Anesthesiology Commons^™

Best Practice Recommendations For Anesthesia Providers In Preventing Postoperative Delirium In The Geriatric Population Undergoing Non-Cardiac Surgery, Ana Primeaux, Ashanti Reed

Doctoral Projects

Postoperative delirium (POD) is a significant and preventable complication in geriatric patients undergoing non-cardiac surgery. Such complication is associated with foreseeable consequences, such as prolonged hospitalization, long-term cognitive decline, increased morbidity and mortality, and increased costs. Despite the emerging awareness of evidence-based nonpharmacologic and pharmacologic interventional strategies, POD still represents a clinical challenge for anesthesia providers.

Currently, there is a lack of clinical guidelines to guide formalized education and evidence-based interventions on POD prevention across anesthesia practice settings. Consequently, there is a critical need to raise awareness that the lack of clinical guidelines and the high incidence of POD may …

Implementation Of An Opioid Free Pediatric Hernia Repair Protocol, Corey Shafer, Antonela Muca, Randy Hilleary, Kristin Lemarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, Begum Akay

Posters

Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

Obstructive Sleep Apnea And Risk Of Postoperative Complications After Non-Cardiac Surgery, Rabail Arif Chaudhry, Lori Zarmer, Kelly West, Frances Chung

Faculty, Staff and Student Publications

Obstructive sleep apnea (OSA), a common sleep disorder, poses significant challenges in perioperative management due to its complexity and multifactorial nature. With a global prevalence of approximately 22.6%, OSA often remains undiagnosed, and increases the risk of cardiac and respiratory postoperative complications. Preoperative screening has become essential in many institutions to identify patients at increased risk, and experts recommend proceeding with surgery in the absence of severe symptoms, albeit with heightened postoperative monitoring. Anesthetic and sedative agents exacerbate upper airway collapsibility and depress central respiratory activity, complicating intraoperative management, especially with neuromuscular blockade use. Additionally, OSA patients are particularly prone …

Enhanced Recovery After Surgery (Eras) Protocol For Bariatric Surgery, Krista Bunch

Doctor of Nursing Practice Projects

Bariatric surgery has been utilized in treating severe obesity and offers several benefits, such as sustainable weight loss, treatment of various metabolic comorbidities, and improved life expectancy (Sundbom et al., 2017). With these benefits and procedural improvements, there has been a marked increase in the demand for bariatric surgery and increased interest in shifting some of these procedures to an ambulatory care setting (Stenberg et al., 2022). However, postoperative complications such as pain, nausea, and inability to tolerate oral intake can cause patients to experience an increased length of stay in the hospital and suboptimal outcomes (King et al., 2018). …

Adjuncts And Additives To Regional Anesthesia, Kaisi Dye, Kelcie Brunnert

Doctor of Nursing Practice Projects

With regional anesthesia becoming increasingly popular, an emphasis has been placed on choosing appropriate adjunct medications to local anesthetics for prolonging peripheral nerve blocks- lengthening postoperative pain control and decreasing perioperative narcotic usage. This project aimed to increase provider knowledge of the proven efficacy of block and adjunct selection for breast, shoulder, and knee surgeries with intended results being prolonged block duration and increased patient satisfaction post-operatively. A focused lecture along with a Likert-scale questionnaire and quiz were administered to a small sample of anesthesia providers at a rural Illinois hospital. Half (55.6%) of the providers showed evidence of knowledge …

Surgical Management During The Covid-19 Era At A Private Tertiary Care Hospital Of Karachi, Pakistan: A Cross-Sectional Study, Nida Zahid, Erum Baig, Gulzar S. Lakhani, Hasnain Zafar, Asad Latif, Syed Ather Enam

