Anesthesiology Commons^™

The Influence On Morbidity And Mortality When Blood Products Are Transfused Using Conventional Coagulation Tests Versus Teg Or Rotem In Trauma Patients Perioperatively, Teresa Diana Kelley

Theses, Dissertations and Capstones

Abstract: Coagulopathy in trauma patients occurs due to tissue injury, hemodilution (dilution of hematocrit and clotting factors), infusion of hypo-coagulable blood products (e.g., packed red blood cells), acidosis, hypothermia, continued blood loss, and depletion of clotting factors. The onset of coagulopathy begins with the initial tissue injury and evolves rapidly. Many factors need consideration when determining resuscitative treatment for the trauma victim. These factors include the amount of time for extraction from the field, transport time to a trauma center, associated weather, and treatment provided in route. This study compared two clinical laboratory pathways (Conventional Coagulation test and Rotational Thromboelastometry …

An Evaluation Of Critical Resources In Nurse Anesthesia Educational Programs, Lois E. Stewart

Theses and Dissertations

Advanced practice nurses fill a vital need in the U.S. by increasing access to needed healthcare. Certified Registered Nurse Anesthetists (CRNAs) are one type of advanced practice nurse with a long history of safe and effective peri-anesthetic care. Nurse anesthetists have a rich tradition of providing anesthetic care for rural and underserved communities, and are a primary provider of anesthesia for active and retired military personnel. CRNAs comprise over one-half of the actively practicing U.S. anesthesia workforce currently, and are able to function in any anesthetic care model. Nurse anesthesia educational programs (NAEPs) are the single source for new graduate …

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 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 …

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

Doctoral 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 …

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 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 …

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

Doctoral 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 …

Malignant Hyperthermia, Aaron Roth

Nursing Student Class Projects (Formerly MSN)

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 …

The Effectiveness Of An Anesthesia Handoff Tool: An Electronic Health Record Application To Enhance Patient Safety, Karen Gillikin, Nathaniel Apatov

Ellmer School of Nursing Faculty Publications

Perioperative patient care handoffs are complex and multidimensional and require accurate attention to detail. Communication failures among healthcare providers increase the risk of morbidity and mortality. Utilizing a standardized handoff tool located within the electronic anesthesia record formalizes the handoff process and improves patient safety. Prior to the introduction of the Electronic Anesthesia Handoff Tool, 82 patient care transfer observations were conducted; subsequent to the launch of the tool, 75 patient care transfer observations were conducted, and then before and after comparisons were made. Descriptive statistics, a two-tailed t-test, and Spearman’s correlations were conducted. Alpha level was set at p < 0.05. There were significantly (p< .05) fewer errors made in all categories of patient information following the introduction of the Electronic Anesthesia Handoff Tool. Though there were trends towards more omissions occurring after 3:00 p.m., the difference in most patient information categories was not significant (p< .05). In addition, there were no differences in omissions related to the severity of patient co-morbidities based on patients’ American Society of Anesthesiologists physical status classification. This study provided information regarding the incidence of patient information inaccuracies and omissions during patient care transfer before and after implementation of an electronic patient care transfer tool.

The Incidence Of Early Stage Postoperative Nausea And Vomiting Following The Use Of Nitrous Oxide And Prophylactic Antiemetic Therapy: Implications For Clinical Practice, James Sullivan

Doctoral Projects

Nitrous oxide (N₂O) is a volatile agent currently used during the induction and maintenance of general anesthesia. Since it’s discovery in 1786 by Dr. Priestly, it is the oldest volatile agent to find continued use in current practice (Kossick, 2014). In conjunction with its extensive history is the debate regarding its emetic properties. Numerous studies have investigated the effect of nitrous oxide to produce postoperative nausea and vomiting (PONV) with varying and often conflicting results. Generally speaking, nitrous oxide is theoretically an emetic and is believed to be associated with PONV (Tramer, Moore, & McQuay, 1996). This has …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

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; …

Turning Up The Heat On Malignant Hyperthermia, Katie Carroll

Nursing Student Class Projects (Formerly MSN)

Surgeries are common, everyday procedures within the walls of America’s hospitals. According to Orser, Mazer, and Baker (2008), more than forty million patients in North America are given anesthetics annually. One of the major complications of anesthesia is malignant hyperthermia: a hyper-metabolic state that affects skeletal muscles. If left uncontrolled, malignant hyperthermia can cause multiple reactions within the body leading to metabolic and respiratory acidosis, cardiac dysrhythmias, kidney failure, coagulopathy, neurologic injury, and ultimately death (Seifert, Wahr, Pace, Cochrane, & Bagnola 2014). The incidence of this condition is estimated to be 1:15,000 in children and 1:20,000-50,000 in adults (Redmond, 2001). …

