Anesthesiology Commons^™

Prophylactic Phenylephrine Infusion To Mitigate Intraoperative Hypotension After Spinal Anesthesia Among Orthopedic Patients, David Nelson, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background

Intraoperative Hypotension (IOH) is common after spinal anesthesia (SA) and is associated with an increased risk of end organ damage.1 2 3 The treatment regimen for IOH after SA varies in the orthopedic population. However, the current research literature suggests that a prophylactic infusion of phenylephrine significantly reduces the number of episodes and duration of hypotension.1 This EBP project aims to report the proportion of patients receiving prophylactic phenylephrine infusions and the incidence of hypotension following SA among orthopedic surgery patients at Providence Sacred Heart Medical Center (PSHMC) in Spokane, WA.

Methods

• A retrospective, observational EBP project was …

Intraoperative Hypotension And Acute Kidney Injury In Non-Cardiac Surgery At Providence Sacred Heart Medical Center, Elizabeth Davison, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Acute kidney injury (AKI) is a serious postoperative complication that increases a patient’s risk for both long and short-term morbidity and mortality.¹ Intraoperative hypotension (IOH) is an independent risk factor for AKI,^2-5 which can be readily modified by anesthesia providers. This project aims to describe the risk factors and rates of AKI following IOH at various absolute mean arterial blood pressure (MAP) thresholds for specified durations of time among adults undergoing non-cardiac surgery at Providence Sacred Heart Medical Center (PSHMC).

Methods PSHMC approved this retrospective, observational evidence-based project and deemed the project exempt by the Institutional Review …

Intraoperative Dexmedetomidine Use On Adult Surgical Patients At Providence Sacred Heart Medical Center, Christina Rose, Scot Pettey, Norel Smith, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Opioids are considered the standard of practice for intraoperative and postoperative pain management but yield unfavorable outcomes.6 The research evidence demonstrates reductions in post-operative opioid use following intraoperative administration of dexmedetomidine.1,3,4,5,6 Due to the prospective nature of literature surrounding dexmedetomidine, the rate of implementation remains largely unknown. The aim of this retrospective, observational project was to identify the rate of adoption of intraoperative dexmedetomidine administration among adult surgical patients at Providence Sacred Heart Medical Center (PSHMC) from January 1, 2015 to December 31, 2019. Accordingly, investigation into dexmedetomidine administration at PSHMC may shed light on this strategy aimed to …

Rate Of Unscheduled Administration Of An Epidural Bolus Among Pregnant Women Receiving Labor Epidurals, Aleksandr A. Lyakhov, Emily L. Mcquaid-Hanson, Amanda Affleck, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background The labor and delivery process is a painful experience that pregnant women undergo and while various medical options are available for managing labor pain, labor epidurals are the most common.1,3 Breakthrough pain, or inadequate analgesia, is a significant complication of labor epidurals that is typically managed with the administration of an unscheduled epidural bolus. The purpose of this evidence-based practice (EBP) project is to describe the rate of unscheduled epidural bolus administration in pregnant women receiving continuous labor epidurals (CLE) at Providence Sacred Heart Medical Center (PSHMC) and Providence Holy Family Hospital (PHFH).

Methods • Design: Retrospective, observational, EBP …

Intratracheal Lidocaine And Postoperative Sore Throat At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Jennifer Cowgill, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative sore throat (POST) is a common side effect from general anesthesia (GA) and has a prevalence of 14.4-50%.1 The experience of POST contributes to patient discomfort during recovery from surgery. The etiology of this is thought to be from tracheal mucosal erosion from the cuff of the endotracheal tube (ETT), trauma from intubation, coughing and bucking, and friction between the ETT and the tracheal mucosa during general anesthesia.2 Risk factors shown to contribute to the development of POST include, but are not limited to, elderly age, smoking history, patient positioning, ETT cuff pressure, and movement of ETT during …

Rates Of Ondansetron Administration Prior To Spinal Anesthesia: Evaluating The Practice Of Prophylactic Attenuation Of Spinal-Induced Hypotension And Bradycardia, Clare Santana, Scot Pettey, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Hypotension and bradycardia are common complications of spinal anesthesia. Intraoperative hypotension and bradycardia may lead to complications that require additional treatment and increase cost. The literature identifies intervention strategies to attenuate spinalinduced hypotension (SIH) and bradycardia.1 Prophylactic administration of ondansetron, a serotonin 5-hydroxytryptamine receptor antagonist, prior to spinal anesthesia is associated with reduced SIH and bradycardia.1,2,3,4,6 The objective of this scholarly project was to report the practice of ondansetron prophylaxis for SIH and bradycardia and the rate of rescue interventions in patients who received ondansetron prior to spinal anesthesia.