Department of Surgery Docs

Background: The coronavirus disease 2019 (COVID-19), declared a pandemic in March 2020, has affected the entire healthcare system, including the surgical practice. Guidelines for the management of surgical patients during this COVID-19 era need to be established to provide timely yet safe surgical care. In this study, we aimed to evaluate the outcomes of the COVID-19 testing algorithm established for surgery patients presenting to a tertiary care hospital in Karachi, Pakistan, and to compare the outcomes among patients who underwent elective versus emergency surgery.
Methodology: This is a cross-sectional study conducted at a tertiary care hospital in Pakistan to apply …

Global Safety In Anaesthesia And Surgery: Implications For Anaesthesia In Pakistan, Fauzia Khan

Department of Anaesthesia

The Lancet Commission report in 2015 highlighted the role of safe surgery and anaesthesia. They also gave a framework of recommendations, indicators and targets to achieve universal access to safe surgery. This article explores the applicability of these indicators in Pakistan namely; access to timely surgery, specialist surgical workforce diversity, surgical volumes, perioperative mortality rate, protection against impoverishing expenditure and protection against catastrophic expenditure.

When Limb Surgery Has Become The Only Life-Saving Therapy In Fop: A Case Report And Systematic Review Of The Literature, Esmée Botman, Sanne Treurniet, Wouter D Lubbers, Lothar A Schwarte, Patrick R Schober, Louise Sabelis, Edgar J G Peters, Annelies Van Schie, Ralph De Vries, Zvi Grunwald, Bernard J Smilde, Jakko A Nieuwenhuijzen, Marieke Visser, Dimitra Micha, Nathalie Bravenboer, J Coen Netelenbos, Bernd P Teunissen, Pim De Graaf, Pieter G H M Raijmakers, Jan Maerten Smit, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Fibrodysplasia ossificans progressiva (FOP) is a rare disease in which heterotopic ossification (HO) is formed in muscles, tendons and ligaments. Traumatic events, including surgery, are discouraged as this is known to trigger a flare-up with risk of subsequent HO. Anesthetic management for patients with FOP is challenging. Cervical spine fusion, ankylosis of the temporomandibular joints, thoracic insufficiency syndrome, restrictive chest wall disease, and sensitivity to oral trauma complicate airway management and anesthesia and pose life-threatening risks. We report a patient with FOP suffering from life-threatening antibiotic resistant bacterial infected ulcers of the right lower leg and foot. The anesthetic, surgical …

Impact Of Best Practice Guideline Statement On Anesthesia Practice In Rural Mississippi Hospitals With Obese Patients Undergoing Total Knee Arthroplasty, Steven Hodnett

Doctoral Projects

The aim of this best practice guideline (BPG) was to be a resource for anesthesia providers practicing with obese patients undergoing total knee arthroplasty (TKA) and to measure the knowledge of these providers. After dissemination of an executive summary to anesthesia providers in two hospitals in rural Mississippi, an anonymous online survey was provided via Qualtrics software for voluntary participation. The survey consisted of 10 questions. The data collection period was five weeks. Respondents are noted at N=2, and the data was reviewed and categorized into one of three domains (i.e., knowledge, practice, and safety). In the domain of knowledge, …

Sleeping Pattern Before Thoracic Surgery: A Comparison Of Baseline And Night Before Surgery, Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

Background: Sleep deprivation is considered a stress factor in the perioperative period. There are several studies on sleep disturbance after surgery but very limited literature available on preoperative sleep patterns, predictors of sleep disturbance and its effect on surgical outcome.
Methodology: Patients scheduled for thoracic surgery were asked to fill out a written Pittsburgh Sleep Quality Index (PSQI) questionnaire. The primary investigator explained this form to all the patients. This was filled out before premedication for subjective assessment of sleeping pattern at two different time point. Only those patients included who spent the previous night at home. Participants were asked …

Patient Perceptions And Expectations About Postoperative Analgesia, Carrie Mok, Nirmal Shah, Do, Stephen F. Goldberg, Md, Amir C. Dayan, Md, Marc Torjman, Phd, Jaime L. Baratta, Md

Phase 1

Introduction

Opioid overdose deaths have nearly quadrupled since 1999. Nearly 2 out of 3 persons being prescribed medications are prescribed an opioid. Physicians may be prescribing opioids for more than what is required for postoperative pain control, leading to increased risk for opioid abuse and addiction. Patient perceptions of perioperative pain medications are poorly understood.