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

Nurse Anesthesia MSNA 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 …

Understanding And Treating Emergence Delirium, Peter Currie

Nurse Anesthesia MSNA Student Capstones

This paper examines our current understanding of the phenomena of emergence delirium, which can occur following general anesthesia. Much research has been conducted to elucidate the causative factors of this condition, with findings ranging from anxiety to volatile agents and the neurodevelopment of the brain (Aono, Ueda, & Mamiya, 1997; Kain et al., 2004; McLott, Jurecic, Hemphill, & Dunn, 2013). While much of our understanding of emergence delirium has come from studying children, who are more prone to this condition, we can attempt to learn even more by examining the increased incidence of emergence delirium that occurs in those with …

Assessment Of The Preoperative Assessment: A Case Study, Steven James Birchenough

Nurse Anesthesia MSNA Student Capstones

The geriatric population defined as individuals 65 years of age or older is expected to increase to 20% of the total population by the year 2020. This population currently makes up one-third of the surgical population and is projected to double by 2020. The perioperative risks for this population are also increased and pose significant increases in morbidity and mortality. The need for a detailed preoperative assessment is crucial in any surgical patient. It is increasingly imperative for the geriatric surgical patient as assessment is vital for the surgical team to make decisions regarding the projected necessity, plan and desired …

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

Nurse Anesthesia MSNA 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.

Detection And Treatment Of Hemorrhage In The Postoperative Patient, Vanessa M. Derosby

Nurse Anesthesia MSNA Student Capstones

Hemorrhage is a devastating event that can occur in the perioperative period. It is estimated that 2.35 in 1000 patients will experience hemorrhage associate with surgery. Adverse outcomes affecting patient morbidity, mortality and quality of life are associated with hemorrhage. Timely detection, diagnosis and appropriate intervention in the setting of hemorrhage are imperative to reduce adverse outcomes of shock such as end organ damage, chronic disability or death. Anesthesia practitioners hold the charge of monitoring and managing the patient’s hemodynamic status and play an integral role in the detection and management of the hemorrhaging patient.

Opioid-Induced Hyperalgesia, Lisa Nieder

Nurse Anesthesia MSNA 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 MSNA 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 …

Inhalation Anesthesia Vs. Total Intravenous Anesthesia For Ambulatory Dental Surgery In Children, Kristin D. Neal

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to compare inhalation anesthesia with sevoflurane versus Total Intra Venous Anesthesia (TIVA) with propofol infusion as it relates to the quality of recovery including postoperative pain, Post Operative Nausea and Vomiting (PONV), and Post Anesthesia Care Unit (PACU) Length Of Stay (LOS) in pediatric patients undergoing ambulatory dental surgery. Introduction: Pediatric dental procedures are increasingly performed in an outpatient setting under general anesthesia due to inadequate cooperation, circumstantial anxiety, and other behavioral and health issues. Commonly used inhalation anesthetics, such as sevoflurane, can induce hyperalgesia in children. While sevoflurane increases the risk PONV, …

Malignant Hyperthermia, Chase Contri

Nursing Student Class Projects (Formerly MSN)

Although very rare, occurring one out of every 100,000 anesthesia cases, malignant hyperthermia is a hypermetabolic disorder that anesthesia providers screen and interrogate patients prior to every case they are administering anesthesia. Many research studies about anesthesia induced malignant hyperthermia have explored new methods of testing for the genetic susceptibility for malignant hyperthermia and into hospital based protocols when a patient starts to show the signs and symptoms of the metabolic disorder. This new knowledge and understanding has decreased patient mortality of anesthesia induced malignant hyperthermia from eighty percent to five percent over the past three decades (Rosenberg et al, …

Malignant Hyperthermia, Devin Poncsak

Nursing Student Class Projects (Formerly MSN)

A crisis of malignant hyperthermia is a medical emergency, and must be treated immediately with a coordinated, multidisciplinary team response in order to give the patient the highest chance for a successful recovery (Dirksen, Van Wicklin, Mashman, Neiderer, & Merritt, 2013). Malignant hyperthermia is defined by Bandschapp & Girard (2012), as “a disturbance of the skeletal muscle calcium homeostasis, triggered by volatile anaesthetics and depolarizing muscle relaxants.” Once a vulnerable patient is exposed to one of these triggering agents, a pathologic hypermetabolic response ensues, and the patient has a rapid increase in oxygen consumption and expired carbon dioxide, hyperthermia, acidosis, …

