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Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini 2017 University of Southern Mississippi

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Nursing Capstone Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more common and may aid in reducing recovery and discharge times from the postoperative anesthesia care unit (PACU) as well as reducing overall costs. A retrospective chart review (N=176; 88 in propofol group and 88 in benzodiazepine and opioid group) was performed to determine if propofol sedation did reduce discharge times and decrease overall costs for the patient. Patients included in this study ...


Subanesthetic Ketamine For Pain Management In Hospitalized Children, Adolescents, And Young Adults: A Single-Center Cohort Study, K A. Sheehy, C Lippoid, A L. Rice, R Nobrega, Julia C. Finkel, Zenaide Quezado 2017 George Washington University

Subanesthetic Ketamine For Pain Management In Hospitalized Children, Adolescents, And Young Adults: A Single-Center Cohort Study, K A. Sheehy, C Lippoid, A L. Rice, R Nobrega, Julia C. Finkel, Zenaide Quezado

Anesthesiology and Critical Care Medicine Faculty Publications

1Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s Research Institute, Children’s National Health System, George Washington University School of Medicine and Health Sciences, 2Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, USA *These authors contributed equally to this work Background: Subanesthetic doses of ketamine, an N-methyl-D-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid ...


Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy 2017 Loma Linda University, School of Medicine

Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy

Loma Linda University Student Journal

No abstract provided.


In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel 2016 University of Southern Mississippi

In The Postoperative Cardiothoracic Surgical Patient Being Mechanically Ventilated, Is There A Difference In Outcomes When Comparing Sedation With Dexmedetomidine Versus Propofol?, Benjamin Heinrich Riebesel

Doctoral Nursing Capstone Projects

Patients undergoing a cardiothoracic operation typically require mechanical ventilation in the postoperative phase. Each year approximately 395,000 of these operations are performed in the United States alone. As many as 10% of these patients require reoperation within the first few hours of recovery due to complications (Barash & Cullen, 2013). This comprehensive review of the literature was performed to determine whether postoperative sedation with dexmedetomidine leads to better patient outcomes than sedation with propofol. Inclusion criteria included publications written in the English language, articles available in full text, articles written within the last 10 years, and publications with a focus ...


Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon 2016 University of Southern Mississippi

Optimizing Anesthesia Providers’ Timing Of Administration Of Dexamethasone For The Prevention Of Post-Operative Nausea And Vomiting: Translating Clinical Guidelines Into Practice, Tanner Young Mixon

Doctoral Nursing Capstone Projects

Research has shown that post-operative nausea and vomiting (PONV) is a significant contributing factor to extended recovery times and unwanted hospital admissions following ambulatory surgery. The purpose of this DNP project was to assess current practice regarding administration of dexamethasone for the prevention of PONV, provide information based on best practice guidelines, and assess willingness to change practice based on the guidelines set forth by the Society for Ambulatory Anesthesia (SAMBA). Administration of dexamethasone is aimed at decreasing the incidence of PONV, optimizing PACU times, and increasing patient satisfaction regarding perioperative care.

An electronic presentation and survey were emailed to ...


Adoption Of Perioperative Lidocaine Infusion For The Reduction Of Postoperative Pain, Brandon Scott Figueiredo 2016 University of Southern Mississippi

Adoption Of Perioperative Lidocaine Infusion For The Reduction Of Postoperative Pain, Brandon Scott Figueiredo

Doctoral Nursing Capstone Projects

Laparoscopic capability provides numerous benefits to patients requiring abdominal surgical procedures. However, the use of these techniques has presented the anesthesia provider with a unique set of challenges in terms of perioperative management and postoperative pain reduction. No standardized method has existed to reduce postoperative pain and improve recovery following these procedures. There were three primary goals of this project. The first goal was to conduct a meta-analysis of randomized controlled trials to determine the benefit of the use of intravenous lidocaine infusions to reduce postoperative pain in laparoscopic abdominal surgery. Twelve articles were included in the meta-analysis that pertained ...


