Anesthesiology Commons^™

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

The Relationship Between Central Venous Catheter And Post-Operative Complications In Patients Undergoing Hepatic Resection, David C. O'Connor

Theses and Dissertations

The Relationship Between Central Venous Catheter and Post-operative Complications in Patients Undergoing Hepatic Resection

David C. O’Connor, Ph.D., DNAP, CRNA

A dissertation submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy at Virginia Commonwealth University

Virginia Commonwealth University, 2018

Dissertation Chair: Clarence J. Biddle, Ph.D., CRNA

Hepatic resection is indicated for primary and secondary malignancies. Use of a low central venous pressure technique is associated with decreased blood loss in these cases. This technique has evolved; central venous catheters and high dose morphine are no longer used, and patients are extubated earlier. The purpose of …

Pediatric Critical Incidents Reported Over 15 Years At A Tertiary Care Teaching Hospital Of A Developing Country, Shemila Abbasi, Fauzia Anis Khan, Sobia Khan

Department of Anaesthesia

Background and Aims: The role of critical incident (CI) reporting is well established in improving patient safety but only a limited number of available reports relate to pediatric incidents. Our aim was to analyze the reported CIs specific to pediatric patients in our database and to reevaluate the value of this program in addressing issues in pediatric anesthesia practice. Material and Methods: Incidents related to pediatric population from neonatal period till the age of 12 years were selected. A review of all CI records collected between January 1998 and December 2012, in the Department of Anaesthesiology of Aga Khan University …

Predicting Arterial Oxygen Desaturation Events Via Patient Journal And Pulse Oximetry Data In Postoperative Ambulatory Surgery Patients, Charles R. Elam Iv

Theses and Dissertations

Associations between patient and procedural factors on the nature and quality of the immediate in-home recovery from anesthesia following ambulatory orthopedic surgery are unknown. Further, there is a paucity of outcomes research quantitatively categorizing in-home

patient recovery and safety following discharge from same-day orthopedic procedures. Tools are available, however, to shed light on outcomes in this population, and integration of such available measures is critical.

Ambulatory orthopedic surgery is a burgeoning specialty, with growth expected over the foreseeable future. The expected increased patient caseload subsequent to implementation of the Affordable Care Act and aging Baby Boom generation suggests greater morbidity …

Is Homocystinuria A Real Challenge For Anesthetist? Are We Making A Difference?, Muhammad Umar Slote, Karima Karam Khan,, Ausaf Ahmed Khan, Mohsin Nazir Butt

Department of Anaesthesia

No abstract provided.

Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy

Loma Linda University Student Journal

No abstract provided.

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 …

Changes To Echocardiography-Derived Left Ventricular Filling Pressures And Cardiac Output In Response To Fluid Boluses In Elderly Patients With Left Ventricular Diastolic Dysfunction Undergoing Vascular Surgery, Sasha K. Shillcutt

Theses & Dissertations

Left ventricular diastolic dysfunction (LVDD) of the heart is a condition where the heart does not relax properly. This condition is important during times of stress, as LVDD is associated with significant morbidity of elderly surgical patients. LVDD is often asymptomatic and unrecognized as many of these patients have normal ejection fractions. However, LVDD may lead to heart failure in patients with preserved systolic function, with the incidence being as high as 50% in hospitalized elderly patients. The diagnosis of LVDD is an independent risk factor for postoperative major adverse cardiac events (MACE) and negatively impacts post-surgery readmission rates. Anesthesiologists …

Malignant Hyperthermia, Aaron Roth

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia is a rare disease trait and can take place in a variety of settings. If not treated in a timely manner, the consequences will be dire. It is recommended that nurses and other healthcare personnel be properly educated on MH crises. By detecting the signs and symptoms associated with the disease, providers can efficiently remedy the crisis and save patient lives (Seifert, 2014). Since the discovery of dantrolene in 1975 and the advancement of genetics regarding MH, death rates dropped from about 80% to about 5% (Schneiderbanger et al., 2014). Today there is a MH group called the …

Turning Up The Heat On Malignant Hyperthermia, Katie Carroll

Nursing Student Class Projects (Formerly MSN)

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

Clinical Utility Of Pharmacogenomic Testing To Support Prescriptive Decision Making Among Anesthesia Providers: A Mixed-Method Study, Jonathan Dru Riddle

