Anesthesiology Commons^™

Does The Addition Of Dexamethasone To Local Anesthetic Used For Peripheral Nerve Block Prolong Analgesia In The Surgical Patient?, Janice M. Oliveira

Nurse Anesthesia Student Capstones

Pain after orthopedic surgery can be intense. Many anesthesia providers and orthopedic surgeons support the use of peripheral nerve blockade to assist in decreasing the amount of pain a patient may experience post operatively. Select medication adjuncts are being added to peripheral nerve blocks to prolong analgesia. The research presented here focuses on the addition of dexamethasone to peripheral nerve blocks to prolong analgesia. Dexamethasone is a synthetic glucocorticoid that acts as an anti-inflammatory. It has been shown to inhibit the release of inflammatory mediators such as, interleukins and cytokines, facilitating the release of anti-inflammatory mediators, decreasing postoperative pain. Recent …

Minimal Opioid Anesthetic In Patient With History Of Substance Abuse: A Case Study, Sarah E. Varney

Nurse Anesthesia Student Capstones

More than half of the population in the United States of America drinks alcohol regularly. Thousands of deaths annually are linked to drug overdoses, and that number continues to rise. Anesthesia professionals can expect to see patients in various levels of substance abuse and recovery during their practice. This case study is presented to discuss a minimal narcotic technique given in a patient with a history of prescription drug abuse, who had been substance free since successfully been through a recovery program years prior.

Detection And Treatment Of Hemorrhage In The Postoperative Patient, Vanessa M. Derosby

Nurse Anesthesia Student Capstones

Hemorrhage is a devastating event that can occur in the perioperative period. It is estimated that 2.35 in 1000 patients will experience hemorrhage associate with surgery. Adverse outcomes affecting patient morbidity, mortality and quality of life are associated with hemorrhage. Timely detection, diagnosis and appropriate intervention in the setting of hemorrhage are imperative to reduce adverse outcomes of shock such as end organ damage, chronic disability or death. Anesthesia practitioners hold the charge of monitoring and managing the patient’s hemodynamic status and play an integral role in the detection and management of the hemorrhaging patient.

Assessment Of The Preoperative Assessment: A Case Study, Steven James Birchenough

Nurse Anesthesia Student Capstones

The geriatric population defined as individuals 65 years of age or older is expected to increase to 20% of the total population by the year 2020. This population currently makes up one-third of the surgical population and is projected to double by 2020. The perioperative risks for this population are also increased and pose significant increases in morbidity and mortality. The need for a detailed preoperative assessment is crucial in any surgical patient. It is increasingly imperative for the geriatric surgical patient as assessment is vital for the surgical team to make decisions regarding the projected necessity, plan and desired …

Understanding And Treating Emergence Delirium, Peter Currie

Nurse Anesthesia Student Capstones

This paper examines our current understanding of the phenomena of emergence delirium, which can occur following general anesthesia. Much research has been conducted to elucidate the causative factors of this condition, with findings ranging from anxiety to volatile agents and the neurodevelopment of the brain (Aono, Ueda, & Mamiya, 1997; Kain et al., 2004; McLott, Jurecic, Hemphill, & Dunn, 2013). While much of our understanding of emergence delirium has come from studying children, who are more prone to this condition, we can attempt to learn even more by examining the increased incidence of emergence delirium that occurs in those with …

Certain General Anesthetics Used In Pediatrics Hinder Neurological Development In Infants, Michael R. Hirschi

Selected Honors Theses

General anesthetics act by either blocking N-methyl-d-aspartate (NMDA) receptors or over stimulating γ-aminobutyric acid (GABA) receptors.^1–3 The actions of these receptors are responsible for the anesthetized state and are also crucial in the neurological development of infants.^2,4–8 Animal studies, although limited, provide vital information about general anesthesia’s neurotoxicity its hindrance of neurological development. Exposure to general anesthesia can severely hinder proper neuronal migration, synaptogenesis, and can drastically increase neuronal apoptosis in infant animals.^9–16 General anesthetics are more neurotoxic to infant animals in combination compared to individually.^10,16,17 Additionally, multiple exposures to general anesthesia tend to have compounding …

Anaesthetic Consideration In A Cannabis Addict, Karima Karam, Shemila Abbasi, Fauzia Anis Khan

Department of Anaesthesia

This case report describes the anaesthetic management of a patient addicted to Bhang(cannabis) for 20 years. Cannabis use has implication in the anaesthetic management of a patient because of its effects on the cardiovascular system, respiratory system, and central nervous system and its interaction with anaesthetic drugs.

