Anesthesiology Commons^™

The Utility Of Thromboelastography In Acute Perioperative Trauma Resuscitation Of The Adult Coagulopathic Patient, Alexandra Sofia Keokosky

Nurse Anesthesia MSNA Student Capstones

One quarter of all patients admitted to level I trauma centers receive transfused blood, and approximately 25% of trauma transfusion recipients are diagnosed with coagulopathies during the resuscitation process (Hess et al., 2008; Kutcher & Cohen, 2021; Maegele et al., 2007). Such pathologies have been associated with negative clinical outcomes such as increased transfusion requirements, organ failure, sepsis, and death. (Barash et al., 2013; Cole et al., 2019; Hess et al., 2008; Sayce et al., 2020). Current laboratory standards of care to diagnose coagulopathies such as prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) are …

Effectiveness Of Ondansetron Prior To Spinal Anesthesia In Obese Parturients Undergoing Caesarean Delivery, Peter O. Lind

Nurse Anesthesia MSNA Student Capstones

Spinal anesthesia is the preferred route of anesthesia for parturients undergoing casesarean section (Hawkins et al., 2011). Parturients with obesity undergo caesarean delivery and have higher rates of initial intrathecal failure comparatively to non-obese (Hood, et al, 2015). Obesity is on the rise leading to a reconsideration as to the dosing of spinal anesthetic type (Dennis, 2017). Historically, the utilization of ondansetron, as a selective 5-HT3 antagonist, has been utilized prior to spinal administration to prevent the sympathectomy that can occur (Sahoo et al., 2012). This has decreased the utilization of vasopressors which can be detrimental to the fetus during …

Effects Of Intravenous Lidocaine Infusions On Postoperative Opioid Consumption In Adults Undergoing Laparoscopic Abdominal Surgery, Kayla Richardson

Nurse Anesthesia MSNA Student Capstones

Lidocaine is a local anesthetic that is often administered to surgical patients undergoing anesthesia. While it was originally utilized as an intravenous antiarrhythmic or for local infiltration, it is now frequently used for the proven opioid-sparing and anti-inflammatory effects during surgeries (Beaussier et al., 2018). A common complaint of postoperative patients is pain, and the administration of intravenous lidocaine can potentially decrease patients' perception of pain after surgical procedures (Lee & Schraag, 2022).

Opioids are commonly administered to patients to help control their pain immediately after surgical procedures. Though opioids are the typically chosen treatment for acute surgical pain, they …

Recurrence And Metastasis Of Breast Cancer After Volatile Inhalation Agents For Primary Cancer Resection, Elise Amico

Nurse Anesthesia MSNA Student Capstones

Surgical resection of a breast tumor is frequently a treatment option for cancer, and in some cases can be curative (Hurtado et al., 2021). Multiple factors increase the risk of metastasis or recurrence including the neuroendocrine stress response to surgery and manipulation of the tumor itself (Kim, 2018). Additional factors include depression of cell-mediated immunity including sympathetic nervous system (SNS) stimulation, hypothalamic-pituitary-adrenal (HPA) axis stimulation, and pain (Hurtado et al., 2021). Research suggests that anesthetic selection, particularly total intravenous anesthesia versus volatile inhalation anesthesia (IA), has an impact on cancer recurrence and metastasis in breast cancer patients, however it remains …

Objective Structured Clinical Examination For Intraoperative Hypotension And Hypertension Management, Andrew Mcginity, James David Ingram

Doctoral Projects

Managing intraoperative hypotension and hypertension is a non-technical skill anesthesia providers need to maintain patient safety. Upon transitioning from didactic training to clinical training, SRNAs may find it difficult to manage a patient’s blood pressure intraoperatively. The ultimate consequence of the delayed or improper treatment of intraoperative blood pressure perturbations is end-organ damage at the patient’s expense. Unintentionally causing a patient harm will lead to an SRNA losing confidence in their abilities. This OSCE is intended to increase SRNA confidence and competence regarding intraoperative hypotension and hypertension management before entering the clinical arena.