Methods Retrospective, multi-center observational evidence-based practice project conducted at Providence …

Correlation Of Ondansetron Timing In Postoperative Nausea And Vomiting: A Retrospective Evaluation Amongst Adult Patients Receiving General Anesthesia, Jeff Tanguay, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Addressed as a national quality initiative by the Centers for Medicare and Medicaid Services (CMS), postoperative nausea and vomiting (PONV) is a vexing complication requiring further attention by anesthesia providers.3 Medication optimization is an area of focus to address this complication.4 Ondansetron, a selective 5- hydroxytryptophan subtype 3 (5-HT3 ) receptor antagonist, is effective and considered the “gold standard” in the prevention of PONV.4 GlaxoSmithKline™ suggests administering Zofran® (ondansetron) before the induction of anesthesia.5 These directions are in contrast to the synthesis of the research evidence, which supports increased effectiveness of ondansetron when administered 30 minutes before emergence from …

Postoperative Nausea And Vomiting With Low-Dose Propofol Infusions In Patients Undergoing Gynecological Surgeries With Volatile Anesthetics At Providence Sacred Heart Medical Center And Providence Holy Family Hospital, Adrianna Silva, Braden Hemingway, Kenn B Daratha

Books, Presentations, Posters, Etc.

Background Postoperative nausea and vomiting (PONV) is a common complication following surgery. It remains the most important determinant of length of stay and leading cause of dissatisfaction in anesthesia.4 Females undergoing gynecological laparoscopic surgery have the highest rates.8 Apfel’s baseline risk factors for PONV include female gender, history of motion sickness and/or PONV, non-smoking status and administration of postoperative opioids.1 Propofol has antiemetic properties and Gan’s evidence supports the use of an intraoperative low-dose infusion to reduce baseline risk factors for PONV.6 This project aims to describe the rates of intraoperative low-dose propofol infusions in female patients undergoing gynecological surgery …

In Adults With Difficult Intubations, What Is A Gold Standard Method For Success?, Nathaniel Kitzmann

Theses and Graduate Projects

The objective of this thesis is to analyze existing literature and guidelines for difficult intubations and provide clinical recommendations. This paper is a retrospective analysis of human trials focusing on preparation, medication, and tools in the field of emergency airway management. Techniques will be described and discussed. A large portion of intubations are described as difficult and have the potential to fail. Articles retrieved from databases PubMed, Medline, and PLOS ONE and the search engine Google Scholar were reviewed. Websites for the institutions of the American Society of Anesthesiologists and Difficult Airway Society were used in guidance. Currently, many guidelines …

Covid-19 And Liver Injury: A Systematic Review And Meta-Analysis, Jawad Ahmed, Tehlil Rizwan, Farheen Malik, Raniyah Akhter, Mehreen Malik, Junaid Ahmad, Abdul Wasay Khan, Muhammad A. Chaudhary, Muhammad Shariq Usman

Department of Anaesthesia

Background and Aims: The prevalence and extent of liver damage in coronavirus disease 2019 (COVID-19) patients remain poorly understood, primarily due to small-sized epidemiological studies with varying definitions of “liver injury”. We conducted a meta-analysis to derive generalizable, well-powered estimates of liver injury prevalence in COVID-19 patients. We also aimed to assess whether liver injury prevalence is significantly greater than the baseline prevalence of chronic liver disease (CLD). Our secondary aim was to study whether the degree of liver injury was associated with the severity of COVID-19.
Materials and Methods: Electronic databases (PubMed and Scopus) were systematically searched in June …

Investigating Sofa, Delta-Sofa And Mpm-Iii For Mortality Prediction Among Critically Ill Patients At A Private Tertiary Hospital Icu In Kenya: A Retrospective Cohort Study, Lillian N. Lukoko, Peter S. Kussin, Rodney Adam, James Orwa, Wangari Siika

Anaesthesiology, East Africa

Background: Outcomes in well-resourced, intensive care units (ICUs) in Kenya are thought to be comparable to those in high-income countries (HICs) but risk-adjusted mortality data is unavailable. We undertook an evaluation of the Aga Khan University Hospital, Nairobi ICU to analyze patient clinical-demographic characteristics, compare the performance of Sequential Organ Failure Assessment (SOFA), delta-SOFA at 48 hours and Mortality Prediction Model-III (MPM-III) mortality prediction systems, and identify factors associated with increased risk of mortality.

