Anesthesiology Commons^™

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

Pharmacologic And Clinical Considerations Of Nalmefene, A Long Duration Opioid Antagonist, In Opioid Overdose., Amber N. Edinoff, Catherine A. Nix, Tanner D. Reed, Elizabeth M. Bozner, Mark R. Alvarez, Mitchell C. Fuller, Fatimah Anwar, Elyse M. Cornett, Adam M. Kaye, Alan D. Kaye

School of Medicine Faculty Publications

No abstract provided.

Pain Control: Opioid Vs. Nonopioid Analgesia During The Immediate Postoperative Period, Shamsie M. Lumpkin Bsn, Srna, Isaac W. Parrish Bsn, Srna, Austin S. Terrell Bsn, Srna, Dwayne S. Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background Opioid analgesia has become the mainstay for acute pain management in the postoperative setting. However, the use of opioid medications comes with significant risks and side effects. Due to increasing numbers of prescriptions to those with chronic pain, opioid medications have become more expensive while becoming less effective due to the buildup of patient tolerance. The idea of opioid-free analgesic techniques has rarely been breached in many hospitals. Emerging research has shown that opioid-sparing approaches have resulted in lower reported pain scores across the board, as well as significant cost reductions to hospitals and insurance agencies. In addition to …

Dexmedetomidine Vs Fentanyl In Attenuating The Sympathetic Surge During Endotracheal Intubation: A Scoping Review, Alexandra Schwieger, Kaelee Shrewsbury, Paul Shaver, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Direct laryngoscopy and endotracheal intubation after induction of anesthesia can cause a reflex sympathetic surge of catecholamines caused by airway stimulation. This may cause hypertension, tachycardia, and arrhythmias. This reflex can be detrimental in patients with poor cardiac reserve and can be poorly tolerated and lead to adverse events such as myocardial ischemia. Fentanyl, a potent opioid, with a rapid onset and short duration of action is given during induction to block the sympathetic response. With a rise in the opioid crisis and finding ways to change the practice in medicine to use less opioids, dexmedetomidine, an alpha 2 …

Opioid Free Anesthesia To Prevent Post Operative Nausea/Vomiting, Aleksander Acred, Milena Devineni, Lindsey Blake, Cindi Dabney Dnp, Crna

Doctor of Nursing Practice Projects

Purpose The purpose of this study is to compare the incidence of post-operative nausea and vomiting (PONV) in opioid-utilizing and opioid-free general anesthesia. Background PONV is an extremely common, potentially dangerous side effect of general anesthesia. PONV is caused by a collection of anesthetic and surgical interventions. Current practice to prevent PONV is to use 1-2 antiemetics during surgery, identify high risk patients and utilize tracheal intubation over laryngeal airways when indicated. Current research suggests minimizing the use of volatile anesthetics and opioids can reduce the incidence of PONV, but this does not reflect current practice.

Methods In this scoping …

Evaluating Anesthetic Protocols For Non-Human Primate Functional Neuroimaging, Megha Verma

Electronic Thesis and Dissertation Repository

Functional magnetic resonance imaging (fMRI) is a non-invasive technique that can be used to measure a proxy of neural activity in vivo with high spatial specificity. One subject can be followed for a long period of time to assess changes in functional brain organization. However, fMRI is extremely sensitive to motion. The challenges of training non-human primates to reduce motion in an MRI scanner motivate the study of anesthesia which is commonly used to substitute for this training. In this thesis, I compare three different commonly used anesthetic protocols: isoflurane, propofol-fentanyl in combination, and fentanyl alone, to test which of …

Water Pollution And Environmental Concerns In Anesthesiology, Marc Kostrubiak, Christine Vatovec, Lesley-Ann Dupigny-Giroux, Donna Rizzo, William Paganelli, Mitchell Tsai

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

Medications administered by anesthesia health care providers and subsequently excreted into the water supply system have the potential to affect ecological systems. Presently, there is a lack of literature examining which medications or metabolites enter the waste stream. Further, assessments of their potential environmental impact are often unknown or simply not considered as an externality of medical practice. Recent work examining the practice of anesthesiology has explored the solid waste stream, and the global warming potential of anesthetic gases, however the potential aquatic impacts remain unexplored. To address the potential for waterborne pollution and environmental toxicity, we extracted the total …

Refrigerated Stability Of Diluted Cisatracurium, Rocuronium, And Vecuronium For Skin Testing After Perioperative Anaphylaxis, Kristen Dinsmore, Bethany Campbell, Timothy Archibald, Greg Mosier, Stacy Brown Phd, Alexei Gonzalez-Estrada Md

Appalachian Student Research Forum

Rationale: The purpose of this study is to investigate the stored stability of dilutions of neuromuscular blocking agents (NMBAs), namely cisatracurium, rocuronium, and vecuronium, for skin prick/intradermal testing.

Methods: Concentrations of NMBAs were monitored by liquid chromatography-mass spectrometry (LC-MS/MS) for a period of 14 days. Dilutions of NMBAs were prepared in saline by factors of 10x, 100x, 1,000x, 10,000x, and 100,000x as sensitivity of the assay allowed. Diluted drug products were stored in a laboratory refrigerator until sampling. On sampling days, aliquots of each dilution were removed and compared to a freshly prepared set of reference dilutions.

Results: The results …

A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister

Doctoral Projects

The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.

PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties; …

Does The Addition Of Dexamethasone To Local Anesthetic Used For Peripheral Nerve Block Prolong Analgesia In The Surgical Patient?, Janice M. Oliveira

Nurse Anesthesia Student Capstones

Pain after orthopedic surgery can be intense. Many anesthesia providers and orthopedic surgeons support the use of peripheral nerve blockade to assist in decreasing the amount of pain a patient may experience post operatively. Select medication adjuncts are being added to peripheral nerve blocks to prolong analgesia. The research presented here focuses on the addition of dexamethasone to peripheral nerve blocks to prolong analgesia. Dexamethasone is a synthetic glucocorticoid that acts as an anti-inflammatory. It has been shown to inhibit the release of inflammatory mediators such as, interleukins and cytokines, facilitating the release of anti-inflammatory mediators, decreasing postoperative pain. Recent …

Minimal Opioid Anesthetic In Patient With History Of Substance Abuse: A Case Study, Sarah E. Varney

Nurse Anesthesia Student Capstones

More than half of the population in the United States of America drinks alcohol regularly. Thousands of deaths annually are linked to drug overdoses, and that number continues to rise. Anesthesia professionals can expect to see patients in various levels of substance abuse and recovery during their practice. This case study is presented to discuss a minimal narcotic technique given in a patient with a history of prescription drug abuse, who had been substance free since successfully been through a recovery program years prior.

Opioid-Induced Hyperalgesia, Lisa Nieder

Nurse Anesthesia Student Capstones

Opioids are a fundamental part in the treatment of pain especially within the perioperative setting. While opioids are routinely administered by nurse anesthetists for the treatment of pain, they can be associated with several undesirable side effects including opioid- induced hyperalgesia (OIH). OIH is a complex phenomenon that has a significant impact on the successful treatment of pain in a surgical setting. While there have been many advances in recent years into the topic of OIH, the mechanisms are complex and remain incompletely understood. OIH is believed to occur from changes in both the peripheral and central nervous systems that …

Buprenorphine And The Anesthesia Considerations: A Literature Review, Elizabeth E. Stern

Nurse Anesthesia Student Capstones

Buprenorphine is a unique pharmaceutical in the management of chronic pain and opioid use disorder (OUD). Buprenorphine is a semisynthetic partial opioid agonist at the mu opioid receptor and an antagonist of the kappa opioid. Buprenorphine Maintenance Therapy (BMT) is utilized for the long-term treatment of patients with OUD. The attraction to this methadone alternative is increased safety profile, more convenient patient access to the drug, as well as increase of ease for the provider. The particular formula used in the US, Suboxone, has properties to discourage intravenous injection to prevent abuse and prevent negative secondary effects of intravascular injections …

A Comparison Of Four Muscle Relaxant Techniques And Their Incidence Of Postoperative Myalgia In Ambulatory Patients, William James Garske Jr.

Community & Environmental Health Theses & Dissertations

Postoperative myalgia was measured 24 and 72 hours following the administration of four different anesthetic regimens to 36 patients undergoing outpatient or 23-hour admission procedures. Each patient, ASA class I or II, was to undergo procedures of limited duration, 30 to 90 minutes, and surgical stimulation, including procedures such as knee arthroscopy, hernia repair, and breast biopsy. Anesthesia was induced with propofol 1.5 mg/kg, fentanyl 50 mcg, and maintained with O₂ , N₂O, and isoflurane. Group I (n=20), the control, received no muscle relaxant and was maintained with mask ventilation. Group II (n=5) received succinylcholine 1.5 mg/kg …

Narcotic Drugs In The Postanesthetic Recovery Room, John W. Ditzler, Paul R. Dumke, Beverly Collier

Henry Ford Hospital Medical Journal

No abstract provided.

Intravenous Procaine During Thoracic Surgery, Forrest E. Leffingwell

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Surgery on the heart and paracardial structures or traction on the hilus of the lung may initiate serious arrhythmias which can result in death if not promptly controlled. Procedures involving the pericardium are particularly apt to be followed by severe derangements of rhythm. Thus anesthesiology is faced with another challenge.

It is now evident that the intravenous administration of procaine has become a valuable addition to the armamentarium of the anesthesiologist in his endeavor to preserve the integrity of the thread of life while the surgeon carries out his heroic assignment without restrictions.

The Central Action Of Procaine, Clarence W. Olsen

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Procaine was introduced as a local anesthetic with advantage over cocaine, especially as regards relative freedom from dangerous central effects. It [now] appears that when procaine hydrochloride is injected intravenously, the indications of a central effect are more emphatic when the solution is given rather rapidly.

Probably some of the central effects of procaine can be obtained with local infiltration. This is, of course, generally admitted when untoward results occur, but it should also be considered in connection with the favorable effects. Macpherson recently expressed the idea that in some cases we are getting the beneficial effects of procaine injection …

A Resume Of Intravenous Procaine Therapy, Fred B. Moor

Medical Arts and Sciences: A Scientific Journal of the College of Medical Evangelists

Summary:

1. The intravenous injection of procaine hydrochloride for a variety of clinical conditions constitutes a surprising new chapter in therapeutics.

2. With adequate precautions as to dosage and rate of administration, procaine can be safely given by the intravenous route in concentrations of 0.1 to 1 per cent.

It has been used successfully for serum sickness, the pruritis of jaundice, trauma of soft tissues, bones and joints, in the prevention and treatment of cardiac arrhythmias during intrathoracic surgery, for the relief of pain in osteoarthritis, for the control of pain during the dressing of burns, for postoperative pain, and …

A Study In Local Anesthesia Diethanolaminoethylester Of Para-Aminobenzoic Acid., Wilbur P. Crouch 1907-1964

Electronic Theses and Dissertations

No abstract provided.