The hypotension and hypertension management tools and …

The Development And Implementation Of Evidence-Based Preanesthesia Assessment Tools For Lvad Patients Undergoing Non-Cardiac Procedures, Tracey Rooney, Casey Weimer, Eileen Giardino, Kerry Shanklin, Pete Pelletier, Audrey Rosenblatt

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Abstract

A university-affiliated tertiary medical center with a newly developed Advanced Heart Failure and Mechanical Circulatory Support program identified the need to implement a more systematic approach to the preanesthesia assessment process for patients with a Left Ventricular Assist Device (LVAD) undergoing noncardiac procedures and standardized guidelines to determine the best blood pressure monitoring system for patients with an LVAD during these noncardiac procedures. A multidisciplinary panel of clinical experts developed an LVAD Preanesthesia Toolkit using standard recommendations identified via evidence-based literature and expert opinion. The Toolkit included an LVAD Preanesthesia Assessment (VaPA) tool and an LVAD Blood Pressure Monitoring …

Reflection Of Mentors And Mentees At Initiation Of Faculty Mentorship Program At Aga Khan University: A Perspective, Rehana Rehman, Fauzia Khan, Naila Kayani, Tazeen Saeed Ali

Department of Biological & Biomedical Sciences

Objectives: To explore perception of mentors and mentees about 'Mentorship Program at Aga Khan University Medical College (AKU-MC) from a structured feedback form.
Methods: A retrospective study was conducted for evaluation of mentorship program at AKU-MC during the period from Jan 2019 to March, 2021. Responses on validated "Pre-intervention Probe Forms", from forty-seven mentors and fourteen mentees inducted in the program were reviewed. Confidentiality and anonymity of data were deliberated. All replies to each question were entered in a separate worksheet to determine the frequency and percentage of answers. Responses conveying same message, but worded differently were then grouped.
Results: …

Podium Presentation: Continuous Labor Epidural Placement Trends Among Parturients: An Evidence-Based Practice Project, Aleksandr A. Lyakhov, Teresa Bigand, Amanda Affleck, Kenn Daratha, Kris Daratha

2022 Providence Nurse Research Conference

Background:

Childbirth is very painful, and unmanaged pain may reduce patient satisfaction or lead to other complications. Evidence indicates that pain severity is lower among parturient women administered analgesia via a continuous labor epidural (CLE) and that maternal request is sufficient indication for CLE placement to manage labor pain. In some cases, a medical induction of labor may be scheduled, offering an opportunity for proactive pain management from hospital staff. Yet, trends on timing of CLE placement among parturient women with scheduled labor induction versus spontaneous labor in hospitals in Eastern Washington at one health system are unclear.

Purpose:

The …

Identifying Skin Integrity Issues In The Post Anesthesia Care Unit: A Qualitative Improvement Project, Lori Patten

2022 Providence Nurse Research Conference

No abstract provided.

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility And Acceptability Study, Joshua Carr

Dissertations

Background/Purpose: Interest in remifentanil patient controlled analgesia (RPCA) as a treatment for labor pain has increased due to its unique pharmacodynamics and effectiveness on pain control among parturients. Despite its promise, RPCA remains infrequently used in the US. The purpose of this study was to 1) examine the implementation and acceptability of a new RPCA protocol in the labor and delivery ward of a mid-sized hospital, and 2) identify the attitudes and beliefs of healthcare workers in a real-world clinical setting.

Theoretical/Conceptual Framework: The holistic nature of Comfort Theory can account for the proposed mechanisms contributing to the …

Identifying Facilitators And Barriers For A Successful Student Registered Nurse Anesthetist’S Clinical Experience, James Clancy, Adam Bruinius

Doctor of Nursing Practice Projects

Student registered nurse anesthetists experience a wide variety of barriers and facilitators to their clinical education; often rotating through several clinical sites during their nurse anesthesia educational program (NAEP) tenure. Existing evidence suggests SRNAs must be proficient in seeking, accepting, and utilizing feedback from clinical preceptors (Algiraigri, 2014). Accepting constructive criticism may be challenging for SRNAs as they are highly skilled, competent nurses who are now entering rigorous NAEPs as novices. Reverting from preceptor to preceptee can be a difficult transition for SRNAs. This project aimed to identify barriers and facilitators to a successful SRNA clinical education through a literature …

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.

