Anesthesiology Commons^™

Opioid Free Anesthesia, Sarah Medina

Doctor of Nursing Practice Projects

Patients undergoing surgery are often given opioids intraoperatively. Administration of opioids is associated with untoward side effects that include nausea, respiratory depression, constipation, ileus, hyperalgesia, prolonged length of stay, and the potential for dependence (Garimella & Cellini, 2013). Emerging research on the topic of opioid-free anesthesia (OFA) is available and indicates several benefits of OFA, including reduction in postoperative pain, reduction in postoperative nausea and vomiting, reduction in postoperative shivering, and improved oxygen saturation levels (Mulier et al., 2018). This quality improvement project aimed to advance anesthesia providers' understanding of OFA by creating an OFA guideline and providing a learning …

Transversus Abdominis Plane Block As A Sole Anesthetic Technique For Open Appendectomy In Patient With Treacher Collins Syndrome: A Case Report, Khalid Maudood Siddiqui, Muhammad Asghar Ali, Bushra Salim

Department of Anaesthesia

Patients with Treacher Collins syndrome (TCS) present serious challenges to anesthetist in securing of airway; upper airway obstruction and difficult tracheal intubation are considered complex entity in these patients. This case report describes the significance of transversus abdominis plane (TAP) block as a sole anesthetic choice in appendectomy where airway management can be avoided. A 17-year-old boy, known case of TCS, presented with acute appendicitis underwent emergency laparotomy. Surgery was successfully performed by TAP block with dexmedetomidine infusion. Open appendectomy can be performed successfully in certain circumstances under TAP block with adjunctive use of dexmedetomidine infusion where airway handling is …

A Case Of Carcinoid Heart Disease And Echocardiographic Findings, Brandon Alex, Jeffrey Songster, Helenmari L. Merritt, Rebecca A. Aron

Graduate Medical Education Research Journal

Abstract: Carcinoid heart disease occurs in approximately 50% of patients with carcinoid syndrome. Right heart involvement resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis is most common. We report a case of tricuspid heart disease resulting in tricuspid regurgitation, tricuspid stenosis, pulmonic regurgitation and pulmonic stenosis.

Response To The Letter To The Editor By Hafer And Johnson Concerning 'Mechanism Of Action Of Htx-011: A Novel, Extended-Release, Dual-Acting Local Anesthetic Formulation For Postoperative Pain'., Thomas Ottoboni, Barry Quart, Jayne Pawasauskas, Joseph F. Dasta, Richard A. Pollak, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

No abstract provided.

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project …

Uniform Clinical Evaluation For Video Laryngoscopy In Nurse Anesthesia Training: A Policy Proposal, Kristen Yelverton

Doctoral Projects

At The University of Southern Mississippi’s (USM) Nurse Anesthesia Program (NAP), no standardized clinical evaluation for video laryngoscopy (VL) use exists. To address the gap in standardized evaluation of VL, an evidence-based, objective structured clinical examination (OSCE) will be developed and proposed to the USM NAP. The intervention to this need is the evaluation of the OSCE and supporting documents by the panel of experts. The aim of the OSCE would be to teach SRNAs in a step-by-step process how to properly handle a video laryngoscope and the necessary techniques to ensure both patient and student safety (Wunder et al., …

Randomised Controlled Trial To Assess The Effectiveness Of Apnoeic Oxygenation In Adults Using Low-Flow Or High-Flow Nasal Cannula With Head Side Elevation Versus Usual Care To Prevent Desaturation During Endotracheal Intubation In The Emergency Department (Apoxed): Study Protocol, Shahan Waheed, Nazir Najeeb Kapadia, Muhammad Faisal Khan, Salima Mansoor Kerai, Ahmed Raheem, Rubaba Naeem

