Anesthesiology Commons^™

The Effects Of Pain On Informed Consent, Bryan Aja

Nurse Anesthesia MSNA Student Capstones

It is common for providers to withhold pain medication as opposed to treating pain prior to obtaining informed consent due to the concern of invalid informed consent. Pain’s influence on cognition can significantly impact the cognitive domains required to obtain valid informed consent. Determining if a patient has the capacity or competence to participate in the informed consent process has medical, ethical, and legal implications. The medical use of competence and capacity is not equivalent to the legal use of the same terminology. Legal implications concerning consent include signing consent while in duress or pain, signing under the influence of …

Clinical Performance And The Student Registered Nurse Anesthetist, Alyson Cronan

Nurse Anesthesia MSNA Student Capstones

The clinical component of graduate nurse anesthesia programs continues to be the key factor in evaluating and ensuring student success. Clinical experience has a direct correlation on student development in areas of self-awareness, psychomotor proficiency, critical thinking and professionalism. To effectively create a positive and motivating learning environment for the student registered nurse anesthetist (SRNA), the literature recommends instructors theoretically adapt to the individual learning style of the student, and incorporate various teaching techniques and modalities clinically. The overall goal of the clinical rotation is to establish an atmosphere where an individual can modify learning and skills. Positive, respectful and …

Prophylactic Phenylephrine Infusion Versus Bolus Regimens During Spinal Anesthesia For Cesarean Section, Safira Iddriss

Nurse Anesthesia MSNA Student Capstones

Hypotension is a well-recognized phenomenon associated with any spinal anesthesia. It is most particularly evident in the parturients as a higher block is required for cesarean section (C-section) (Nagelhout, 2014). These populations are also more prone to the effect of sympathectomy because of decreased sensitivity to endogenous vasoconstrictors in addition to increased synthesis of endothelium vasodilators (Miller, 2009). Sympathectomy results in hypotension and other adverse effects such as nausea and vomiting. Many studies over the decades have examined the best management option for the hypotension. This review seeks to determine the best management regimen for the use of the vasopressor …

Manual Trans-Tracheal High Frequency Positive Pressure Ventilation For Left Main Bronchus And Carinal Mass Surgical Resection In A Child, Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid

Department of Anaesthesia

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was …

Pharmacology, Pharmacokinetics, And Metabolism Of The Dna-Decoy Ayx1 For The Prevention Of Acute And Chronic Post-Surgical Pain, Julien Mamet, Scott Harris, Michael Klukinov, David C. Yeomans, Renee R. Donahue, Bradley K. Taylor, Kelly Eddinger, Tony Yaksh, Donald C. Manning

Physiology Faculty Publications

Background: AYX1 is an unmodified DNA-decoy designed to reduce acute post-surgical pain and its chronification with a single intrathecal dose at the time of surgery. AYX1 inhibits the transcription factor early growth response protein 1, which is transiently induced at the time of injury and triggers gene regulation in the dorsal root ganglia and spinal cord that leads to long-term sensitization and pain. This work characterizes the AYX1 dose-response profile in rats and the link to AYX1 pharmacokinetics and metabolism in the cerebrospinal fluid, dorsal root ganglia, and spinal cord.

Results: The effects of ascending dose-levels of AYX1 on mechanical …

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 intake. However, less is …

Robert Reynolds Macintosh, M.D. (1897-1989): Forefather Of Anesthesiology, Advocate For Patient Safety., Haig Minassian, Scott W. Cowan, Charles J. Yeo

Department of Surgery Gibbon Society Historical Profiles

No abstract provided.

Ultrasound-Guided Vascular Access: An Evolving Standard Of Care Clinical Practice, Which Is Extremely Under-Utilized In Pakistan, Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai

Department of Anaesthesia

No abstract provided.

Endothelin Signaling In Bone, Jasmin Kristianto, Michael Johnson, Rafia Afzal, Robert D. Blank

Department of Anaesthesia

The endothelin (ET) system includes 3 small peptide hormones and a pair of G-protein-coupled receptors. This review first outlines the ET signaling pathway and ET metabolism. Next, it summarizes the role of ET1 signaling in craniofacial development. Then, it discusses observations relating ET signaling to osteoblastic and other osteosclerotic processes in cancer. Finally, it describes recent work in our laboratory that points to endothelin signaling as an upstream mediator of WNT signaling, promoting bone matrix synthesis and mineralization. It concludes with a statement of some remaining gaps in knowledge and proposals for future research.