Airway Management And The Hypoglossal Nerve Stimulator For Obstructive Sleep Apnea Patients, Chandler Barnes

Nurse Anesthesia MSNA Student Capstones

The pathophysiology of obstructive sleep apnea (OSA) relates to anatomical and non-anatomical factors. Anatomical considerations correlate to narrowing of the pharynx. When present, non-anatomical factors can intensify the severity of OSA and ease of collapsibility of upper airway tissue. The negative consequences of untreated OSA are well-defined and many treatment options are available. The novel hypoglossal nerve stimulator makes for a viable treatment option in patients who do not tolerate more traditional therapy, such as continuous positive airway pressure (CPAP), and meets eligibility requirements of device implantation as outlined by the Food and Drug Administration (FDA). The Inspire® Hypoglossal Nerve …

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five years. …

The Anxiolytic Effects Of Aromatherapy On Preprocedural Anxiety: An Integrated Review, Rebekah Smith

Senior Honors Theses

Anxiety before procedures can negatively impact patients by increasing cortisol levels which delays wound healing and increases infection risk, increasing pain and sedation medication needs, and increasing hospitalization time. This review was conducted to find how inhaled essential oils affect pre-procedural anxiety of adults in acute care settings. Nine databases and some gray literature were searched within the past ten years, and documented using the PRISMA flow chart. Ten articles fitting the inclusion criteria were retrieved. Nine of the articles found a significant difference between the aromatherapy group and control group and pre- and post- intervention anxiety scores, and none …

Efficacy Of Dexmedetomidine As An Opioid Sparing Adjunct To Regional Anesthesia For Shoulder Surgery, Matthew Austin

Nurse Anesthesia MSNA Student Capstones

Regional anesthetics are often the preferred route for patients who are having orthopedic shoulder procedures (Rai & Bhutia, 2017). Traditionally, plain local anesthetics, like bupivacaine or ropivacaine, are used as the local anesthetic of choice because of their fast onset and relatively predictable duration of action. However, several different additives have been trialed to prolong the duration or improve the density of regional blocks. When looking at additives to regional anesthetic techniques, side effects and duration of the block can be unpredictable and unpleasant. For example, additives like fentanyl, morphine, and dexamethasone have been trialed in regional techniques and have …

Do The Benefits Of Sugammadex Outweigh Its Higher Cost Compared To Neostigmine?, Ashley Mcdonald

Nurse Anesthesia MSNA Student Capstones

Neuromuscular blocking agents (NMBAs) are frequently utilized in anesthetic practice to relax the vocal cords in preparation for endotracheal intubation and to facilitate optimal operating conditions for various surgical procedures. Residual muscle paralysis in the postoperative period is a serious consequence of NMBAs that can lead to severe consequences including airway obstruction, hypoxia, reintubation, aspiration, and pneumonia. Neuromuscular blockade (NMB) is overcome either by spontaneous recovery or, in most cases, with the use of a reversal agent. Two of the most common reversal agents are neostigmine, a cholinesterase inhibitor, and sugammadex, a modified gamma-cyclodextrin. Of the two medications, sugammadex is …

The Impact Of Dexmedetomidine Use In Patients Over The Age Of 60 Undergoing General Anesthesia On Postoperative Delirium Incidence, Elaina Branco

Nurse Anesthesia MSNA Student Capstones

Postoperative cognitive dysfunction (POCD) and postoperative delirium (POD) are of concern in the elderly population undergoing an anesthetic due to increased mortality and decreased quality of life that can ensue. Sui et al. (2021) reported a 15-50% incidence of POD in elderly surgical patients. Dexmedetomidine is a highly selective, alpha-2 agonist with sedative, analgesic, and anxiolytic properties that mimics a sleep-like state and causes bradycardia and hypotension but not respiratory depression. Dexmedetomidine has neuroprotective properties, including anti-apoptosis and anti-inflammation (Wu et al., 2019). A current review of the literature revealed that dexmedetomidine use can decrease POD incidence in the aged …

Comparing Intravenous And Inhalation Anesthetics For Intraoperative Anesthesia In Adult Patients With An Acute Traumatic Brain Injury, Natasha K. Moody

Nurse Anesthesia MSNA Student Capstones

As research and science has progressed to further analyze the effects of anesthetics on cerebral physiology, the margin of safety for each anesthetic is reassessed to enhance patient outcomes and recovery. The purpose of this review is to strategically examine and provide updated information on the impact of specific anesthetics administered during the intraoperative period as it applies to patients with acute traumatic brain injury (TBI). In efforts to preserve the cerebral physiology of the patient, current research has identified benefits of administering intravenous over inhalation anesthetics to reduce secondary injuries that have been linked to chronic TBI, morbidity, and …

The Effect Of Clonidine On Hyperbaric Bupivacaine And Opioid In Cesarean Section Women Under Spinal Anesthesia, Novisi Abba

