Anesthesiology Commons^™

Quality Improvement Initiative To Improve Adherence To Ob Hemorrhage Policy And Standardize Pitocin Administration During Cesarean Sections To Reduce Postpartum Hemorrhage Risk, Lauren R. Litz, Monica Blauser

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality, and Pitocin administration is an important component of hemorrhage prevention and management during cesarean delivery. Variation in Pitocin timing, dosing, method of administration, and adherence to evidence-based recommendations may compromise patient safety and create barriers to standardized obstetric anesthesia care. The purpose of this Doctorate of Nurse Anesthesia Practice quality improvement project was to evaluate current anesthesia provider practices for Pitocin administration during cesarean delivery, compare observed practices with the California Maternal Quality Care Collaborative hemorrhage toolkit and Society for Obstetric Anesthesia and Perinatology Enhanced Recovery After Cesarean recommendations, …

Improving Iv Access Outcomes In Obstetric Care Through A-Diva Scale Utilization And Point-Of-Care Ultrasound, Parth S. Patel, Matthew T. Komorowski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Obstetric (OB) patients frequently present physiological changes, including edema, obesity, and peripheral vasoconstriction, that increase the risk of difficult intravenous access (DIVA). Multiple IV attempts can delay time-sensitive therapies in obstetric emergencies and increase patient discomfort and provider workload. Research studies have supported the use of the Modified Adult Difficult Intravenous Access (A-DIVA) scale to assess patients for DIVA, and the use of point-of-care ultrasound (POCUS) guided peripheral intravenous access (PIVA). In 2025, a preceding Doctor of Nurse Anesthesia Practice (DNAP) project implemented A-DIVA in the Labor & Delivery (L&D) unit of an OB department and found that 35% of …

Assessing The Impact Of Interprofessional Simulation Training On Perioperative Staff's Confidence In Managing Maternal Hemorrhage, Mallory Duncan, Lidia Vazquez

Scholars Week

Globally, maternal mortality rates remain a critical public health challenge, often related to inadequate healthcare infrastructure in low-income countries. Yet according to the American Journal of Obstetrics and Gynecology (ACOG), maternal mortality rates in the United States are also on the rise, with nearly 32.9 deaths per 100,000 live births. These deaths are largely contributed to maternal hemorrhage (PPH), defined by ACOG as cumulative blood loss of at least 1,000 mL accompanied by symptoms of hypovolemia within 24 hours of the birth process. These findings underscore an urgent need to strengthen the training for perioperative staff in the management of …

Breastfeeding Safety Following Maternal Anesthesia: A Guideline Development, Megan Honea, Mary Johnson

Doctoral Projects

Recommendations regarding breastfeeding following maternal anesthesia are inconsistent and often not up to date with current best practice guidelines. Previous recommendations have led to mothers unnecessarily “pumping and dumping” breast milk has benefits for both mother and baby. These benefits include (a) increasing the infant’s access to colostrum, (b) encouraging mother-baby bonding, (c) improving the mother’s breastfeeding experience, (d) and providing significant health benefits to the infant. The purpose of this scholarly project was to develop a set of evidence-based recommendations that focus on mothers who desire to breastfeed following general anesthesia. These recommendations will highlight maternal- fetal transfer of …

Low Unintended Dural Puncture Rate Using A Flush-Measure-Check-Advance Technique To Perform Combined Spinal-Epidural Anesthesia In Parturients: A Quality Improvement Clinical Series, James Riopelle, Julie Gayle, Zubaer Anwar, Jeff Burton

School of Medicine Faculty Publications

Background: Reported rates of unintended dural puncture during performance of continuous epidural anesthesia (CEA) or combined spinal-epidural anesthesia (CSEA) have remained steady at approximately 0.5% to 1% since the 1970s. Methods: A modified method of inserting the Tuohy epidural catheterization needle was used during performance of CSEA in 393 parturients. A single staff/faculty anesthesiologist performed or supervised resident use of a flush-measure-check-advance Tuohy needle insertion algorithm. Results: The rate of evident Tuohy needle dural puncture during the series was 0%. One parturient experienced a post-dural puncture headache possibly because of intentional subarachnoid puncture with a very small diameter (25 gauge) …