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety At A Tertiary Hospital In Kenya: A Cohort Study, Anthony Kamau, Vitalis Mung’Ayi, Gerald Yonga

Anaesthesiology, East Africa

Background: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction.

Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.

Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and …

Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar

Department of Anaesthesia

No abstract provided.

Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai

Department of Anaesthesia

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and …

Emerging Protagonists In Cancer Metastasis: An Oath Of Allegiance By Platelets, Akbar Shoukat Ali, Arzoo Ajaz, Heeba Hamid

Department of Anaesthesia

No abstract provided.

Physical Manipulation Of Larynx As A Technique For Insertion Of Nasogastric Tube, Sheema Siraj, Mehmood Mian, Fauzia Anis Khan

Department of Anaesthesia

No abstract provided.

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy

Loma Linda University Student Journal

No abstract provided.

Anesthesia Duration As An Independent Risk Factor For Early Postoperative Complications In Adults Undergoing Elective Acdf., K. Phan, J. S. Kim, J. H. Kim, S. Somani, J. Di'capua, J. E. Dowdell, S. K. Cho

Journal Articles

Study Design: Retrospective study.

Objective: To determine the presence of any potential associations between anesthesia time with postoperative outcome and complications following elective anterior cervical discectomy and fusion (ACDF).

Methods: Patients who underwent elective ACDF were identified in the American College of Surgeons National Quality Improvement Program database. Patient demographics, medical comorbidities, and perioperative and postoperative complications up to 30 days were analyzed by univariate and multivariate analysis.

Results: A total of 3801 patients undergoing elective ACDF were identified. Patients were subdivided into quintiles of anesthesia time: Group 1, 48 to 129 minutes (n = 761, 20%); Group 2, 129 …

Intraoperative Administration Of Intravenous Acetaminophen At Induction Or End Of Surgery And Its Relationship With Opioid Consumption And Pain Scores, Spencer Davis Greenwood

Theses, Dissertations and Capstones

Obesity has become increasingly prevalent in the United States. Bariatric surgeries have increased as the prevalence of obesity has risen, providing an effective alternative to weight loss. Intravenous acetaminophen (IVA) is a safe and effective non-opioid medication that can be given without the risk of respiratory or cardiac complications. Research has shown that the use of IVA during surgery can improve postoperative pain scores, reduce opioid requirements, and improve patient satisfaction.

A retrospective cohort study of 200 patients (100 per group) undergoing laparoscopic bariatric surgery (LBS) was performed. Statistical analysis was used to determine the relationship between those who received …

What Is The Relationship Of Increased Intraocular Pressure And Body Mass Index In Patients Undergoing Robotic Prostatectomy In Sleep Trendelenburg Position?, Seth Parsons

Theses, Dissertations and Capstones

Introduction: Robotic Prostatectomy is a common procedure performed in surgery centers all over the world, but these procedures can be long and difficult to manage for Anesthesia providers. This study examined the relationship between increased intraocular pressure (IOP) and Body Mass Index (BMI) during Robotic Prostatectomies in Steep Trendelenburg (ST) position. Other variables studied were length of procedure, age, and ASA physical classification.

Methodology: The study was a retrospective cross-sectional design of 100 patients with a BMI over 30 and 100 patients with a BMI under 30 who have undergone Robotic Prostatectomies at Charleston Area Medical Center (CAMC) between …

Does Rotem-Guided Therapy Influence Postoperative Chest Tube Output In On-Pump Cabg?, Preston Franklin Woodburn-Camp

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to identify the association between ROTEM-guided therapy and chest tube output in patients who have undergone elective on-pump CABG.