Methods: A retrospective cohort study was conducted of adult patients admitted to the ICU between January 2015 and September 2017. SOFA and MPM-III scores were determined …

Malignant Hyperthermia For The Nurse Anesthetist, Victor Clark

Nursing Student Class Projects (Formerly MSN)

Malignant Hyperthermia (MH) is a rare, autosomal dominant skeletal muscle disorder that can have an insidious onset in susceptible patients exposed to the triggering agents succinylcholine, halothane, desflurane, sevoflurane, and isoflurane. MH can occur in patients who have received anesthesia with these agents in the past (Nagelhout & Plaus, 2018, p 775). Patients with a family history of MH or associated skeletal muscle disorder must be treated as MH-susceptible until proven otherwise. Failure to detect an MH crisis can lead to kidney failure, profound acidosis, coagulopathies, rhabdomyolysis, cardiac dysrhythmias, cardiovascular collapse, and death (Seifert et al., 2015). It is the …

Basic Airway Management For Non-Anesthesia Operating Room Personnel: Education Implementation, Dylan Ouellette

Nurse Anesthesia MSNA Student Capstones

A review of basic airway management for non-anesthesia personnel is presented. Included is a literature review of 20 articles surrounding the most current literature on preoperative airway assessment, cricoid pressure, video laryngoscopy, adjuncts for airway management, and airway management education for non-anesthesia health-care personnel. Following the review, an in-service style education presentation was developed and implemented at two sites in Maine. A pre- and post-test evaluation of the participants demonstrated an overall increase in test scores of 22%.

Simulation To Reduce Medical Errors And Improve Patient Safety In Anesthesia, Matthew Leblanc

Nurse Anesthesia MSNA Student Capstones

Over the past two decades, simulation in medical education has been adopted by health education programs and established as a proven method of education for health care students and providers. Despite the addition of simulation to healthcare education, medical errors are ranked as the third leading cause of death in the United States. The purpose of this literature review is to investigate the translation of simulation education into increased patient safety and reduction of medical errors in anesthesia. Overall, the literature reviewed confirms that simulation can be used to reduce medical errors and improve patient safety. Additional correlational research between …

Current Recommendations For The Perioperative Management Of Patients On Buprenorphine: A Case Study, Coreen Tanner

Nurse Anesthesia MSNA Student Capstones

According to the US Department of Health and Human Services, more than 2 million Americans suffer from opioid use disorder (DHHS, 2020). Opioid maintenance therapy (OMT) for OUD has been shown to reduce the rates of inpatient hospitalization and overall opioid-related mortality (Quaye & Zhang, 2019). Buprenorphine is a partial mu receptor agonist and kappa receptor antagonist that is used frequently by patients on OMT. Beginning in 2010 annual prescriptions for buprenorphine products have increased dramatically (Lembke, Ottestad, & Schmiesing, 2019).

With the rising level of chronic pain and opioid use nationally, more and more patients taking buprenorphine are presenting …

Norepinephrine Use In Septic Patients Undergoing General Anesthesia, Lauren Reed

Nurse Anesthesia MSNA Student Capstones

Anesthesia providers are frequently confronted by the problem of caring for patients presenting with sepsis in the operating room. Sepsis is associated with high healthcare costs and a significant mortality rate despite advancements in the understanding of its complicated pathophysiology. The 2016 Surviving Sepsis Campaign recommends norepinephrine as the first-choice vasopressor in septic patients. Its mild beta-adrenergic effects, in addition to its alpha-adrenergic effects, make it an attractive agent for the vasoplegia and myocardial dysfunction associated with sepsis. Earlier achievement of adequate perfusion pressures, earlier lactate clearance, and higher in-hospital survival have all been associated with norepinephrine use in the …

Treating Post-Dural Puncture Headaches: Sphenopalatine Block, Cosyntropin And Epidural Blood Patch, Amalia Zychowicz

