease is the leading cause of mortality worldwide, necessitating a high demand for cardiac surgery. A unique stressor for cardiac surgery is an increased surgical stress response involving hyperglycemia. Perioperative hyperglycemia contributes to adverse postoperative outcomes following cardiac surgery. Current evidence examines blood glucose control and its effect on adverse postoperative outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit. Despite the link between hyperglycemia and poor postoperative outcomes, most facilities lack standardized guidelines for the perioperative management of blood glucose levels in cardiac surgery patients. …
Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison
Development Of Clinical Practice Guidelines For Incorporating Paravertebral Blockade For Thoracic Surgery Adult Patients, India Hutchison
Doctor of Nursing Practice Scholarly Projects
Thoracic surgery is considered one of the most painful surgical procedures due to its severity and the duration of the procedure. Pain is detrimental to the patient experience, and poor patient satisfaction results in revenue loss for hospitals. Maintaining adequate pain control after surgery is crucial in preventing pulmonary complications such as atelectasis and respiratory failure that prolong patient recovery. It is the responsibility of the anesthesia provider to ensure adequate pain control throughout the perioperative experience. Although current evidence-based data shows that regional anesthesia provides superior thoracic postoperative pain control, the current practice continues to be the utilization of …
Development Of Evidence-Based Practice Guidelines For Utilizing Erector Spinae Plane Blockade For Patients Undergoing Cardiac Surgery, Gabrielle Metoyer
Development Of Evidence-Based Practice Guidelines For Utilizing Erector Spinae Plane Blockade For Patients Undergoing Cardiac Surgery, Gabrielle Metoyer
Doctor of Nursing Practice Scholarly Projects
In the United States, the aging population and high rates of cardiovascular disease leads to increased cardiothoracic surgeries. Analgesia for cardiac surgeries often involves high-dose opioids. However, with an ever-increasing opioid epidemic and adverse effects on the postoperative healing process, recent literature seeks to decrease opioid consumption by utilizing alternative methods of analgesia. The American Association of Nurse Anesthetists recommends the use of regional anesthesia techniques to reduce the incidence of undertreated postoperative pain that can occur from opioid-sparing methods of analgesia. This project aims to create an evidence-based analgesia guideline for adult patients undergoing cardiac surgery. Interventions will include …
Final Scholarly Project: The Administration Of Transversus Abdominis Plane Blocks In Patients Undergoing Anesthesia For Open Ventral Hernia Repairs, Brennon Pinion
Doctor of Nursing Practice Scholarly Projects
Ventral hernia repairs are the only definitive treatment for umbilical or abdominal hernias. These procedures are prevalent and often lifesaving but also carry high risks of adverse effects. Some of the problems that follow include postoperative ileus, increased opioid use, and prolonged length of stay. Due to the rate of complications, there was a need to improve these outcomes. One way to improve outcomes is to implement superior anesthetic techniques. This Final Scholarly Project (FSP) followed the Plan-Do-Study-Act (PDSA) model to conduct evidence-based practice (EBP) and quality improvement (QI) sections. The plan phase included a thorough literature search and analysis …
Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen
Evidence-Based Practice Guidelines For Perioperative Use Of Dexmedetomidine In Pediatric Congenital Cardiac Surgery, Kayla Thomsen
Doctor of Nursing Practice Scholarly Projects
Tachyarrhythmias are common postoperatively in the congenital cardiac surgery population. About 1% of the population is born with congenital heart disease (CHD), with 50% of patients undergoing surgery for CHD experiencing arrhythmias. Complications can arise from postoperative arrhythmias, including hemodynamic instability and myocardial depression, having catastrophic health repercussions. Despite the high prevalence and complications, there is no standard practice for postoperative tachyarrhythmia prevention in the chosen population, and prevention is at the provider's discretion. However, literature exploring the effects of dexmedetomidine notes promising results for using the drug for postoperative tachyarrhythmia prevention. The project aims to address the lack of …
Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler
Final Scholarly Project: Enhanced Recovery After Surgery (Eras) Guidelines For Pancreaticoduodenectomies, Rebecca Wheeler
Doctor of Nursing Practice Scholarly Projects
A pancreaticoduodenectomy, or Whipple procedure, is the only curative option for pancreatic cancer. For those eligible for tumor resection, the Whipple procedure is a difficult surgery for both the patient and provider. Complications following pancreaticoduodenectomy are numerous and include infection, delayed gastric emptying, high hospital costs, and pancreatic fistulas. Enhanced Recovery After Surgery (ERAS) protocols exist to provide evidence supporting standardization of practices that lead to the improvement of these patient outcomes. An ERAS protocol for the pancreaticoduodenectomy, first established in 2012, is inconsistently implemented in healthcare facilities. Researchers collected data involving the use of the Whipple procedure ERAS guidelines …
Guidelines For Intraoperative Use Of Quantitative Neuromuscular Monitoring, Alex Thompson
Guidelines For Intraoperative Use Of Quantitative Neuromuscular Monitoring, Alex Thompson
