Anesthesiology Commons^™

Decreasing Pre-Procedural Fasting Times: A Benchmark Study, Sheila Gasparek

MSN Capstone Projects

On a busy Surgical Trauma unit, scheduled procedures and operations are often delayed for priority emergent cases. Patients admitted to the unit with delayed procedures often endure extended fasting times beyond the six-hour intention of standard nothing by mouth (NPO) after midnight fasting order. With prolonged fasting times, patients inquire about pending surgery times and dietary options. Some providers may allow ice chips, but most doctors prefer patients to remain NPO in case Operating Room availability opens for surgery, leaving already anxious and uncomfortable patients more frustrated as prolonged fasting affects patients’ physical and psychological well-being (Anderson & Comrie, 2009). …

The Effect Of Saline Flush After Rocuronium Bolus On Intubating Conditions In Adult Patients Undergoing Elective Surgery: A Randomized Controlled Trial, Ian Odari, Vitalis Mung’Ayi, Rajpreet Bal, David Odaba

Anaesthesiology, East Africa

Background: In emergency surgeries requiring endotracheal intubation, the time to effect of neuromuscular blocking drugs is a crucial time to avoid hypoxia and aspiration into the lungs. Various strategies have been undertaken to shorten this time. All these methods have positive results but some are associated with side effects. The effectiveness of a muscle relaxant can either be assessed using the train of four or intubating conditions on the Goldberg scale. In this study, we investigated the effects of a 20 ml saline bolus following intravenous rocuronium at 0.6 mg/kg on the proportions of patients with excellent intubating conditions …

Post-Operative Use Of Hme Filter‑Protected Open Tracheostomy Circuit During The Covid-19 Pandemic, Way Siong Koh, Irene Ng, Megan Downing

Journal of Perioperative Nursing

Introduction

In the era of the COVID-19 pandemic, the avoidance of aerosol generating procedures (AGPs) is paramount to reduce the risk of viral transmission to staff and other patients. Perioperative management of a new tracheostomy is challenging as routine care, such as suctioning, frequently involves AGPs.

Methods

We developed and implemented an apparatus called the heat and moisture exchanger (HME) filter-protected open circuit. This enabled closed suctioning to be performed and allowed spontaneously breathing patients to be managed with an open circuit in a shared environment while reducing the risk of viral aerosolisation. We performed a prospective observational study of …

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 …

Applying A Mixed-Method Approach To Improve On-The-Job Learning And Job Satisfaction In A Cohort Of Interns At A University Hospital, Amna Subhan Butt, Muhammad Shahzad Shamim, M Asghar Ali, Farah Naz Qamar, Irum Qamar Khan, Swaleha Tariq, Syeda Amrah Hashmi, Quratulain Hafeez, Muhammed Tariq

Section of Gastroenterology

Introduction: Job satisfaction is vital for the optimal functioning of medical practitioners. Herein, we report our experience of restructuring the internship program by identifying the gaps, developing, implementing strategies to overcome gaps and sharing the results of the pre-implementation and post-implementation audit, as an example for establishing a system for improving intern's work-based learning and satisfaction in a university hospital setting.
Methods: Using Kern's six-step instructional model, a prospective mixed-method study was conducted at Aga Khan University Hospital. In phase 1 (2013) gaps were identified by evaluating various aspects of the internship program. Strategies were developed and implemented to overcome …

Operative Management Of Symptomatic, Metachronous Carotid Body Tumors Involving The Skull Base And Its Neurological Sequelae, Roberto G. Aru, Rony K. Aouad, Justin F. Fraser, Amanda M. Romesberg, Kevin W. Hatton, Sam C. Tyagi

Otolaryngology--Head & Neck Surgery Faculty Publications

A 44-year-old morbidly obese woman with a history of right carotid body tumor (CBT) resection presented with a symptomatic, nonfunctional, left Shamblin-III CBT. Abutment of the skull base precluded distal internal carotid artery control for arterial reconstruction, favoring parent vessel sacrifice after an asymptomatic provocative test. She underwent CBT resection with anticipated sacrifice of cranial nerves X and XII and the common carotid artery and its branches, developing baroreceptor failure syndrome and sequelae of cranial nerve sacrifice. When facing a symptomatic, metachronous CBT abutting the skull base, upfront operative intervention with adjuvant radiation for residual tumor optimizes curative resection.