Enhancing Patient Outcomes: Developing A Comprehensive Database For Tracking Post- Dural Puncture Headache Incidence And Contributing Factors, Meredith B. Auge, Brittany Bogonovich

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Post-dural puncture headache (PDPH) is a debilitating complication following labor analgesia, often resulting from unintentional dural puncture (UDP). While national incidence is approximately 1.5%, institutional rates may vary due to provider experience, documentation practices, and patient factors. This Doctor of Nurse Anesthesia Practice (DNAP) quality improvement project aimed to improve identification and monitoring of UDP and PDPH through a revised tracking tool, retrospective review of 2024 data, and planning for an electronic registry. A multidisciplinary team of anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), Student Registered Nurse Anesthetists (SRNAs), and IT and quality specialists revised an existing tracking tool to better …

Development And Implementation Of An Ob/L&D Sbar Framework To Enhance Communication Between Obstetric Nurses And Anesthesia Providers: A Quality Improvement Initiative, Jenna E. Bigam, Laina J. Uzarski

Doctor of Nurse Anesthesia Practice (DNAP) Manuscripts

Effective communication between obstetric (OB) nurses and anesthesia providers is critical to ensure patient safety during epidural placements in labor and delivery (L&D) settings. At a large teaching hospital, communication gaps were identified when OB nurses requested anesthesia for epidural placements without consistently providing vital patient information. The lack of structured communication can result in important details being overlooked, which may lead to delays in care and potential patient harm. To address this, the SBAR (Situation, Background, Assessment, Recommendation) communication framework was implemented to standardize and improve information exchange. This Doctorate of Nurse Anesthesia Practice (DNAP) project aimed to enhance …

A Case Report Of Disseminated Intravascular Coagulation After Intrauterine Fetal Demise., Gabrielle A Agcaoili, Kyriaki V Schooley, Elizabeth Johnson-Gray, Vincent Relli-Dempsey, Greeshma Allareddy

Women’s Health Articles

Disseminated intravascular coagulation (DIC) is a rare, life-threatening complication of pregnancy in which a hypercoagulable state develops secondary to the contact of tissue factor with circulating blood and causes widespread abnormal clotting. This pathological process disrupts normal blood flow, which can cause multi-organ dysfunction and is associated with very high maternal morbidity and mortality. Occurring in two phases, DIC begins with overactive clotting, which leads to the formation of blood clots within the vessels, and ultimately, the overactive clotting process uses up the body's stores of platelets and clotting factors. The most common obstetric cause of DIC is placental abruption, …

Implementation Of Guidelines For Preprocedural Ultrasound In Neuraxial Placement For Obstetric Patients With Scoliosis, Luther Nyirenda

Doctor of Nursing Practice Scholarly Projects

Neuraxial anesthesia including epidural, spinal, and combined spinal-epidural, is used with 65% of parturients in the United States for the management of pain and discomfort. Conventional landmark palpation has been the mainstay technique for neuraxial anesthesia, but unfamiliar spinal anatomy can lead to incomplete blockade or an increased incidence of complications. Scoliosis causes lateral curvature and rotation of the spine leading to arthritis and soft tissue changes that can present obscure anatomical landmarks, cause difficulty in needle passage, and result in inadequacy of local anesthetic efficacy. The literature illustrates that preprocedural ultrasound is recommended for needle placement in parturients with …

Volatile Anesthetic Exposure During Organogenesis (Weeks 6-9): Implications For Fetal Brain Development, Cheryce Daniel, Kylon Coombs

Rowan-Virtua Research Day

Organogenesis, particularly during gestational weeks 6 through 9, represent a critical window for fetal brain development. During this period, neurogenesis, neural tube closure and synaptic organization are actively occurring. Disruption of these processes, especially from exogenous agents, can result in lasting developmental consequences.