Objective

This survey aims to understand patient expectations of perioperative analgesics.

Methods

Following IRB approval, patients 18 years of age or older, were given a 13-question survey prior to their surgery at Thomas Jefferson University Hospital, to evaluate the perception of pain medications, medication efficacy, …

Effect Of Laryngeal Mask Airway Manometry On Post-Operative Sore Throat In Spontaneously Breathing Adult Patients Presenting For Surgery At Aga Khan University Hospital, Nairobi, David Njoroge Waruingi

Master of Medicine in Anaesthesiology

Background: Laryngeal mask airways (LMAs) are widely used in anaesthesia and are considered to be generally safe. Postoperative sore throat (POST) is a frequent complication following LMA use and can be very distressing to patients. The use of an LMA cuff pressure of between 30 and 32cm of H20 in alleviating postoperative sore throat has not been investigated. Primary objective: To compare the occurrence of POST between the intervention group in which LMA cuff pressures will be adjusted to 30-32cm of H20 and the control group in which only monitoring of LMA cuff pressures will be done. Secondary Objectives: To …

Effects Of Intravenous Diclofenac On Postoperative Sore Throat In Patients Undergoing Laparoscopic Surgery At Aga Khan University Hospital, Nairobi: A Prospective, Randomized, Double Blind Controlled Trial, Thang'a P., Dorothy Kamya, Vitalis Mung’Ayi

Anaesthesiology, East Africa

Background: Postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated.

Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat.

Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and …

Cancellation Of Surgery In Patients Attending The Preoperative Anaesthesia Assessment Clinic: A Prospective Audit, Tauseef Ahmed, Mueenullah Khan, Fauzia Khan

Department of Anaesthesia

OBJECTIVE: To find the causes of operating room cancellation in patients attending preoperative anaesthesia clinic and scheduled for surgery at our institution.

METHODS: This audit included all those patients who presented to the pre anaesthesia clinic with their surgeries planned in the main operating rooms of our hospital. The duration of this audit was two months. Cancelled cases were identified from the operating room lists and the reasons for cancellations were categorized into above mentioned four factors.

RESULTS: Fifty five (55) cancellations were identified; patient related factors (58%) were the most frequent cause followed by anaesthetic (22%), surgical (18.2%) and …

Wound Infiltration With Bupivacaine Versus Ketorolac For Postoperative Pain Relief In Minor To Moderate Surgeries, Mohammad Irfan Akhtar, Mohammad Saleem, Jawad Zaheer

Department of Anaesthesia

OBJECTIVE: To compare the analgesic efficacy of Bupivacaine 0.25% wound infiltration with Ketorolac incisional infiltration in relieving postoperative pain for first twenty-four hours.

METHODOLOGY: Analytical, interventional and comparative study was performed on seventy patients, of both sexes, with varied age groups. Patients underwent minor and moderate surgeries, confined to American Society of Anaesthesiologist ASA category 1-II. Patients were selected by convenience sampling and were divided into two groups i.e. Group I and Group II. Group-I comprised of thirty five patients and were infiltrated with Bupivacaine 0.25% at wound margins postoperatively. Group-II also comprised of thirty-five patients and were infiltrated with …

Adequacy Of Postoperative Pain Relief After Discharge, Samina Ismail, Aziza M. Hussain

Department of Anaesthesia

Day care surgery has shown a remarkable development over the last two decades, comprising approximately 60-70% of all surgical procedures. Therefore major proportions of surgical patients are recovering at home and have little or no assessment of the adequacy of their pain relief. The aim of our audit was to compare suggested postoperative pain indicators with targets for best practice. This audit was done at the Aga Khan University Hospital day care unit for a period of three months. On the day of surgery patients having the contact numbers were informed about the telephone call 24 hrs after the surgery …