Anesthesia and Analgesia Commons^™

Availability Of Pain Medications For Npo Patients, Anna Augustin Do, Kyle Borodunovich Do, Sean Quinonez Do, Furqan Haq, My Myers Md

Family Medicine

In recent years, the opioid epidemic has been a key catalyst in changing the medical standards for treating both acute and chronic pain. Instead of relying heavily on narcotics for pain management, practitioners are not encouraged to adapt a non-pharmacologic, non-opioid approach to analgesia. While many guidelines have been set to standardize outpatient pain management, the rules surrounding inpatient analgesia are limited or lacking.

A Case Of Cannot Intubate, Cannot Ventilate, Evan Davidson Md, Su Min Oon

Anesthesiology

69M with a PMH of parotid gland carcinoma status post resection and radiation therapy with extensive reconstruction, G-tube placement, COPD, multiple tracheostomies with takedowns (with refusal permanent tracheostomy over objections of family members) presented for CTR and ulnar tunnel exploration. With plans of MAC, an axillary block was placed and maintained on minimal propofol infusion. After administration of 50 mcg fentanyl due to pain, he was noted to be apnic. Ventilation via mask and #3 LMA failed, as well as placement of an 6 mm ET tube. Eventually, patient was ventilated via emergency surgical cricothyroidotomy. He was discharged on POD4.

The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava

Evidence-Based Practice Project Reports

The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient outcomes, …

Comparison Of Post-Operative Pain Control Modalities For Pectus Excavatum Repair, Charlene Dekonenko

Presentations

This study compares patient outcomes following pectus excavatum repair using cryoablation, epidural, or patient-controlled analgesia for post-operative pain control. Primary outcome: length of stay
Secondary outcomes: operative time, pain scores, time to only oral analgesics.
Conclusion: Intercostal cryoablation during minimally invasive pectus excavatum repair significantly reduces length of stay and time to oral analgesics alone.

Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education …

Children And Their Parents’ Assessment Of Postoperative Surgical Pain: Agree Or Disagree?, Olivia Kaminsky, Michelle Fortier, Brooke N. Jenkins, Robert S. Stevenson, Jeffrey I. Gold, Jeannie Zuk, Brenda Golianu, Sherrie H. Kaplan, Zeev N. Kain

Psychology Faculty Articles and Research

Objective

The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration.

Methods

This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain …

Pain Management For Intrauterine Device Insertion And Endometrial Biopsy, Michelle Lipton-Carroll

Evidence-Based Practice Project Reports

Intrauterine device (IUD) insertions and endometrial biopsies (EMB) can be painful in office gynecological procedures. In the clinical setting used for this evidence-based project (EBP) it was noted there was no consistent pain management being used for these procedures. For this EBP project a protocol for pain management during IUD insertions and EMBs was developed and implemented into this clinical setting. The protocol was created from an exhaustive literature search, which yielded six pieces of high-level evidence of good quality. The evidence supported the use of a 1% lidocaine paracervical block prior to IUD insertion and a 2% lidocaine intrauterine …

Changing Healthcare Provider And Parent Behaviors In The Pediatric Post‐Anesthesia‐Care‐Unit To Reduce Child Pain: Nurse And Parent Training In Postoperative Stress (Np‐Tips), Brooke N. Jenkins, Michelle Fortier, Robert S. Stevenson, Mai Makhlouf, Paulina Lim, Remy Converse, Zeev N. Kain

Psychology Faculty Articles and Research

Background

Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.

Methods

In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents …

Pediatric Erythromelalgia Treated With Epidural Ropivacaine Infusion, Caroline E. Lee, Kelly Paulk, Kristen Garvie, Elizabeth Grieshaber, Jeffrey Carter, Brian Ball

School of Medicine Faculty Publications

No abstract provided.

Npo Or Ama? Patients Allowed Clear Liquids Up To 2 Hours Pre-Procedure Have Equivalent Aspiration Risk And Increased Patient Satisfaction, Erich Smith

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Itou K, Fukuyama T, Sasabuchi Y, et al. Safety and efficacy of oral rehydration therapy until 2 h before surgery: a multicenter randomized controlled trial. Journal of Anesthesia. 2012;26(1):20-27. doi: 10.1007/s00540-011-1261-x.

Development Of A Descriptive Model Of Flow Disruption Effect On Bypass Time In A Cardiovascular Operating Room, Timothy J. Disher

Doctoral Dissertations and Master's Theses

The current paper proposes utilizing extant flow disruption data, collected from two cardiovascular operating rooms, and utilizing that to develop a mathematical model. Of particular interest is bypass time which is a critical surgical phase, the length of which has been linked to post-operation complications such as hospital-borne infections and readmission. By developing a model that predicts bypass time, the present research can determine the impact by types of flow disruptions – coded based on the RIPCHORD-TWA taxonomy, team member disrupted, and where in the surgery the FD occurs.

After a review of literature, a variety of models were explored …

Protecting Patients Who Lack A Voice, Rainer Spiegel

Animal Sentience

Neither human young today nor future human generations nor non-human species have a voice in protecting the biosphere. Treves et al. propose courts and trustees for defending their interests. I describe an analogy with attempts to represent the interests of children and comatose patients in medicine.

Non-Human Animals Providing Rescue In Medical Emergencies, Rainer Spiegel

Animal Sentience

In their target article, Chapman & Huffman challenge the quotation of Sir William Osler that the desire to take medication distinguishes humans from non-human animals. They provide examples of self-medication in non-human animals. Based on these examples, it can be inferred that non-human animals practice at least some form of medicine for symptom control. I would like to extend this view by showing that non-human animals not only provide self-medication, but also rescue others facing emergencies.