Is Current Evidence That Avoidance Of Inhalation Agents And Opioids May Decrease Metastasis Strong Enough For Crnas To Show A Willingness To Change Practice?, Michael Wesley Tillman 2016 University of Southern Mississippi

Is Current Evidence That Avoidance Of Inhalation Agents And Opioids May Decrease Metastasis Strong Enough For Crnas To Show A Willingness To Change Practice?, Michael Wesley Tillman

Doctoral Nursing Capstone Projects

Metastasis following the surgical resection of primary site breast cancer is a medical issue, which plagues mastectomy patients. The intention of this project was to synthesize current literature in order to make a presentation and disseminate it to Certified Registered Nurse Anesthetists (CRNAs) in southern Mississippi and assess the providers' willingness to change practice. CRNAs took part in a Qualtrics survey after viewing a PowerPoint presentation of evidence regarding anesthesia and metastasis. The presentation illustrated the anesthetic techniques and pharmacological agents utilized, which either mitigate or potentiate a patient's risk for metastasis. The survey assessed for a willingness to ...


Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgicalpatients 65 Years Of Age Or Older, Simon Jack Gibson 2016 The University of Southern Mississippi

Evaluating The Likelihood Of Use Of Bispectral Index Guided Anesthesia As A Strategy To Reduce Postoperative Delirium In Surgicalpatients 65 Years Of Age Or Older, Simon Jack Gibson

Doctoral Nursing Capstone Projects

Postoperative delirium (POD) is the most common postoperative complication in the elderly, accounting for approximately $164 billion in costs per year in the United States (Inouye, Westendorp, & Saczynski, 2014, p. 911). This complication occurs in as many as 50% of elderly patients, but can be prevented as much as 40% of the time (Inouye et al., 2014). The use of processed encephalographic monitoring, such as Bispectral Index (BIS) monitoring, to guide anesthetic dosage is the single intraoperative intervention with enough evidence to support it as a recommendation for use to reduce POD (American Geriatrics Society, 2015). There were two parts ...


The Evaluation Of An Information Booklet In The Use Of Effective Patient Communication In The Setting Of Thoracic Anesthesia, Camille Guillot Miss, Gerry Keenan Dr 2016 University of Edinburgh, UK

The Evaluation Of An Information Booklet In The Use Of Effective Patient Communication In The Setting Of Thoracic Anesthesia, Camille Guillot Miss, Gerry Keenan Dr

Patient Experience Journal

Effective communication is crucial in assuring a good patient experience during an in-hospital stay. In some settings, such as thoracic anaesthesia, patients are given a heavy load of new complex information, in a very limited space of time. Written information, such as patient information booklets, could help as an aid memoir and improve patient’s subjective understanding and preparedness for procedures. This study aims to produce a booklet, specifically targeted at thoracic anaesthesia, and to evaluate it using a linguistics framework in relation to the patient experience and clinical communication. For the study, a booklet was produced in the context ...


Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt 2016 University of Nebraska Medical Center

Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt

Theses & Dissertations

Left ventricular diastolic dysfunction (LVDD) of the heart is a condition where the heart does not relax properly. This condition is important during times of stress, as LVDD is associated with significant morbidity of elderly surgical patients. LVDD is often asymptomatic and unrecognized as many of these patients have normal ejection fractions. However, LVDD may lead to heart failure in patients with preserved systolic function, with the incidence being as high as 50% in hospitalized elderly patients. The diagnosis of LVDD is an independent risk factor for postoperative major adverse cardiac events (MACE) and negatively impacts post-surgery readmission rates. Anesthesiologists ...


Long-Term Clinical Outcome Of Peripheral Nerve Stimulation For Chronic Headache And Complication Prevention, Linqiu Zhou, Avi Ashkenazi, Joseph W. Smith, Na Jen, Timothy R. Deer, Chen Zhou 2016 Thomas Jefferson University

Long-Term Clinical Outcome Of Peripheral Nerve Stimulation For Chronic Headache And Complication Prevention, Linqiu Zhou, Avi Ashkenazi, Joseph W. Smith, Na Jen, Timothy R. Deer, Chen Zhou

Department of Anesthesiology Faculty Papers

Background: Subcutaneous peripheral nerve stimulation (PNS) has emerged as a useful tool in the treatment of intractable headaches. However, complications such as skin erosion, infection and lead migration have adversely affected clinical outcome, and occasionally led to treatment cessation. Objectives: Here we report the results of peripheral nerve stimulator implantation performed on 24 patients with various chronic headaches at our center over a period of 9 years. We describe the complications of the procedure and their prevention with a modified surgical technique. Patients and Methods:We searched our database for patients with chronic refractory headacheswhohad undergone PNS. Patients were assessed ...