Opioid-Induced Hyperalgesia, Lisa Nieder

Nurse Anesthesia Student Capstones

Opioids are a fundamental part in the treatment of pain especially within the perioperative setting. While opioids are routinely administered by nurse anesthetists for the treatment of pain, they can be associated with several undesirable side effects including opioid- induced hyperalgesia (OIH). OIH is a complex phenomenon that has a significant impact on the successful treatment of pain in a surgical setting. While there have been many advances in recent years into the topic of OIH, the mechanisms are complex and remain incompletely understood. OIH is believed to occur from changes in both the peripheral and central nervous systems that …

Buprenorphine And The Anesthesia Considerations: A Literature Review, Elizabeth E. Stern

Nurse Anesthesia Student Capstones

Buprenorphine is a unique pharmaceutical in the management of chronic pain and opioid use disorder (OUD). Buprenorphine is a semisynthetic partial opioid agonist at the mu opioid receptor and an antagonist of the kappa opioid. Buprenorphine Maintenance Therapy (BMT) is utilized for the long-term treatment of patients with OUD. The attraction to this methadone alternative is increased safety profile, more convenient patient access to the drug, as well as increase of ease for the provider. The particular formula used in the US, Suboxone, has properties to discourage intravenous injection to prevent abuse and prevent negative secondary effects of intravascular injections …

Chiral Symmetry Breaking And Chiral Polarization: Tests For Finite Temperature And Many Flavors, Andrei Alexandru, Ivan Horváth

Anesthesiology Faculty Publications

It was recently conjectured that, in SU(3) gauge theories with fundamental quarks, valence spontaneous chiral symmetry breaking is equivalent to condensation of local dynamical chirality and appearance of chiral polarization scale Λ_ch. Here we consider more general association involving the low-energy layer of chirally polarized modes which, in addition to its width (Λ_ch), is also characterized by volume density of participating modes (Ω) and the volume density of total chirality (Ω_ch). Few possible forms of the correspondence are discussed, paying particular attention to singular cases where Ω emerges as the most versatile …

Temperature Management Guidelines, J. W. Hammon, L. Shore-Lesserson, T. A. Dickinson

Journal Articles

No abstract provided.

The Society Of Thoracic Surgeons, The Society Of Cardiovascular Anesthesiologists, And The American Society Of Extracorporeal Technology: Clinical Practice Guidelines For Cardiopulmonary Bypass-Temperature Management During Cardiopulmonary Bypass, R. Engelman, R. A. Baker, D. S. Likosky, A. Grigore, T. A. Dickinson, L. Shore-Lesserson, J. W. Hammon

Journal Articles

To improve our understanding of the evidence-based literature supporting temperaturemanagement during adult cardiopulmonary bypass, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiology and the American Society of ExtraCorporeal Technology tasked the authors to conduct a review of the peer-reviewed literature, including 1) optimal site for temperature monitoring, 2) avoidance of hyperthermia, 3) peak cooling temperature gradient and cooling rate, and 4) peak warming temperature gradient and rewarming rate. Authors adopted the American College of Cardiology/American Heart Association method for development clinical practice guidelines, and arrived at the following recommendation.

Effects Of Ondansetron 4 Milligrams Compared With Ondansetron 8 Milligrams On The Incidence Of Post-Operative Nausea And Vomiting In Patients With Body Mass Index Greater Than 30kg/M2 Undergoing Mastectomy, Diego Alejandro Arroyo

Theses, Dissertations and Capstones

Introduction: Post-Operative Nausea and Vomiting (PONV) is a recurrent and frequent issue for the patient, the anesthesia team, and Post Anesthesia Care Unit (PACU) team. Both pharmacologic and non-pharmacologic recommended modalities have been utilized for both the prevention and treatment of PONV in the surgical-anesthesia setting. The 5-HT3-receptor antagonist ondansetron is one of the many known pharmacological modalities commonly utilized by anesthesia providers in preventing PONV.