Department of Emergency Medicine

Introduction: Apnoeic oxygenation is a process of delivering continuous oxygen through nasal cannula during direct laryngoscopy. The oxygen that is delivered through these nasal cannulas is either low flow or high flow. Although the effectiveness of apnoeic oxygenation has been shown through systematic reviews and randomised controlled trials, a comparison of high-flow versus low-flow oxygen delivery has not been tested through a superiority study design. In this study we propose to assess the effectiveness of giving low-flow oxygen with head side elevation versus high-flow oxygen with head side elevation against the usual practice of care in which no oxygen is …

Effective Number Theory: Counting The Identities Of A Quantum State, Ivan Horváth, Robert Mendris

Anesthesiology Faculty Publications

Quantum physics frequently involves a need to count the states, subspaces, measurement outcomes, and other elements of quantum dynamics. However, with quantum mechanics assigning probabilities to such objects, it is often desirable to work with the notion of a “total” that takes into account their varied relevance. For example, such an effective count of position states available to a lattice electron could characterize its localization properties. Similarly, the effective total of outcomes in the measurement step of a quantum computation relates to the efficiency of the quantum algorithm. Despite a broad need for effective counting, a well-founded prescription has not …

Blood Pressure Monitoring Following Individual Carpules Of Anesthetic Utilizing Computer-Controlled Anesthetic Delivery, Kristi M. Soileau, Adam E. Degenova, Qingzhao Yu

School of Dentistry Faculty Publications

To date, no study has evaluated blood pressure following administration of each carpule given for dental procedures using a computerized dental anesthesia system. Blood pressures taken prior to performing invasive periodontal procedures were compared with those readings measured following delivery of each of up to three consecutive carpules of Marcaine or Xylocaine in varying order. Pressure differences were also adjusted for age, sex, race, and whether a prescribed anxiolytic was taken beforehand. Neither systolic nor diastolic blood pressures changed significantly as compared to initial blood pressure readings. However, compared with Whites, Hispanics, and Middle Easterners, Blacks had significantly higher systolic …

Anaesthetic Management Of Patients Undergoing Deep Brain Simulation: A Retrospective Review Of 8 Cases From A Tertiary Care Center Of Pakistan, Usama Ahmed, Faraz Shafiq, Dileep Kumar, Khalid Ahsan, Waleed Bin Ghaffar, Muhammad Ehsan Bari

Department of Anaesthesia

Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS).
Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data.
Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth …

Global Safety In Anaesthesia And Surgery: Implications For Anaesthesia In Pakistan, Fauzia Khan

Department of Anaesthesia

The Lancet Commission report in 2015 highlighted the role of safe surgery and anaesthesia. They also gave a framework of recommendations, indicators and targets to achieve universal access to safe surgery. This article explores the applicability of these indicators in Pakistan namely; access to timely surgery, specialist surgical workforce diversity, surgical volumes, perioperative mortality rate, protection against impoverishing expenditure and protection against catastrophic expenditure.

Mepivacaine Versus Bupivacaine Spinal Anesthesia For Early Postoperative Ambulation., Eric S. Schwenk, Vincent P. Kasper, Jordan D. Smoker, Andrew M. Mendelson, Mathew S. Austin, Scot A. Brown, William J. Hozack, Alexa J. Cohen, Jonathan J. Li, Christopher S. Wahal, Jaime L. Baratta, Marc Torjman, Alyson C. Nemeth, Eric E. Czerwinski

Department of Anesthesiology Faculty Papers

BACKGROUND: Early ambulation after total hip arthroplasty predicts early discharge. Spinal anesthesia is preferred by many practices but can delay ambulation, especially with bupivacaine. Mepivacaine, an intermediate-acting local anesthetic, could enable earlier ambulation than bupivacaine. This study was designed to test the hypothesis that patients who received mepivacaine would ambulate earlier than those who received hyperbaric or isobaric bupivacaine for primary total hip arthroplasty.