Nurse Anesthesia MSNA Student Capstones

Post-dural puncture headache (PDPH) is a severe and debilitating complication that can occur following neuraxial anesthesia. Obstetric patients are at an increased risk for this complication due to their gender, young age, and widespread use of neuraxial anesthesia. A hallmark sign of PDPH is a postural headache that improves when lying down and worsens when sitting or standing. It requires prompt diagnosis and treatment due to its incapacitating effects. The gold-standard treatment for PDPH is an epidural blood patch (EBP). However, this is an invasive procedure with multiple contraindications and the potential for severe complications. Noninvasive, more conservative therapies such …

Sugammadex Versus Neostigmine In Reducing Postoperative Adverse Effects In The Pediatric Population, Robert Vieto Jr.

Nurse Anesthesia MSNA Student Capstones

Neostigmine and sugammadex are two medications used to reverse the neuromuscular blockade caused by nondepolarizing aminosteroidal neuromuscular blocking agents. Research has shown an association between the use of acetylcholinesterase inhibitors, such as neostigmine, and residual neuromuscular blockade in pediatric patients. Sugammadex has been shown to reduce residual neuromuscular blockade in adults without adverse effects, but minimal research has been performed on the effects of sugammadex in the pediatric population. Therefore, the objective of the present study is to compare sugammadex and neostigmine to determine if using sugammadex instead of neostigmine reduces postoperative adverse effects in the pediatric population. A systematic, …

Anesthetic Implications Of Intraarterial Chemotherapy For Retinoblastoma: A Literature Review, Marguerite Mullin

Nurse Anesthesia MSNA Student Capstones

Retinoblastoma (RB) is a rare pediatric cancer commonly diagnosed in patients at a very young age. New therapies for this disease are emerging that involve some degree of sedation, requiring anesthesia providers to be involved in their care. Intraarterial chemotherapy (IAC) is one of these new exciting treatment options and requires general anesthesia. Multiple studies and case reports have reported a sudden decrease in pulmonary compliance during IAC for RB and attribute this response to the trigemino-cardiac reflex (TCR). Once this event occurs, patients experience associated hypoxemia, hypotension, bradycardia, and cardiovascular collapse. A systematic literature review was aimed at educating …

Dexmedetomidine Use And Various Techniques Of Administration To Reduce Emergence Delirium In Pediatric Surgical Patients Undergoing General Anesthesia With Volatile Agents, Sara K. Dusza

Nurse Anesthesia MSNA Student Capstones

This analysis of literature evaluated retrospective chart reviews and randomized controlled trials of school aged children undergoing surgical procedures necessitating general anesthesia with volatile inhalant anesthetic agents. These studies assessed and compared the efficacy of various routes and timing of administration of dexmedetomidine as a pre-medication to determine the most effective technique in reducing the incidence of postoperative emergence delirium (ED). ED presents as a transient, acute episode of delirium occurring during the transition from unconsciousness to complete wakefulness after general anesthesia with anesthetic gases. The results of this review suggested that pediatric patients treated with intranasal dexmedetomidine preoperatively experienced …

Exparel Versus Bupivacaine: Outcomes, Advantages, And Costs, Jessica Duraney

Nurse Anesthesia MSNA Student Capstones

Research shows that adequate pain control is associated with increased patient satisfaction, faster rehabilitation, mobilization, reduced hospital stays, and ultimately decreased hospital costs. Due to the many disadvantages of opioids, such as ileus, nausea, vomiting, respiratory depression, tolerance, and physical dependence, there has been a push for opioid-sparing and multimodal analgesia perioperatively. The purpose of this paper is to compare two local anesthetics, bupivacaine and Exparel (liposomal bupivacaine). The use of these drugs in various regional techniques, specifically for total knee arthroplasty (TKA) and abdominal surgeries, will be discussed.

Reducing Anesthesia Workstation Contamination, Taryn Giese

Nurse Anesthesia MSNA Student Capstones

Healthcare-associated infections are a source of morbidity and mortality in the United States and have been shown to be more preventable than current incidence. Anesthesia providers may be a source of and vector for some of these infections. Nurse anesthetists provide direct individual care for numerous patients daily, managing airways and invasive devices that contaminate hands with secretions which then may be transferred to the anesthesia workstation. Due to its complexity, the anesthesia machine is difficult to thoroughly clean and may become a reservoir for contaminants.