Methodology: The design used for this research was a quantitative, retrospective case control study that evaluated existing data enclosed in the Electronic Medical Records (EMR) from Charleston Area Medical Center (CAMC), which is …

Inhalation Anesthesia Vs. Total Intravenous Anesthesia For Ambulatory Dental Surgery In Children, Kristin D. Neal

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to compare inhalation anesthesia with sevoflurane versus Total Intra Venous Anesthesia (TIVA) with propofol infusion as it relates to the quality of recovery including postoperative pain, Post Operative Nausea and Vomiting (PONV), and Post Anesthesia Care Unit (PACU) Length Of Stay (LOS) in pediatric patients undergoing ambulatory dental surgery. Introduction: Pediatric dental procedures are increasingly performed in an outpatient setting under general anesthesia due to inadequate cooperation, circumstantial anxiety, and other behavioral and health issues. Commonly used inhalation anesthetics, such as sevoflurane, can induce hyperalgesia in children. While sevoflurane increases the risk PONV, …

Remote Video Auditing With Real-Time Feedback In An Academic Surgical Suite Improves Safety And Efficiency Metrics: A Cluster Randomised Study, F. J. Overdyk, O. Dowling, S. Newman, D. Glatt, M. Chester, D. Armellino, B. Cole, G. S. Landis, D. Schoenfeld, J. F. Dicapua

Journal Articles

IMPORTANCE: Compliance with the surgical safety checklist during operative procedures has been shown to reduce inhospital mortality and complications but proper execution by the surgical team remains elusive. OBJECTIVE: We evaluated the impact of remote video auditing with real-time provider feedback on checklist compliance during sign-in, time-out and sign-out and case turnover times. DESIGN, SETTING: Prospective, cluster randomised study in a 23-operating room (OR) suite. PARTICIPANTS: Surgeons, anaesthesia providers, nurses and support staff. EXPOSURE: ORs were randomised to receive, or not receive, real-time feedback on safety checklist compliance and efficiency metrics via display boards and text messages, followed by a …

Prehospital Use Of Plasma In Traumatic Hemorrhage (The Pupth Trial): Study Protocol For A Randomised Controlled Trial, Penny S. Reynolds, Mary Jane Michael, Emily D. Cochran, Jacob A. Wegelin, Bruce D. Spiess

Anesthesiology Publications

Background

Severe traumatic injury and haemorrhagic shock are frequently associated with disruptions of coagulation function (such as trauma-induced coagulopathy TIC) and activation of inflammatory cascades. These pathologies may be exacerbated by current standard of care resuscitation protocols. Observational studies suggest early administration of plasma to severely-injured haemorrhaging patients may correct TIC, minimise inflammation, and improve survival. The proposed randomised clinical trial will evaluate the clinical effectiveness of pre-hospital plasma administration compared with standard- of-care crystalloid resuscitation in severely-injured patients with major traumatic haemorrhage.

Methods/design

This is a prospective, randomized, open-label, non-blinded trial to determine the effect of pre-hospital administration of …

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 …

A Report From The First Regional Pain Medicine Symposia In East, Central And Southern African Region. (Ecsa-R)-“The Rhino Model In Pain Education In Africa”, Thikra Sharif, John Bugo

Anaesthesiology, East Africa

The 1st Regional pain medicine symposia were held between the 14th and 18th of November 2011 in 3 cities (Nairobi, Mombasa and Dar-es-salaam), across 2 countries, Kenya and Tanzania. It was funded by the International Association for the Study of Pain (IASP), through the IASP developing country education grant for 2011 and The Aga Khan University Hospital Nairobi (AKUHN). It was organized by faculty from the Pain Management Unit (PMU) AKUHN. The Pain medicine educators were from PMU, AKUHN and from Specialists in Pain International Network (SPIN).

The aims of the symposia were to introduce the Rhino model concept, the …

Job Stress Among Female Residents During Postgraduate Training At A University Hospital In Karachi, Pakistan, Madiha Hashmi, Fauzia A. Khan, Khan S, Ali S. K

Department of Anaesthesia

Background: Postgraduate medical training is a stressful experience for both male and female doctors but previous studies have shown that stress might be more prevalent amongst female residents. Since women make up 70-80% of medical graduates in Pakistan we conducted this study to determine the prevalence of stress among female residents during postgraduate training and identify the most common stressors.