METHODS: This randomized controlled trial included American Society of Anesthesiologists Physical Status I to III patients undergoing primary total hip arthroplasty. The patients were randomized 1:1:1 to 52.5 mg of mepivacaine, 11.25 mg of hyperbaric bupivacaine, …

Physical Activity After Delivery: A Feasibility Study, Antonio Gonzalez Fiol, Md, Geoffrey Ho, Mbbs, Dongchen Li, Md, Richard Amdur, Phd, Chapman Wei, Md, Homa K. Ahmadzia, Md, Marianne David, Md, Christopher Jackson, Md, Jeffrey S. Berger, Md, Mba

Anesthesiology and Critical Care Medicine Faculty Publications

Background: Early mobility is one of the main goals of the enhanced recovery after cesarean delivery, yet it is rarely objectively measured. Benefits related to this goal include mechanical prevention of deep venous thrombosis and early discharge.

Methods: We conducted a multi-center prospective study in which an activity tracker was utilized to measure the steps taken by patients after delivery. The primary outcome was steps taken after vaginal or cesarean delivery. Secondary outcomes was factors affecting ambulation (e.g pain/satisfaction with pain management and mode of delivery).

Results: Data from 50 postpartum patients were analyzed. Vaginal delivery patients took more cumulative …

Prediction Of Opioid-Induced Respiratory Depression On Inpatient Wards Using Continuous Capnography And Oximetry: An International Prospective, Observational Trial., Ashish K Khanna, Sergio D Bergese, Carla R Jungquist, Hiroshi Morimatsu, Shoichi Uezono, Simon Lee, Lian Kah Ti, Richard D Urman, Robert Mcintyre, Carlos Tornero, Albert Dahan, Leif Saager, Toby N Weingarten, Maria Wittmann, Dennis Auckley, Luca Brazzi, Morgan Le Guen, Roy Soto, Frank Schramm, Sabry Ayad, Roop Kaw, Paola Di Stefano, Daniel I Sessler, Alberto Uribe, Vanessa Moll, Susan J Dempsey, Wolfgang Buhre, Frank J Overdyk, Marianne Tanios, Eva Rivas, Miluska Mejia, Kavita Elliott, Assad Ali, Juan Fiorda-Diaz, Ruben Carrasco-Moyano, Ana Mavarez-Martinez, Alicia Gonzalez-Zacarias, Cory Roeth, January Kim, Alan Esparza-Gutierrez, Carleara Weiss, Chiahui Chen, Arata Taniguchi, Yuko Mihara, Makiko Ariyoshi, Ichiro Kondo, Kentaro Yamakawa, Yoshifumi Suga, Kohei Ikeda, Koji Takano, Yuuki Kuwabara, Nicole Carignan, Joyce Rankin, Katherine Egan, Lakeisha Waters, Ming Ann Sim, Lyn Li Lean, Qi En Lydia Liew, Lawrence Siu-Chun Law, James Gosnell, Salina Shrestha, Chisom Okponyia, Mohammed H Al-Musawi, María José Parra Gonzalez, Claudia Neumann, Vera Guttenthaler, Olja Männer, Achilles Delis, Anja Winkler, Bahareh Marchand, Frauke Schmal, Fuad Aleskerov, Mohammedumer Nagori, Muhammad Shafi, Gloria Mcphee, Cynthia Newman, Elizabeth Lopez, Sabrina Ma Har, Moumen Asbahi, Kim Nordstrom Mccaw, Maurice Theunissen, Valerie Smit-Fun

Articles, Abstracts, and Reports

BACKGROUND: Opioid-related adverse events are a serious problem in hospitalized patients. Little is known about patients who are likely to experience opioid-induced respiratory depression events on the general care floor and may benefit from improved monitoring and early intervention. The trial objective was to derive and validate a risk prediction tool for respiratory depression in patients receiving opioids, as detected by continuous pulse oximetry and capnography monitoring.

METHODS: PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) was a prospective, observational trial of blinded continuous capnography and oximetry conducted at 16 sites in the United States, Europe, and …

The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High

Graduate Medical Education Research Journal

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate.

Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were …

Ponv Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance, Karl A. Krieser, John B. Riley Iii, Jospeh E. Baus, Julie T. Hoffman, James N. Sullivan Md, Robert L. Lobato

Graduate Medical Education Research Journal

Objectives: To compare postoperative nausea and vomiting (PONV) prophylaxis treatment and outcomes based on patients’ sex, using a retrospective cohort. The setting was the operating room and post-anesthesia care unit of a tertiary care university medical center.