Pseudocholinesterase Deficiency, Ross Gerken

Nursing Student Class Projects (Formerly MSN)

Pseudocholinesterase deficiency is a rare genetic or acquired variation in the metabolism of choline esters such as the neuromuscular blockers succinylcholine, mivacurium, and ester local anesthetics. Pseudocholinesterase deficiency genetically is transmitted in an autosomal recessive pattern with the frequency of apnea from a genetic abnormality of pseudocholinesterase between 1:480 and 1:3200 people (Ok et al., 2013). An extended period of neuromuscular blockade results from these medications than what is clinically expected. The signs and symptoms which occur are apnea and paralysis hours longer. This condition is rare but must be known and understood by the clinician in order to provide …

Secondhand Smoke Exposure As A Risk Factor For Perioperative Airway Complications In Pediatric Outpatient Procedures, Ashlee Denise Loudin

Theses, Dissertations and Capstones

Abstract: The purpose of this study is to assess the risk of perioperative airway complications, analyze extubation times, and PACU Length Of Stay (LOS), and their association with secondhand smoke exposure in pediatric populations receiving outpatient procedures that require general anesthesia.

Introduction: Tobacco Smoke Exposure (TSE), is well documented to cause physiologic changes in lung tissue that are associated with decreased lung function, increased risk of lower and upper respiratory tract illness, exacerbation of asthma or increased risk of asthma, increased prevalence of non-allergic bronchial hyperresponsiveness, sudden infant death syndrome, and a host of other respiratory complications in adult and …

In Children And Elderly Patients, What Are The Effects Of General Anesthesia On Neurological Health Compared With Procedural Sedation?, Taylor G. Caldwell

Theses and Dissertations

Anesthesia has been a necessity in the field of health care since it was discovered in the early to middle 1800s. Before anesthesia, many procedures and surgeries that are now considered an easy fix were life-threatening and patients often chose the inevitable death over the pain of surgery. The idea was stumbled upon when "laughing gas," nitrous oxide, was inhaled and credited in "produc[ing] a state of intoxication during which people became highly amused and insensitive to pain" (Palo Alto, 2013, para. 2). Anesthesia has come an unbelievably long way since the first surgery under anesthesia was performed by Dr. …

Improving Anesthesia Professional Adherence To Hand Hygiene, Martha E. Seneca

UNF Graduate Theses and Dissertations

Performance of hand hygiene is among the most effective means of preventing healthcare associated infections (HAI) among patients. Deaths resulting from HAIs are one of the top ten leading causes of death in the United States. Any improvement in the frequency of hand hygiene among healthcare professionals may have a direct impact on patient mortality and associated costs. While anesthesia professionals have been found to have low rates of hand hygiene adherence, few targeted studies seeking to improve hand hygiene adherence among this group exist. Studies conducted to improve hand hygiene among health care professionals have reported limited improvement, with …

Anesthesia Safety: Filter Needle Use With Glass Ampules, Debran L. Harmon

UNF Graduate Theses and Dissertations

Glass particle contamination of medication occurs when opening ampules which may cause patient harm. The use of filter needles reduces this risk. Many anesthesia providers use ampules daily, but do not use filter needles when aspirating medications from ampules. In addition, filter needles may not be readily available at the anesthesia medication preparation site. Not using filter needles or having them available for use can increase the risk of patient harm by glass particle contamination. The purpose of this project was to increase anesthesia provider’s knowledge thereby improving compliance with evidence-based standards when preparing medications from ampules. The goal is …

Increasing Practitioner Knowledge Of Ketamine As An Adjunct Analgesic For Postoperative Pain, Allison Goldfarb

UNF Graduate Theses and Dissertations

Postoperative pain is of serious concern to patients and anesthesia providers alike. Management of a patients’ pain is a central component of anesthesia care. Ketamine as an anesthetic agent has been available for 50 years. It has been utilized as a general anesthetic and selectively as an anesthetic agent for high-risk patients. Due to dysphoric side effects associated with the dosage required to render general anesthesia, anesthesia providers may be reluctant to utilize this medication to its full potential. Recently there has been a resurgence of interest in ketamine as an analgesic agent. The researcher for this project performed a …

The Effect Of An Educational Intervention On The Knowledge And Management Of Ponv Among Anesthesia Providers: A Pilot Study, Eleazar Comprendio, Juan E. Ruan, Mohammad Zyed, Julie Lamoureux, Feliciano Villalba

All Publications

No abstract provided.