Anesthesiology Commons^™

Norepinephrine Use In Septic Patients Undergoing General Anesthesia, Lauren Reed

Nurse Anesthesia 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 …

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

Nurse Anesthesia 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 …

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 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 …

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

Nurse Anesthesia 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 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, …

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

Nurse Anesthesia 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%.

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

Nurse Anesthesia 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 …

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

Nurse Anesthesia Student Research Posters

Research poster comparing 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, is discussed. 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.

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 …

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

Nurse Anesthesia 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 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 …

Managing Acute Pain In Hiv+/Aids Patients: Knowledge And Practice Trends Among Emergency Physicians Of Major Tertiary Care Centers Of A Developing Country, Aliya Ahmed, Gauhar Afshan, Robyna Irshad Khan, Badar Afzal Khan, Seemin Jamali, Nighat Farooq, Sarosh Saleem, Rubaba Naeem, Uzma R. Khan

Department of Anaesthesia

Objective: To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire.
Results: Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for …

Laryngotracheal Stenosis, Kelsey Stuckey

Doctor of Nursing Practice Projects

Laryngotracheal stenosis (LTS) is the luminal compromise at the laryngeal, subglottic, or tracheal level (Gelbard et al., 2014). Various etiologies for LTS exist. Endotracheal cuff over-inflation, inappropriately sized endotracheal tubes, and sudden movements of the tube contribute to injury, as well as anatomical differences(Cardillo et al., 2010; Divatia & Bhowmick, 2005; Medina et al., 2009; Miñambres et al., 2009; Nikolovski et al., 2019; Zaghi et al.,2016). The influence of estrogen may contribute to the development of LTS in women during the third through fifth decades Dedo & Catten, 2001; Poetker et al., 2006; Valdez & Shapshay, 2002). The project goal …

Developing A Clinical Practice Guideline For Surgical Diabetic Patients, Barbie Denise Harbaugh, Diane Whitehead

Walden Faculty and Staff Publications

Diabetes is a recognized risk factor for postoperative infection, acute renal failure, ileus, and lengthy hospital stay. Optimal screening, management, and scheduling of elective surgery for diabetic patients has been shown to improve quality care, decrease complications, and increase the efficiency and lower the costs of preoperative patient care. However, surgery cancellations are common due to inadequate preoperative glycemic control and poor intraoperative glycemic control, which is a recognized risk factor for perioperative or postoperative complications. There were no clinical practice guidelines or optimization protocols for elective surgery patients at a small rural hospital in the Northeast United States. The …

Potential Barriers Amongst Health Care Professionals Of Pakistan In Managing Covid-19 Patients, Muhammad Irfan Ul Haq, Faraz Shafiq, Haris Sheikh

Department of Anaesthesia

Objectives: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managing COVID 19 patients. It includes information regarding infection control measures, administrative and professional support. This was followed by evaluation of psychological factor that can act as a barrier in effective management of these patients.
Methods: The survey was conducted on line using Google Form. After approval from hospital ethical committee survey link was disseminated to HCPs using social media.
Results: Four hundred fifteen HCPs were participated. Most of them were younger than 30 years and majority of them were postgraduate trainees. Results showed gaps in the …

The Use Of Guedel Airway For Naso-Orogastric Tube Insertion In Patients With Covid-19. A Way To Minimize Aerosol Generation, Faraz Shafiq, Dileep Kumar

Department of Anaesthesia

No abstract provided.

One-Year Progress Oa A Large-Scale Collaborative Project For Improving The Care Of Mechanically Ventilated Patients, Yaseen M. Arabi, Zohair Al Aseri, Tareef Alaama, Abdulrhman Alharthy, Fahad M. Al-Hameed, Yasser Mandourah, Alyaa Elhazmi, Hend Sallam, Ghaleb A. Almekhlafi, Asad Latif

Department of Anaesthesia

No abstract provided.