Patients: A total of 678 adult male and female patients with American Society of Anesthesiologist (ASA) scores of 1-4 underwent surgery with general anesthesia. All patients received preoperative PONV risk assessment. PONV prophylaxis was administered at the discretion of the anesthesia care team members with guidance from a computerized decision support system.

Measurements: Adequacy of prophylaxis was retrospectively determined based on individual patient …

Prophylactic Mesh Placement For The Prevention Of Incisional Hernia In High-Risk Patients After Abdominal Surgery: A Systematic Review And Meta-Analysis, Jawad Ahmed, Nimra Hasnain, Iayla Fatima, Farheen Malik, Muhammad A. Chaudhary, Junaid Ahmad, Mehreen Malik, Laraib Malik, Muhammad Osama, Mirza Zain Baig, Faisal Khosa, Faiz Bhora

Department of Anaesthesia

Background and objectives: In high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC).
Materials and methods: PubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses …

Role Of Extracellular Vesicles In Substance Abuse And Hiv-Related Neurological Pathologies, Katherine E. Odegaard, Subhash Chand, Sydney Wheeler, Sneham Tiwari, Adrian Flores, Jordan Hernandez, Mason Savine, Austin Gowen, Gurudutt Pendyala, Sowmya V. Yelamanchili

Journal Articles: Anesthesiology

Extracellular vesicles (EVs) are a broad, heterogeneous class of membranous lipid-bilayer vesicles that facilitate intercellular communication throughout the body. As important carriers of various types of cargo, including proteins, lipids, DNA fragments, and a variety of small noncoding RNAs, including miRNAs, mRNAs, and siRNAs, EVs may play an important role in the development of addiction and other neurological pathologies, particularly those related to HIV. In this review, we summarize the findings of EV studies in the context of methamphetamine (METH), cocaine, nicotine, opioid, and alcohol use disorders, highlighting important EV cargoes that may contribute to addiction. Additionally, as HIV and …

Comparison Of Trigger Point Injections Versus Traditional Therapies In The Management Of Post-Surgical Pain In Patients Who Had Anterior Cervical Surgery: A Retrospective Study, Vivien Pat, Ivy Benjenk, Everett Chu, Eric Heinz, Geoffrey Ho, Anita Vincent

Anesthesiology and Critical Care Medicine Faculty Posters and Presentations

Introduction: The opioid epidemic has launched the United States into a public health crisis, resulting in a greater emphasis on non-opioid multimodal pain control methods.

At our institution, postoperative posterior neck stiffness and myofascial pain is a common concern after anterior cervical discectomy and fusion or anterior cervical corpectomy with fusion surgery (hereinafter ACS), likely due to prolonged intraoperative positioning in neck extension. Studies have shown successful analgesic outcomes of trigger point injections with local anesthetic for generalized myofascial pain.^1-2 This retrospective pilot study aimed to evaluate whether trigger point injections with bupivacaine decreases postsurgical pain compared with …

Blood-Brain Barrier: Mechanisms Governing Permeability And Interaction With Peripherally Acting Μ-Opioid Receptor Antagonists., Eugene R. Viscusi, Andrew R Viscusi

Department of Anesthesiology Faculty Papers

The blood-brain barrier (BBB) describes the unique properties of endothelial cells (ECs) that line the central nervous system (CNS) microvasculature. The BBB supports CNS homeostasis via EC-associated transport of ions, nutrients, proteins and waste products between the brain and blood. These transport mechanisms also serve as physiological barriers to pathogens, toxins and xenobiotics to prevent them from contacting neural tissue. The mechanisms that govern BBB permeability pose a challenge to drug design for CNS disorders, including pain, but can be exploited to limit the effects of a drug to the periphery, as in the design of the peripherally acting μ-opioid …

Nsaids For Analgesia In The Era Of Covid-19, Daniel L Herzberg, Harry P Sukumaran, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

Globally, non-steroidal anti-inflammatory drugs (NSAIDs) are highly used to treat pain. With the rise of the COVID-19 pandemic, the safety of NSAIDs use has been called into question. These concerns are worthy of review. At present, there is no compelling data showing that NSAIDs worsen the severity of COVID-19 symptoms or increase one's likelihood of contracting the illness. For patients in pain and without symptoms that could potentially be attributed to COVID-19 (cough, fevers/chills, lethargy, myalgias, anosmia and so on), NSAIDs should continue to remain a viable option to provide analgesia to patients in need.