Nurse Anesthesia MSNA Student Capstones

Pain is undoubtedly one of the most undesirable outcomes associated with cesarean section in parturients. The most effective post-cesarean section pain relief option should prioritize maternal, fetal, and neonatal safety, with minimal to no medication transfer to the fetus and neonate. In obstetric anesthesia, neuraxial approaches, with the inclusion of adjuncts like clonidine for pain management may provide some additional benefits. Consequently, obstetric anesthesia practitioners have increasingly used intrathecal clonidine to alleviate post-cesarean section pain. This manuscript examines whether intrathecal clonidine, when combined with hyperbaric bupivacaine and/or opioids (fentanyl and/or preservative-free morphine), has a sustained analgesic effect in parturients following …

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed …

Implementation Of A Pre-Anesthesia Take-Home Evaluation (Pathe) As A Means Of Process Improvement: A Best Practice Recommendation, Russell Gray, Hunter Brown, Trey Galloway

Doctoral Projects

The pre-anesthesia evaluation (PAE) is a vital component to anesthesia providers when choosing an appropriate anesthetic plan for patients requiring surgery. The PAE, pre-anesthesia risk-factor assessment, and provision of pre-anesthesia instructions are standards of care implemented in order to assess the patient’s likely outcome of surgery and anesthesia as well as stratify any known risk factors to optimize surgical/anesthetic outcomes. Any disruption in this process could potentially lead to decreased patient/provider satisfaction, reduced patient compliance with pre-anesthetic instructions, reduced patient safety, and unnecessary financial burden.

After the completion of a literature review, the need for a best practice recommendation was …

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). …

Objective Structured Clinical Evaluation For Supraclavicular And Femoral Nerve Blocks Utilizing Ultrasound Guidance For Student Nurse Anesthetists, Mitchell Fowler, Christopher Bond

Doctoral Projects

The purpose of this DNP project was to create a tool to teach and evaluate student registered nurse anesthetists (SRNAs) at TheUniversity of Southern Mississippi (USM) on supraclavicular and femoral nerve blocks to promote safety in the clinical setting. An objective structured clinical evaluation (OSCE) for ultrasound-guided supraclavicular and femoral nerve blocks was created as the basis for this project. Best-practice techniques as identified by the AANA’s 14^thstandard of nurse anesthesia practice were researched and used in the development of the OSCE to promote a culture of safety for SRNAs and patients (AANA, 2019).

A culture of safety …

Creation And Implementation Of An Intraoperative Lidocaine Infusion Protocol For Gastric Surgery, Kayla Donnay, Eric Howard, Lindsey Krueger, Linda Mcdonald, Kyle Nelson

Conference Presentation Abstracts

Background: The recent opioid epidemic in the United States has damaged the country’s public health system and led to devastating patient outcomes. Healthcare providers are responsible to do their part in reducing these negative consequences. The purpose of this quality improvement project was to develop and implement an evidence-based protocol for an intraoperative lidocaine infusion during gastric surgery. The project consisted of five parts: (1) development of an evidenced-based Intraoperative Lidocaine Infusion Protocol, (2) education of the anesthesia team, (3) collection of baseline data, (4) implementation of the Intraoperative Lidocaine Infusion Protocol and (5) evaluation of the results. Method: Baseline …

Examining Enhanced Recovery After Surgery (Eras) Protocol Compliance, Joseph Vecore, Jonathon Baich, Linda Mcdonald

Conference Presentation Abstracts

Background: The development of enhanced recovery after surgery (ERAS) protocols have allowed for improved patient outcomes by utilizing a multimodal approach. The use of ERAS for surgical procedures reduces perioperative complications that could lead to increased morbidity, mortality, and length of stay. Additionally, by utilizing a multimodal approach, ERAS protocols help limit opioid use during the perioperative period. The purpose of this quality improvement project was to examine the rate of compliance to the ERAS protocol during colorectal surgery at Beaumont Hospital- Royal Oak. The different levels of compliance were evaluated for their effects on the following patient outcomes: opioid …

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 …

Eras Protocol For Lower Extremity Orthopedic Procedures, Tyler Mcdonald, Joshua Vaughn

Doctor of Nursing Practice Projects

The demand for total knee arthroplasty (TKA) and total hip arthroplasty (THA) will continue to rise as life expectancy increases. Coupling increased age with the increased prevalence of both obesity and osteoarthritis, the need for total joint arthroplasties is likely to increase (Oseka & Pecka, 2018). The frequency of arthroplasty procedures and the associated recovery period lead to heavy economic demands felt by most healthcare systems (Stowers et al., 2016). To address this burden, enhanced recovery after surgery (ERAS) protocols have been implemented at institutions and are designed to improve patient outcomes while simultaneously limiting cost and reducing readmission rates …