The purpose of this paper will be to examine new interventions being explored to …

In Response To Letter Title "Immediate Hemodynamic And Gaseous Exchange Effect Of Bi-Level Positive Airway Pressure After Cardiac Surgery: Our Insight To Hamid Et Al.'S Study", Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

No abstract provided.

Twin Pregnancy Complicated By Intrauterine Death Of One Fetus And Herniated Bowel Loops Over Gravid Uterus, Malika Hameed, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Development Of Interdisciplinary Communication Tools To Improve Handoffs For Emergent Airway Management, Aaron Ocker, Do, Daniel Katz, Do, Jason Kopenitz, Do, Daniel Casey, Alexander Olson, Anna Rabinowitz, Md

Health Equity and Quality Improvement (HEQI) Summit

Project goal

Improve response time from airway alert to intubation while ensuring pertinent critical patient information is communicated to the airway team to reduce negative patient outcomes and better mobilize anesthesia resources.

Creation Of A Dedicated Anesthesia Airway Cart For Use In High-Volume Covid-19 Airway Management, Anna Rabinowitz, Alexander M. Olson, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

The COVID-19-specific approach to intubation required a change in the team structure and workflow for emergent airway management.

1. New need for bulky PPE and the introduction of an aerosol barrier shield for emergent intubations
2. Higher volume of intubations and use of videolaryngoscopy requires additional equipment
3. Concern for Code Cart contamination and wastage of airway equipment
4. Desire for more efficient approach to selecting and customizing equipment

Initiatives In Anesthesia Workspace Hygiene During Covid-19: The Gray Airway Basin And The Epic Hand Hygiene Event, Anna Rabinowitz, Kent Berg, Daniel Casey, Dietrich Gravenstein

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

The COVID-19 Pandemic has highlighted the need for anesthesia providers to decrease workspace contamination, particularly during and after airway management.

Delineation of “clean” and “dirty” spaces in the anesthesia workplace has been historically challenging, but the heightened awareness of microbial contamination presents a new opportunity to effect behavioral change among staff.

Anesthesiologist-Led Covid-19 Airway Training Skills Session To Teach Novel Team Approach And Workflow, Anna Rabinowitz, Daniel Casey, Elaine Kilmartin

Health Equity and Quality Improvement (HEQI) Summit

What’s the Problem?

Intubation is an aerosol-generating procedure that poses a significant infectious risk to the operator in the COVID-19 era, where the volume of intubations was expected to increase dramatically. Following national anesthesia societal and organizational recommendations regarding best practices to decrease risk of viral transmission, a new 3-person airway team approach was developed. Additions to the preexisting airway management workflow included an aerosol-containing intubation shield, a new breathing circuit configuration incorporating HEPA filtration, and the use of unfamiliar PPE, all of which required mastery of a complex sequence of events surrounding the patient encounter. This high-stakes workflow was …

Development And Implementation Of A Covid-19 Specific Peri-Operative Workflow For Anesthesia Providers, Alexander Olson, David Maguire, David Gratch, Dietrich Gravenstein, Michael Mahla, Anna Rabinowitz

Health Equity and Quality Improvement (HEQI) Summit

What's the Problem?

• Needed to develop and clarify the use of PPE in the COVID-19 era
• New considerations for infection control in OR
• Unique airway equipment and filter placement considerations
• Potential shortages of equipment and medications, need for conservation
• Need to incorporate human factors principles into protocol release and procedural compliance

We realized that there was no standard protocol for these functions existing in a visually compelling graphic form for wide distribution throughout anesthesia care areas, and sought to create one.

Telogen Effluvium: A Review Of The Literature, Fahham Asghar, Nazia Shamim, Umar Farooque, Haris Sheikh, Ramsha Aqeel

Department of Anaesthesia

Telogen effluvium is one of the most common causes of alopecia. It is a scalp disorder characterized by excessive shedding of hair. Several factors such as drugs, trauma, and emotional and physiological stress can lead to the development of telogen effluvium. Multiple alterations in the hair cycle have been proposed as the underlying mechanism. Telogen effluvium can present as acute or chronic hair fall with symptoms such as trichodynia. Diagnostic tests that can be used include hair wash test, trichogram, phototrichogram, and scalp biopsy. In the treatment of telogen effluvium, it is essential to identify and remove the causative factors …