Building Focused Cardiac Ultrasound Capacity In A Lower Middle-Income Country: A Single Centre Study To Assess Training Impact, Wangari Siika, Anders Barasa, Benjamin Wachira, David Nekyon, Barbara Karau, Fatimah Juma, Grace Wanjiku, Harun Otieno, Gerald S. Bloomfield, Erik Sloth

Anaesthesiology, East Africa

Background: In low- and middle-income countries (LMICs) where echocardiography experts are in short supply, training non-cardiologists to perform Focused Cardiac Ultrasound (FoCUS) could minimise diagnostic delays in time-critical emergencies. Despite advocacy for FoCUS training however, opportunities in LMICs are limited, and the impact of existing curricula uncertain. The aim of this study was to assess the impact of FoCUS training based on the Focus Assessed Transthoracic Echocardiography (FATE) curriculum. Our primary objective was to assess knowledge gain. Secondary objectives were to evaluate novice FoCUS image quality, assess inter-rater agreement between expert and novice FoCUS and identify barriers to the establishment …

Frequency Of Intraoperative Hypotension After The Induction Of Anesthesia In Hypertensive Patients With Preoperative Angiotensin-Converting Enzyme Inhibitors, Fahad Salim, Fazal Hameed Khan, Muhammad Nasir, Rashid Ali, Ayesha Iqbal, Amir Raza

Department of Anaesthesia

Introduction: The renin-angiotensin-aldosterone system (RAAS) is an important target in the treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II. ACE inhibitors not only treat hypertension but also decrease morbidity and mortality in heart failure patients and in patients with acute myocardial infarction. The discontinuation of ACE inhibitors before the surgery is still controversial. To assess the current magnitude of the problem in our population, we aimed to conduct this study, which evaluated the frequency of intraoperative hypotension after the induction of anesthesia in controlled hypertensive patients with preoperative ACE inhibitors.
Material and …

When Limb Surgery Has Become The Only Life-Saving Therapy In Fop: A Case Report And Systematic Review Of The Literature, Esmée Botman, Sanne Treurniet, Wouter D Lubbers, Lothar A Schwarte, Patrick R Schober, Louise Sabelis, Edgar J G Peters, Annelies Van Schie, Ralph De Vries, Zvi Grunwald, Bernard J Smilde, Jakko A Nieuwenhuijzen, Marieke Visser, Dimitra Micha, Nathalie Bravenboer, J Coen Netelenbos, Bernd P Teunissen, Pim De Graaf, Pieter G H M Raijmakers, Jan Maerten Smit, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare disease in which heterotopic ossification (HO) is formed in muscles, tendons and ligaments. Traumatic events, including surgery, are discouraged as this is known to trigger a flare-up with risk of subsequent HO. Anesthetic management for patients with FOP is challenging. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. We report a patient with FOP suffering from life-threatening antibiotic resistant bacterial infected ulcers of the right lower leg and foot. The anesthetic, surgical …

Implementing Positive Language In Anesthesia: Utilizing The Comfort Scale, Elisabeth Prehm, Tricia Oakes

Grace Peterson Nursing Research Colloquium

Implementing Positive Language in Anesthesia: Utilizing the Comfort Scale

Tricia Oakes & Elisabeth Prehm

Faculty Sponsor: Pamela Schwartz DNP, CRNA

Background

Verbal numeric pain scales (ranking pain on a scale from zero to ten) are widely utilized and taught in medicine. Evidence-based research has shown that verbal numeric comfort scales are associated with a decrease in opioid administration, improved pain perceptions, and overall better patient satisfaction .7