MUSC Theses and Dissertations

Anesthesia care is delivered world wide on a daily basis. Provision of anesthesia cares for surgical, obstetrical, or pain management procedures mandate a thorough understanding of physiology, pathophysiology, and pharmacology. Nearly 4 million anesthetics are delivered in the United States each year and the impact of genetics on anesthesia care is becoming greater. Anesthesia providers make prescriptive decisions based on an individual patient's disease processes, proposed surgical or therapeutic procedure, and a thorough clinical history. The age of personalized medicine is upon us and the ability to use genetic testing to help predict how a patient will respond to various …

Pseudocholinesterase Deficiency, Ross Gerken

Nursing Student Class Projects (Formerly MSN)

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

Anesthesia For Cardiac Catheterization Procedures, A Hamid

Department of Anaesthesia

Anesthesiologist's involvement for the purpose of diagnostic and interventional procedures in cardiac catheterization laboratory has been evolving particularly since last two decades. Catheterization laboratory environment poses certain challenges for the anesthesiologist including unfamiliar remote location, exposure to radiation, limited help from colleagues and communication with cardiologists. Anesthesiologists working in catheterization laboratory are required to have adequate knowledge of the environment, personnel, fluoroscope, echocardiography and type of radio contrast dye during the procedure. Anyone who is exposed to radiation environment is expected to protect himself from the exposure and must also wear a dosimeter for cumulative exposure tracing.There is no ideal …

Perceptions Of Acupuncture And Acupressure By Anesthesia Providers, Amanda Faircloth

Theses and Dissertations

BACKGROUND: Randomized controlled trials show acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness and received governmental support (NIH, PPACA, WHO, U.S. Military), but have not yet diffused into mainstream anesthesia practice. This study examined US anesthesia providers' perceptions of acupuncture and acupressure.

METHODS: Ninety-six anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children’s hospitals, and VA hospitals) were selected for participation in an anonymous, online survey. The target sample was 1,728 providers …

Medical Errors Related To Look-Alike And Sound-Alike Drugs, Samina Ismail,, Arshad Taqi

Department of Anaesthesia

Despite recent developments in the inventory management, introduction of electronic drug trolleys and cabinets, color coding of the filled syringes and many more interventions, medication errors could not be eliminated. The most common of these are syringe swap and human errors regarding wrong drug administration due to look-alike drug containers or sound-alike names of the drugs belonging to diverse groups. Many of the fatalities, that occur in third world countries due to these causes, go unnoticed and unregistered. This special article complements two special editorials on the same topic by Professor Joseph D. Tobias et al and Professor Robert Stoelting, …

Predictors Of Postoperative Respiratory Failure In Patients Receiving Anesthesia, Marty Henley

Theses, Dissertations and Capstones

Introduction: Postoperative Respiratory failure has been identified as a prevention quality indicator by The Agency for Health Research and Quality (AHRQ). Postoperative Respiratory Failure is associated with increased length of stay, increased costs and increased morbidity and mortality. Unfortunately, current research is limited regarding scoring methods which are predictive for postoperative respiratory failure. This retrospective case control study was conducted to determine if the various tools of evaluation of risk currently available and to determine if any are predictive of the risk of developing postoperative respiratory failure.

Methodology: The design of this research was a retrospective case control study conducted …

The Dose-Response Of Nitrous Oxide In Postoperative Nausea In Patients Undergoing Gynecologic Laparoscopic Surgery: A Preliminary Study., Boris Mraovic, Tatjana Simurina, Zdenko Sonicki, Neven Skitarelic, Tong J. Gan

Department of Anesthesiology Faculty Papers

BACKGROUND: Whether nitrous oxide (N(2)O) increases the incidence of postoperative nausea and vomiting (PONV) after laparoscopic gynecologic surgery is still controversial, which may be due to the administration of different concentrations of inspired N(2)O. We investigated whether N(2)O results in a dose-response increase in PONV. METHODS: Patients undergoing gynecologic laparoscopic surgery were randomized to receive 30% oxygen with air (G0, n = 46), 50% N(2)O with oxygen (G50, n = 46), or 70% N(2)O with oxygen (G70, n = 45). A standardized general anesthetic was used with no PONV prophylaxis. Known risk factors for PONV were controlled. Metoclopramide was used …