Introduction: In open heart surgery, there are a variety of ways that coagulation disturbances occur, such as hemodilution of coagulation factors and platelets, a reduction in coagulation factors due to the use of cardiopulmonary bypass the administration of the anticoagulant heparin, and altered temperature. Severe bleeding is frequently associated with open-heart surgery, especially on-pump coronary artery bypass grafting (CABG). Thromboelastometry using rotational thromboelastometry (ROTEM) is a point-of-care testing that can show specific defects in …

Application Of Incident Command Structure To Clinical Trial Management In The Academic Setting: Principles And Lessons Learned, Penny S. Reynolds, Mary J. Michael, Bruce D. Spiess

Anesthesiology Publications

Background

Clinical trial success depends on appropriate management, but practical guidance to trial organisation and planning is lacking. The Incident Command System (ICS) is the ‘gold standard’ management system developed for managing diverse operations in major incident and public health arenas. It enables effective and flexible management through integration of personnel, procedures, resources, and communications within a common hierarchical organisational structure. Conventional ICS organisation consists of five function modules: Command, Planning, Operations, Logistics, and Finance/Administration. Large clinical trials will require a separate Regulatory Administrative arm, and an Information arm, consisting of dedicated data management and information technology staff. We applied …

Does Perioperative Angiotensin-Converting Enzyme Inhibitor Therapy Correlate With Increased Use Of Vasopressors During Posterior Lumbar Interbody Fusion Versus Those Not Receiving Angiotensin-Converting Enzyme Inhibitor Therapy: A Retrospective Study, Joshua Ross

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to evaluate if patients who took Angiotensin Converting Enzyme (ACE) inhibitors the morning of surgery for Posterior Lumbar Interbody Fusion (PLIF) required more treatment for intraoperative hypotension.

Introduction: PLIF is a surgical procedure used to correct spinal disorders that include compression, instability, pathological lesions, deformities, and pain. PLIF is completed utilizing the prone position for optimal access to the lumbar spine. Complications associated with prone position have included Post-Operative Vision Loss (POVL), compression of abdominal vessels, and head and neck venous compression resulting in neurologic injury. Currently, there are no set recommendations …

The Association Between Intraoperative Single-Dose Dexamethasone And Postoperative Pain In Patients Undergoing Laparoscopic Cholecystectomy, Sara Hatfield

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to examine the association between a single dose of intraoperative dexamethasone in patients undergoing outpatient laparoscopic cholecystectomy surgery and postoperative pain scores and the amount of postoperative opioid administration.

Introduction: Pain is one of the most common complaints in the postoperative period and the days following a patient’s procedure. While opioids are commonly used for treating intraoperative and postoperative pain, anesthesia providers can lessen their use by adopting multimodal analgesia techniques. This study attempts to fill the research gap related to the association of a single dose of intravenous dexamethasone intraoperatively …

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 …

Anaesthesia Error In United States: Reasons For Mismanagement, Abby Wolfe, Anh Nguyen, Ashleigh Galles, Madison Wolfe, Ben Lundberg

Posters and Presentations: College of Public Health

A poster from the UNMC Undergraduate Public Health Workshop

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 …

Pulmonary Hypertensive Crisis And Its Efficient Management. A Case Report And Literature Review, Karima Karam Khan, Fazal Hameed Khan

Department of Anaesthesia

Perioperative anaesthetic management of patients with pulmonary hypertensive crisis is complex and challenging because of limited window period and treatment options. This case report describes the successful management of a patient with severe valvular heart disease superimposed by severe pulmonary hypertension, who developed pulmonary hypertensive crisis soon after induction of general anaesthesia for cardiac surgery. Pulmonary hypertensive crisis is not a usual phenomenon in these patients, but if it occurs it can be fatal. Anticipatory care of the patient to prevent crisis is the mainstay of treatment, otherwise it adds additional morbidity to such patients. Fortunately our patient survived the …

An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan

Department of Anaesthesia

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke, paraparesis/paraplegia/quadriparesis/or quadriplegia, new …

Multi-Organ Dysfunction Secondary To Yellow Scorpion Sting, Muhammad Faisal Khan, Hameed Ullah

Department of Anaesthesia

Scorpion stings are common in tropical and subtropical regions. The history and clinical manifestation warrant urgent recognition and treatment. The incidence of scorpion stings in Pakistan is not known as there is no published data available in literature. We report our experience of a yellow scorpion sting victim who required intensive care admission after developing multi-organ dysfunction.