The U.S Food and Drug Administration has issued warnings regarding the use of anesthetic agents such as isoflurane, sevoflurane, and desflurane. Noting the potential risk of neurotoxic effects on the developing brain. This warning is particularly highlighted when administered drugs are present for long periods of time or during repeated procedures. The goal of this literature review …

Do Patients Who Receive Dexmedetomidine As An Adjunct To Spinal Anesthesia For Cesarean Delivery Achieve Longer Block Duration Compared To Those Who Receive Spinal Anesthesia With Local Anesthetic Alone?, Liana S. Garrison

Theses, Dissertations and Capstones

Problem Statement: Cesarean delivery is associated with significant postoperative pain, typically managed with spinal anesthesia using a local anesthetic. While opioids are often added as adjuncts, the addition of dexmedetomidine, an alpha-2 agonist, has emerged as a potential alternative that may enhance the efficacy of the spinal block in terms of pain management, potentially improving block duration and quality compared to local anesthetic alone.

Methodology: A literature review was conducted on the use of dexmedetomidine as an adjunct to spinal anesthesia for patients undergoing cesarean sections. Databases used for the search included PubMed, CINAHL Complete, and MEDLINE. The keywords used …

Does Esketamine In Cesarean Delivery Increase Postoperative Adversities And Related Diseases?, Cheryce Daniel, Kylon Coombs

Rowan-Virtua Research Day

Esketamine has emerged as a promising treatment option, particularly noted for its effectiveness in reducing postpartum depression, alleviating pain, and promoting faster recovery. Despite its therapeutic benefits, recent research has raised concerns regarding potential adverse effects associated with high doses of esketamine in patients. Specifically, there is growing interest in understanding the potential risks linked to the administration of esketamine during cesarean delivery, given its increasing use in obstetric anesthesia.

This comprehensive review aims to investigate the potential associations between the use of esketamine during cesarean delivery and the subsequent risk of related diseases or physiological disorders. The goal is …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …

The Analgesic Efficacy Of Ultrasound-Guided Transversus Abdominis Plane Block Vs. Local Anesthetic Infiltration Technique In Major Gynecologic Surgery: A Randomized Controlled Trial, Samina Ismail, Akbar A. Mistry, Ali S. Siddiqui, Aliya Aziz, Nadeem Zuberi

Department of Anaesthesia

Background and aim: Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial.
Material and methods: Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia …

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

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 …

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 …

Epidural Anesthesia For Cesarean Section For Parturient With Recently Diagnosed Asymptomatic Chiari Malformation Type I: A Case Report, Ashie Kapoor, Jon Halling

HCA Healthcare Journal of Medicine

Chiari malformations (CMs) are congenital defects of the brain and skull that result in inferior displacement of the cerebellum. There are four types of CMs distinguished by the severity of the anatomic defects and parts of the brain that protrude beyond the foramen magnum. Of these types, CM Type I (CMI) is the least severe. It is characterized by the downward displacement of the cerebellar tonsils beyond the foramen magnum by more than 5 millimeters and goes into the cervical spinal canal. CMI is the most common type with an incidence of 0.1-0.5% in the general population and a predominance …

Augmented Package Of Palliative Care For Women With Cervical Cancer: Responding To Refractory Suffering, Eric L. Krakauer, Khadidjatou Kane, Xiaoxiao Kwete, Gauhar Afshan, Lisa Bazzett-Matabele, Danta Dona Ruthnie Bien-Aimé, Lawrence F. Borges, Sarah Byrne-Martelli, Stephen Connor, Raimundo Correa

Department of Anaesthesia

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all …

Just Another Labor Epidural, Whitney King Do, William B. Smith

Anesthesiology

A 32 year-old healthy pregnant patient with no significant past medical history who presented to the hospital for delivery of fetus status post intrauterine fetal death. Vaginal delivery with epidural placement was initially the mother’s preference. Fetal movement last felt 4 days prior. The patients H&P and laboratory findings revealed early stages DIC. Patient underwent Caesarean delivery with general anesthesia, the OB physician found the patient to have Couvelaire uterus, a form of placental abruption. The patient’s uterus was atonic requiring multiple units of blood products. Case assessed indications for epidural placement versus general anesthesia.

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege L. Ersdal, Estomih R. Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter T. Wangwe, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif

Section of General Surgery

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health …

Post-Dural Puncture Posterior Reversible Encephalopathy Syndrome, Fauzia N. Minai, Syeda Fauzia Hasan, Mughis Sheerani

Department of Anaesthesia

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there …