Methodology: All female residents enrolled in postgraduate training programmes at the Aga Khan University meeting the inclusion criteria were recruited and informed written consent was obtained. Job Stress Inventory (JSI) was used to identify symptoms and sources of job stress. …

Perioperative And Acute Care Transesophageal Echocardiography (Toe), Madiha Hashmi

Department of Anaesthesia

In Pakistan perioperative transoesophageal echocardiography (TOE) during cardiac surgery is available in a few centers with reliance on cardiologists and cardiac technicians and its use in noncardiac surgery and intensive care units is very limited. In view of the increasing popularity of TOE based on obvious benefits this review is presented with an aim to evaluate the current indications and potential benefits of using TOE during anesthesia for cardiac and non-cardiac surgery and the intensive care units and compare TOE with pulmonary artery catheter (PAC) and transthoracic echocardiography (TTE) as an hemodynamic monitor in the acute care setting.

Developing Local Guidelines For Management Of Sepsis In Adults: Sepsis Guidelines For Pakistan (Sgp), Madiha Hashmi, Fazal Hameed Khan, Sarwar Zubairi, S. Tipu Sultan, Saeeda Haider, Sadqa Aftab, Javed Husain, Anwar Ul Haq, Zahid Akhtar Rao, Amin Khuwaja, Syed Farjad Sultan, Zunairah Rais, Roohina Baloch, Naseem Salahuddin, Aslam Khan, Faisal Sultan, Kamran Chima, Amjad Ali, Gohar Ali

Department of Anaesthesia

Background: The purpose of developing ‘Sepsis Guidelines for Pakistan’ (SGP) is to provide clinicians practicing in local hospitals with a framework to aid timely recognition and management of adult patients in sepsis by adopting evidence-based recommendations of Surviving Sepsis Campaign (SSC) tailored to available resources. These recommendations are not meant to replace the SSC Guidelines.
Methodology: SGP is an initiative of Pakistan Society of Critical Care Medicine (PSCCM). Four key decision points to be addressed in the guidelines were identified by a thirteen member multidisciplinary committee i.e., grading the hospitals in the country, recognition of sepsis and associated organ dysfunction, …

Planning A Safe Exit: A Multidisciplinary Approach, Srijaya K. Reddy, Nina Deutsch

E-Learning Modules

This resource is a problem-based learning discussion (PBLD) case addressing the challenges and approach to planning and safely executing an EXIT procedure. It is primarily aimed at pediatric anesthesiologists but also applies to healthcare providers in fetal medicine and surgery.

The clinical scenario involves a fetus with a large cervical neck mass requiring an EXIT procedure for tracheal obstruction. This case highlights the challenges and implications of a procedure involving a multidisciplinary team. After presentation of the case stem, the instructor moderates a student-focused group discussion using a series of questions that build upon the case and a review of …

Malignant Hyperthermia, Chase Contri

Nursing Student Class Projects (Formerly MSN)

Although very rare, occurring one out of every 100,000 anesthesia cases, malignant hyperthermia is a hypermetabolic disorder that anesthesia providers screen and interrogate patients prior to every case they are administering anesthesia. Many research studies about anesthesia induced malignant hyperthermia have explored new methods of testing for the genetic susceptibility for malignant hyperthermia and into hospital based protocols when a patient starts to show the signs and symptoms of the metabolic disorder. This new knowledge and understanding has decreased patient mortality of anesthesia induced malignant hyperthermia from eighty percent to five percent over the past three decades (Rosenberg et al, …

Malignant Hyperthermia, Devin Poncsak

Nursing Student Class Projects (Formerly MSN)

A crisis of malignant hyperthermia is a medical emergency, and must be treated immediately with a coordinated, multidisciplinary team response in order to give the patient the highest chance for a successful recovery (Dirksen, Van Wicklin, Mashman, Neiderer, & Merritt, 2013). Malignant hyperthermia is defined by Bandschapp & Girard (2012), as “a disturbance of the skeletal muscle calcium homeostasis, triggered by volatile anaesthetics and depolarizing muscle relaxants.” Once a vulnerable patient is exposed to one of these triggering agents, a pathologic hypermetabolic response ensues, and the patient has a rapid increase in oxygen consumption and expired carbon dioxide, hyperthermia, acidosis, …