Malignant Hyperthermia, Aaron Roth 2016 Otterbein University

Malignant Hyperthermia, Aaron Roth

Master of Science in Nursing (MSN) Student Scholarship

Malignant hyperthermia is a rare disease trait and can take place in a variety of settings. If not treated in a timely manner, the consequences will be dire. It is recommended that nurses and other healthcare personnel be properly educated on MH crises. By detecting the signs and symptoms associated with the disease, providers can efficiently remedy the crisis and save patient lives (Seifert, 2014). Since the discovery of dantrolene in 1975 and the advancement of genetics regarding MH, death rates dropped from about 80% to about 5% (Schneiderbanger et al., 2014). Today there is a MH group called the ...


Effects Of Diabetes Mellitus And Chronic Kidney Disease On Major Outcomes In Patients Undergoing Cardiac Surgery, Mark W. Berguson, Jordan E. Goldhammer, Hong Liu, Rohinton Morris, Jianzhong Sun 2016 Department of Anesthesiology, Thomas Jefferson University Hospital

Effects Of Diabetes Mellitus And Chronic Kidney Disease On Major Outcomes In Patients Undergoing Cardiac Surgery, Mark W. Berguson, Jordan E. Goldhammer, Hong Liu, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

• Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). CKD typically manifests in late stages of DM.

• DM and CKD are prevalent in patients with cardiovascular disease.

• The impact of concurrent DM and CKD on major adverse cardiocerebral events (MACE) in patients undergoing cardiac surgery remains unclear.1,2

Objective:

To determine the effect of DM and CKD on major outcomes in patients undergoing cardiac surgery.


Effects Of Preoperative Aspirin On Major Outcomes In Graded High-Risk Patients Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Jordan E. Goldhammer, Jianzhong Sun 2016 Department of Anesthesiology, Thomas Jefferson University Hospital

Effects Of Preoperative Aspirin On Major Outcomes In Graded High-Risk Patients Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Jordan E. Goldhammer, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

  • Among patients with cardiovascular disease, nearly 70% take preventive aspirin.1
  • The benefits of aspirin are greater as a patient’s risk of cardiovascular events increases; patients with a lower risk of cardiovascular events derive less of a benefit from aspirin.2
  • The effect of aspirin in surgical patients has not yet been investigated, in particular if there is an optimal effect based on operative risk when undergoing cardiac surgery.

Objective:

To determine the effects of preoperative aspirin on major outcomes after cardiac surgery in patients with low, medium, and high predicted operative mortality as determined by the EuroSCORE ...


Preoperative Aspirin And Major Perioperative Outcomes In Patients With Hypertension Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Rohinton Morris, Jianzhong Sun 2016 Department of Anesthesiology, Thomas Jefferson University Hospital

Preoperative Aspirin And Major Perioperative Outcomes In Patients With Hypertension Undergoing Cardiac Surgery, Qian Ding, Eric Yuen, Mark Berguson, Hong Liu, Linong Yao, Rohinton Morris, Jianzhong Sun

Department of Anesthesiology Posters

Introduction:

  • Hypertension is prevalent in patients undergoing cardiac surgery and associated with a higher incidence of cardiovascular complications.
  • Aspirin has been shown to prevent cardiovascular events in patients with a high risk of cardiovascular disease.
  • Very few studies have investigated aspirin and hypertension, particularly its effects on major outcomes in hypertensive patients undergoing cardiac surgery.1,2

Objective

To determine the effects of preoperative aspirin on postoperative outcomes for patients with hypertension undergoing cardiac surgery.

To examine the impact of chronic kidney disease and heart failure superimposed with hypertension on outcomes after cardiac surgery.


Safety Culture In Cardiac Surgical Teams: Data From Five Programs And National Surgical Comparison., Jill A Marsteller, Mei Wen, Yea-Jen Hsu, Laura C Bauer, Nanette M. Schwann M.D., Christopher J Young, Juan A Sanchez, Nicole A Errett, Ayse P Gurses, David A Thompson, Joyce A Wahr, Elizabeth A Martinez 2016 Lehigh Valley Health Network

Safety Culture In Cardiac Surgical Teams: Data From Five Programs And National Surgical Comparison., Jill A Marsteller, Mei Wen, Yea-Jen Hsu, Laura C Bauer, Nanette M. Schwann M.D., Christopher J Young, Juan A Sanchez, Nicole A Errett, Ayse P Gurses, David A Thompson, Joyce A Wahr, Elizabeth A Martinez

Nanette M Schwann MD

BACKGROUND: Little is known about safety culture in the area of cardiac surgery as compared with other types of surgery. The unique features of cardiac surgical teams may result in different perceptions of patient safety and patient safety culture.