Doctor of Nursing Practice Scholarly Projects
Chemical paralysis with neuromuscular blocking agents is common practice in anesthesia. Adequate reversal of these medications is essential for postoperative recovery and return to physiologic baseline. Inadequate reversal may lead to residual paralysis and respiratory complications such as hypoxemia, upper airway obstruction, atelectasis, and pneumonia. Quantitative neuromuscular monitoring was introduced as an objective measure of adequate recovery from neuromuscular blockade. The American Society of Anesthesiologists recommends utilizing quantitative neuromuscular monitoring before tracheal extubation in their 2023 practice guidelines, as the research involving quantitative neuromuscular monitoring shows a reduction in postoperative residual paralysis rates and adverse respiratory complications postoperatively. In this …
Analysis Of Clinical Outcomes And Cost Effectiveness Of Neuromuscular Blocking Drug Reversal In Patients Classified As Obese, Trevor Mack
Doctor of Nursing Practice Scholarly Projects
Obesity predisposes patients to heightened risks of adverse outcomes following surgery, including residual neuromuscular blockade and postoperative complications. The administration of non-depolarizing neuromuscular agents (NMBAs) is fundamental for muscle relaxation and optimal surgical conditions. However, the subsequent reversal of these blockers with agents like sugammadex or neostigmine is crucial to mitigate these risks. While sugammadex is recognized as a clinically superior choice due to its rapid and more complete reversal, its extensive use is often limited by cost, presenting challenges in obese patients who already face increased susceptibility to complications. This project evaluates the cost-effectiveness of sugammadex versus neostigmine in …
Development Of Evidence-Based Clinical Practice Guidelines For Pediatric Preoperative Anxiety, Whitney R. Stant
Development Of Evidence-Based Clinical Practice Guidelines For Pediatric Preoperative Anxiety, Whitney R. Stant
Doctor of Nursing Practice Scholarly Projects
Preoperative anxiety is a problem that occurs frequently in pediatric patients. Preoperative anxiety creates physical and psychological changes that impact a child’s surgical experience. Pediatric patients who experience preoperative anxiety may also experience prolonged postoperative care, long-term psychological complications, and increased postoperative pain. Sedating medications are often administered to prevent and treat preoperative anxiety. Commonly, midazolam is administered intranasally to prevent preoperative anxiety. Midazolam increases the risk of cognitive impairment and respiratory depression. Dexmedetomidine is an effective alternative to midazolam. Dexmedetomidine is a highly selective alpha-2 agonist and provides arousable sedation without respiratory depression. Dexmedetomidine is safe and effective at …
Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes
Using The Bispectral Index Monitor To Decrease The Incidence Of Unintended Intraoperative Awareness In The High-Risk Population, Bridget Hayes
Doctor of Nursing Practice Scholarly Projects
Unintended intraoperative awareness is a traumatizing complication of general anesthesia. This negative outcome affects 0.1-0.2% of all patients undergoing general anesthesia. Patients at higher risk for this experience include those undergoing emergency surgery, traumas, cesarian sections, those on cardiopulmonary bypass, those with substance use disorder, and those undergoing total-intravenous anesthesia (TIVA). This high-risk population is affected by unintended intraoperative awareness 1% of the time. The bispectral index (BIS) monitor has been proposed as a tool to decrease the incidence of unintended intraoperative awareness. There are several large, randomized controlled trials that demonstrate that using a BIS monitor decreases the incidence …
Clinical Guidelines For The Perioperative Management Of Patients With Aortic Stenosis Undergoing Noncardiac Surgery, Owen Diehl
Doctor of Nursing Practice Scholarly Projects
Aortic stenosis (AS) is a common valvular disorder that causes left ventricular (LV) outflow obstruction. The prevalence of AS may increase with the aging population and the widespread availability of diagnostic capabilities like echocardiography. With the increasing patient population diagnosed with AS, the chance of encountering these patients during noncardiac surgery (NCS) increases. Performance of anesthesia is challenging in patients with AS due to the pathophysiological consequences of AS and the hemodynamic changes associated with anesthesia. The patient with AS presenting for NCS is at an increased risk of perioperative major adverse cardiac events (MACEs). This project aimed to determine …
Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle
Implementation Guidelines For Total Hip And Total Knee Arthroplasty To Reduce The Incidence Of Deep Vein Thrombosis And Subsequent Pulmonary Embolism, Mitchell Mccorkle
Doctor of Nursing Practice Scholarly Projects
With patients living longer, the orthopedic sector has given rise to joint prostheses as a treatment for those experiencing osteoarthritis (OA). With the increase of these procedures, there is also an increased risk of deep vein thrombosis (DVT) and subsequent pulmonary embolus (PE) following these surgical procedures. The orthopedic medical community and anesthesia providers aim to decrease DVT and PE risk through multiple modalities. The anesthesia focuses on reducing DVT, and PE involves a multimodal approach to each anesthetic. Modalities used for the multimodal approach involve peripheral nerve blocks (PNB), neuraxial spinal anesthesia, early mobilization, postoperative nausea and vomiting (PONV) …