Postoperative Cognitive Dysfunction Following General Anaesthesia In Patients Undergoing Elective Non-Cardiac Surgery, Khalid Samad, Hameed Ullah, Muhammad Saad Yousuf

Department of Anaesthesia

Objective: To determine frequency of early postoperative cognitive dysfunction (POCD) in patients aged 40 to 60 years, following general anaesthesia in patients undergoing elective, non-cardiac surgery.
Study design: Descriptive study.
Place and duration of study: Department of Anaesthesiology, The Aga Khan University Hospital (AKUH), Karachi, from December 2015 to May 2016.
Methodology: After obtaining approval from Ethical Review Committee of AKUH and informed consent, ASA I and II patients, aged between 40 to 60 years of either gender, undergoing general anaesthesia for elective non-cardiac surgical procedures, were recruited. Patients were assessed preoperatively by using mini-mental state examination (MMSE); and patients …

Anaesthetic Management For Hiatal Hernia Repair In A Child With Bartter's Syndrome: A Case Report, Durriya Raza, Fauzia Khan

Department of Anaesthesia

Bartter syndrome is a rare disorder characterized by reduced sodium chloride transport in the distal nephrons of the kidney. Its clinical features are renal salt wasting, hypokalemic metabolic alkalosis, elevated renin and aldosterone levels with normal or low blood pressure, polyuria, hypercalciuria and malnutrition. The pathophysiologic and biochemical changes in these patients should be kept in mind when considering anaesthetic management. This case report describes our management in a nineteen months old, 3.6 kg weight male child with Bartter's syndrome who underwent elective repair of hiatal hernia and gastrostomy.

Assessment And Management Of Adult Preoperative Anxiety: A Survey Of The Anesthesiologist Perspective, Arif Musa, Jeffrey C. Wang, Rana Movahedi, David Safani, Christopher Cooke, Syed F. Hussain, Jahan Tajran, Shafi Hamid, Gligor Gucev

Medical Student Research Symposium

Introduction: Preoperative anxiety often goes unaccounted for in the surgical setting. Given that anesthesiologists are routinely involved in perioperative care, this study was performed to assess anesthesiologists’ views of adult preoperative anxiety assessment and management. Methods: Active members of the American Society of Anesthesiologists (ASA) were sent an online questionnaire. Survey items included demographic information in addition to questions about measurement of preoperative anxiety, management of anxiety, and which entities were allocated responsibility to reduce patient anxiety. Data were collected from February to March 2019. Results: Of 3,661 respondents, most asked their patients about preoperative anxiety (n=2332, …

Ultrasound-Guided Out-Of-Plane (Oop) Adductor Canal Continuous Catheter Placement Compared To In-Plane (Ip) Placement In Total Knee Arthroplasty: A Randomized, Single Blinded, Pilot Clinical Trial, Sandeep H. Krishnan M.D., Carter Batista M.D, Samir Patel M.D., Farhad Ghoddoussi Phd, Kaveh Nabavigahadi M.D., Brendan Lynch B.S.

Medical Student Research Symposium

Background: Adductor canal continuous catheters (ACCCs) have largely replaced femoral nerve continuous catheters for providing analgesia after total knee arthroplasty. Both have similar analgesic efficacy, but ACCCs preserve quadricep strength and facilitate patient mobility more quickly. We hypothesized that placing the ACCC using an out of-plane (OOP) technique would decrease pain scores and opioid use due to parallel alignment with the saphenous nerve when compared to the in-plane (IP) technique. Methods: Sixty-nine patients undergoing total knee arthroplasty were randomized to either the IP or OOP technique for ultrasound-guided ACCC. The primary outcomes of the investigation were hospital length of stay, …

Immediate Changes In Hemodynamics And Gas Exchange After Initiation Of Noninvasive Ventilation In Cardiac Surgical Patients, Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

Introduction: Cardiac surgery is associated with pulmonary dysfunction and complications such as prolonged intubation and reintubation. Bilevel positive airway pressure (BiPAP) machine has been used in the clinical settings to improve oxygenation, reduce work of breathing, and avoid reintubation. The effect of BiPAP on cardiovascular parameters is not well established, and very few studies have targeted hemodynamic changes. The aim of the study was to assess the immediate effect of BiPAP on respiratory and hemodynamic parameters in post-cardiac surgery patients.
Materials and methods: This quasi-experimental study was done on 33 adult cardiac surgery patients. Ethical review committee approval was sought …