METHODS: We measured and described safety culture in five cardiovascular surgical centers using the Hospital Survey on Patient Safety Culture, and compared the data with the Agency for Healthcare Research and Quality (AHRQ) 2010 comparative database in surgery and anesthesiology (all types). We reported mean scores, standard deviations, and percent positive responses for the two single-item measures and 12 patient safety ...


Retrograde Epidural Catheter Relieves Intractable Sacral Pain, Ruchir Gupta, Shivam Shodhan, Amr Hosny 2016 New York Medical College

Retrograde Epidural Catheter Relieves Intractable Sacral Pain, Ruchir Gupta, Shivam Shodhan, Amr Hosny

NYMC Student Publications

Pain caused by tumor infiltration of the sacral area remains a major clinical challenge. Patients with poor pain control despite comprehensive medical management may be treated with neuraxial techniques such as continuous epidural or spinal anesthetic. We report a case in which a patient with metastatic breast cancer experienced inadequate pain relief after multiple intravenous pain management regimens as well as intrathecal (IT) drug delivery. The concentration of local anesthetics delivered via the IT catheter was limited due to the patient's baseline motor weakness which would be exacerbated with higher concentrations of local anesthetics. Thus, a decision was made ...


Effectiveness Of A New Method For Endotracheal Tube Pilot Balloon Repair, Amir C. Dayan, MD, Richard H. Epstein, MD 2016 Thomas Jefferson University Hospital, Philadelphia, PA

Effectiveness Of A New Method For Endotracheal Tube Pilot Balloon Repair, Amir C. Dayan, Md, Richard H. Epstein, Md

Department of Anesthesiology Posters

Introduction:

  • An intact pilot balloon is crucial to proper function of a cuffed endotracheal tube (ETT).
  • Failure of the pilot balloon or disruption of the inflation tubing results in cuff deflation which may lead to inadequate ventilation and aspiration of oropharyngeal secretions.
  • We describe a method that we employed using readily available components to repair a pilot balloon and inflation tubing, and report on the effectiveness of the repair method, as tested in vitro.


Sciatic Peripheral Nerve Blockade For Pain Control Following Hamstring Autograft Harvest In Adolescents: A Comparison Of Two Techniques, James Furstein 2016 Virginia Commonwealth University

Sciatic Peripheral Nerve Blockade For Pain Control Following Hamstring Autograft Harvest In Adolescents: A Comparison Of Two Techniques, James Furstein

Theses and Dissertations

Anterior cruciate ligament reconstruction utilizing a hamstring autograft is a surgical technique that has gained popularity among orthopedic surgeons caring for adolescent patients. While utilization of a hamstring autograft is a revered technique, harvest of the hamstring yields significant pain. Sciatic peripheral nerve blockade has proven to reliably provide analgesia at the hamstring donor site. Single-injection sciatic peripheral nerve blockade is considered a basic and effective technique, making its use following anterior cruciate ligament reconstruction standard practice in many institutions. The duration of action of a single-injection sciatic peripheral nerve blockade may fail to outlast the pain arising from the ...


Where Is Pain In The Brain?, Marshall Devor 2016 The Hebrew University of Jerusalem

Where Is Pain In The Brain?, Marshall Devor

Animal Sentience: An Interdisciplinary Journal on Animal Feeling

Key argues that fish cannot experience pain based on (1) brain imaging in humans, (2) consequences of lesions and (3) direct brain stimulation. Imaging indeed shows that pain-relevant signals reach the cortex, but not that they underlie the subjective experience of pain. Lesions and stimulation data are more to the point, but Key paints an idiosyncratic and misleading picture of their effects. S1 and S2 ablation does not eliminate evoked or spontaneous pain, although there may be up- or down-modulation. Likewise, stimulation of pain-associated cortical areas rarely induces pain, and pain almost never occurs at the onset of epileptic seizures ...


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