Implementation Of An Infant Male Circumcision Programme, Pakistan, Shazia Moosa, Ammar Ali Muhammad, Sohail Asghar Dogar, Sundus Iftikhar, Walter Johnson, Asad Latif, Lubna Samad

Section of Paediatric Surgery

Objective: To retrospectively review outcomes of a health provider-led infant circumcision programme in Pakistan.
Methods: Based on World Health Organization guidelines, we trained surgical technicians and midwives to perform circumcisions using the Plastibell device at two Indus Health Network facilities. Programme tools include a training manual for health providers, information brochures for families, an enrolment form and standardized forms for documenting details of the procedure and outcomes. Infants aged 1-92 days were eligible for the study. Health workers contacted families on days 1 and 7 after the procedure to record any adverse events. We compared the characteristics of infants experiencing …

Incidence And Risk Factors Of Delirium In Surgical Intensive Care Unit, Muhammad Asghar Ali, Madiha Hashmi, Waqas Ahmed, Syed Amir Raza, Muhammad Faisal Khan, Bushra Salim

Department of Anaesthesia

Background: To evaluate the incidence and modifiable risk factors of delirium in surgical intensive care unit (SICU) of tertiary care hospital in a low-income and middle-income country.
Methods: We conducted a single cohort observational study in patients over 18 years of age who were admitted to the SICU for >24 hours in Aga Khan University Hospital from January to December 2016. Patients who had pre-existing cognitive dysfunction were excluded. Intensive Care Delirium Screening Checklist was used to assess delirium. Incidence of delirium was computed, and univariate and multivariable analyses were performed to observe the relationship between outcome and associated factors. …

Persistent Post-Surgical Pain Following Breast Cancer Surgery: An Observational Study In A Tertiary Care Hospital, Ali Sarfraz Siddiqui, Sana Zeeshan, Aliya Ahmed, Shaista Khan

Department of Anaesthesia

Objective: To determine the frequency of persistent pain in patients after breast cancer surgery, and to assess the distribution and characteristics of pain in such patients.
Methods: The prospective observational single cohort study was conducted at the Department of Anaesthesiology and in the Breast Clinic of the Department of Surgery, Aga Khan University Hospital, Karachi, from August 2016 to January 2017, and comprised adult female patients with biopsy-proven carcinoma of breast who were scheduled for elective definitive breast cancer surgery. The patients were followed up for up to three months post-surgery and those with persistent pain were followed up for …

Management Of Difficult Airway In A Pregnant Patient With Severely Reduced Mouth Opening, Faisal Shamim, Aly Bahadur, Dinaz Ghandhi, Anum Aijaz

Department of Anaesthesia

Pregnancy is associated with a wide variety of oral and dental changes ranging from gingivitis to odontogenic infections. If left untreated, severe dental abscess can progress to Ludwig's angina, which is a potentially lethal cellulitis that rapidly extends to the neck region and may lead to life-threatening upper airway obstruction. We report the case of a pregnant woman who presented with intense throbbing pain, trismus and severely reduced mouth opening due to dental abscess for the last one week. She required incision and drainage of abscess with extraction of third molar under general anaesthesia. There are some significant challenges to …

Quality Assurance Audit In Adult Cardiac Anaesthesia, Syed Shabbir Ahmed, Mohammad Hamid, Faisal Junejo

Department of Anaesthesia

Objective: To assess different anaesthesia-related quality indicators during adult cardiac surgery.
Methods: The prospective clinical audit was conducted at the Aga Khan University Hospital, Karachi, from October 2016 to March 2017, and comprised all adult patients scheduled for cardiac surgery. Different anaesthesia-related quality indicators were observed during the pre-induction phase, before the cardiopulmonary bypass, during the procedure, and post-surgery till the transfer from the operating room to the cardiac intensive care unit. Data was analysed using SPSS 19.
Results: Of the 264 patients, 217(82.2%) had complete record; 160(73.7%) males and 57(26.3%) females. The overall mean age was 56.56±12.46 years. In …

A Multidisciplinary Approach To Triage Patients With Breast Disease During The Covid-19 Pandemic: Experience From A Tertiary Care Center In The Developing World, Abida K. Sattar, Hania Shahzad, Adnan Abdul Jabbar, Azmina Tajdin Valimohammad, Sadaf Khan, Yasmin Vellani, Romana Idrees, Nasir Ali, Imrana Masroor, Humera Saeed, Gulzar S. Lakhani, Nadia Ayoub, Atif Waqar, Muhammad Zia-Ul Islam, Salman Kirmani, Asad Latif, Ather Enam

Section of General Surgery

Background: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting.
Aim: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease.
Methods and results: The breast disease management guidelines were developed and approved …