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 …

Cesarean Sections, Buprenorphine, Intrathecal Opioids & Pain Control – What To Do?, Madeel A. Abdullah, Md, Michelle Beam, D.O., H. Jane Huffnagle, D.O., Suzanne Huffnagle, D.O., Michelle Mele, Md, Eugene R. Viscusi, Md

Department of Anesthesiology Faculty Papers

Introduction

Suboxone^® is becoming a popular alternative to methadone maintenance in opioid abstinence. This population will likely expand in the future presenting a challenge for perioperative analgesia. Conventional pharmacology suggests that buprenorphine has a high binding affinity for the mu-opioid receptor (MOR), displacing any other opioid; and, only overcome by extremely high opioid doses. Hence recommendations are usually that buprenorphine should be discontinued before surgery so the MOR is available perioperatively. Buprenorphine is considered to have a “ceiling” analgesic effect rather than a classic opioid dose-response curve; it should not be effective for postoperative analgesia. This case supports an …

Secondhand Smoke Exposure As A Risk Factor For Perioperative Airway Complications In Pediatric Outpatient Procedures, Ashlee Denise Loudin

Theses, Dissertations and Capstones

Abstract: The purpose of this study is to assess the risk of perioperative airway complications, analyze extubation times, and PACU Length Of Stay (LOS), and their association with secondhand smoke exposure in pediatric populations receiving outpatient procedures that require general anesthesia.

Introduction: Tobacco Smoke Exposure (TSE), is well documented to cause physiologic changes in lung tissue that are associated with decreased lung function, increased risk of lower and upper respiratory tract illness, exacerbation of asthma or increased risk of asthma, increased prevalence of non-allergic bronchial hyperresponsiveness, sudden infant death syndrome, and a host of other respiratory complications in adult and …

Attenuating The Systemic Inflammatory Response To Adult Cardiopulmonary Bypass: A Critical Review Of The Evidence Base, R. Clive Landis, J. R. Brown, D. Fitzgerald, D. S. Likosky, L. Shore-Lesserson, R. A. Baker, J. W. Hammon

Journal Articles

A wide range of pharmacological, surgical, and mechanical pump approaches have been studied to attenuate the systemic inflammatory response to cardiopulmonary bypass, yet no systematically based review exists to cover the scope of anti-inflammatory interventions deployed. We therefore conducted an evidence-based review to capture "self-identified" anti-inflammatory interventions among adult cardiopulmonary bypass procedures. To be included, trials had to measure at least one inflammatory mediator and one clinical outcome, specified in the "Outcomes 2010" consensus statement. Ninety-eight papers satisfied inclusion criteria and formed the basis of the review. The review identified 33 different interventions and approaches to attenuate the systemic inflammatory …

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety In Aga Khan University Hospital; A Cohort Study, Anthony Kamau

Master of Medicine in Anaesthesiology

Background: Preoperative anxiety is a common perioperative complication, according to studies done it is seen in approximately 11-80% of adults undergoing surgery. Various pharmacological and non pharmacological techniques have been used to reduce preop anxiety. One of the goals of the preanaesthesia clinic is to allay anxiety. Literature shows that a preanaesthesia clinic evaluation reduces anxiety however b current studies done 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. Study Design: A cohort and before – after study …

A Randomized Control Trial Comparing Weight Adjusted Dose Versus Fixed Dose Prophylactic Phenylephrine Infusion On Maintaining Systolic Blood Pressure During Caeserean Section Under Spinal Anaesthesia, Lucy Wambui Mwaura

Master of Medicine in Anaesthesiology

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. Its advantages over general anaesthesia include: decreased blood loss, reduced postoperative pain and faster recovery time. Despite these advantages, the sympathetic blockade induced by spinal anaesthesia results in 80 percent incidence of hypotension without prophylactic management. This hypotension can cause: nausea, vomiting, cardiovascular collapse or even loss of consciousness in the mother, and fetal acidosis. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in …