Objective

The purpose of this study is to assess the impact of a video-based educational tool demonstrating the use of a comfort scale in the perioperative setting among Nurse Anesthesia Trainees (NATs), and …

Crnas And Sugammadex Use: A Qualitative Analysis, Natalia Izquierdo Bsn, Rn, Emily Mancewicz Bsn, Rn

Grace Peterson Nursing Research Colloquium

Background: The availability of Sugammadex has increased options for Certified Registered Nurse Anesthetists’ (CRNAs) and their choice of neuromuscular reversal agents, however administration is impacted by a variety of provider and institutional factors.

Objectives: The purpose of this study was to examine and describe the personal and institutional factors impacting the use of Sugammadex in Illinois by CRNAs.

Method: A qualitative study design using an open-ended survey yielded 209 responses. The three main themes that emerged were 1) Why CRNAs choose to use or avoid Sugammadex 2) How CRNAs dose Sugammadex and 3) Practice variations existing within the clinical setting. …

Intratracheal Lidocaine And Postoperative Sore Throat At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Jennifer Cowgill, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative sore throat (POST) is a common side effect from general anesthesia (GA) and has a prevalence of 14.4-50%.1 The experience of POST contributes to patient discomfort during recovery from surgery. The etiology of this is thought to be from tracheal mucosal erosion from the cuff of the endotracheal tube (ETT), trauma from intubation, coughing and bucking, and friction between the ETT and the tracheal mucosa during general anesthesia.2 Risk factors shown to contribute to the development of POST include, but are not limited to, elderly age, smoking history, patient positioning, ETT cuff pressure, and movement of ETT during …

Postoperative Length Of Stay Following Enhanced Recovery After Surgery Protocol Implementation For Scheduled Cesarean Deliveries, Hannah Zimmerman, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Cesarean delivery is the most common major surgery worldwide. 1 In 2018, 1.2 million cesarean deliveries occurred in the United States, accounting for nearly 32% of all deliveries.2 Research has shown ERAS benefits include decreased length of stay, improved pain control, and improved patient satisfaction.2,3 Despite its use in numerous surgical specialties, ERAS implementation within obstetrics has been slow.2 The ERAS Society released a three-part guideline specific to cesarean deliveries in 2018 and 2019,4,5,6 yet few studies have assessed the impact of ERAS on cesarean postoperative outcomes.2 An improved perioperative course would be particularly beneficial for mothers undergoing cesarean …

Opioid Consumption After Scheduled Cesarean Delivery Following Implementation Of Enhanced Recovery After Surgery, Mindy Woodruff, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background With 47,600 opioid overdose related deaths in the U.S. in 2017, the opioid crisis is of national concern.1 Cesarean delivery is the most common surgery worldwide, with over 1.2 million in the U.S. in 2018 alone.2,3 As cesarean delivery is a highly prevalent surgery it has a large capacity to influence the opioid epidemic. Literature is showing that Enhanced Recovery after Surgery (ERAS) and multimodal analgesia are effective means of managing postoperative pain while minimizing opioid use.4,5,6,7,8 This project aims to help discover if introduction of ERAS, and more specifically it’s multimodal analgesia aspect, has helped decrease oral morphine …

Neostigmine Versus Sugammadex And The Relationship To Reintubation Rates In The Pacu, Delanie Urrutia, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Findings Discussion Reintubation in the post-anesthesia care unit (PACU) is a complication that may be related to residual neuromuscular blockade. Neostigmine and sugammadex have different pharmacokinetics that effect speed and completeness of reversal of paralysis. According to Tillquist et al. (2016) reintubation following general anesthesia in the PACU is associated with a 50% increased risk of mortality. Few studies have investigated the incidence rate of PACU reintubation and its possible relationship and choice of reversal medication.

Methods • Retrospective Observational Research Study. • This project was approved by the PSHMC Clinical Innovation and Research Council and deemed human subjects …