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Anesthesia and Analgesia Commons

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Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori 2021 Arcadia University

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached ...


Evaluating The Preemptive Use Of Ofirmev To Address Post-Cesarean Pain, Kris Huerta 2020 Marian University - Indianapolis

Evaluating The Preemptive Use Of Ofirmev To Address Post-Cesarean Pain, Kris Huerta

DNP Final Project Depository

Uncontrolled postpartum pain has been linked to increased opioid use, increased risk for opioid dependency, depression, and the development of persistent pain (Bateman et al., 2016). The purpose of this project is to assess the use of a preemptive dose of Ofirmev (Tylenol, acetaminophen, paracetamol) 1,000 mg IV in decreasing post-cesarean pain and consequently opioid usage within the first 24-hour postoperative period. This project will evaluate documented pain scores charted in the EPIC charting system by the obstetrics nurses at Hendricks Regional Health. The 24-hour postoperative pain scores of cesarean patients who received acetaminophen before cesarean section will be ...


Implementing Bedside Regional Anesthesia: Improving Clinical Effectiveness, Geoffrey Ho, Everett Chu, Adam Greenwood, Jason Podolnick, Rachel Lubran, Natalie Pudalov, Philip TH Dela Cruz, Paul Dangerfield 2020 Himmelfarb Health Sciences Library, The George Washington University

Implementing Bedside Regional Anesthesia: Improving Clinical Effectiveness, Geoffrey Ho, Everett Chu, Adam Greenwood, Jason Podolnick, Rachel Lubran, Natalie Pudalov, Philip Th Dela Cruz, Paul Dangerfield

Anesthesiology and Critical Care Medicine Faculty Posters and Presentations

No abstract provided.


Anesthetic Use In Status Epilepticus: A Concise Review, Furkan M. Yilmaz MD., Lauren A. Igneri PharmD, Yasir A. Yilmaz MD., Evren Burakgazi-Dalkilic MD. 2020 Cooper University Hospital, Department of Neurology

Anesthetic Use In Status Epilepticus: A Concise Review, Furkan M. Yilmaz Md., Lauren A. Igneri Pharmd, Yasir A. Yilmaz Md., Evren Burakgazi-Dalkilic Md.

Cooper Rowan Medical Journal

The purpose of this review is to summarize the recent literature focusing on intravenous (IV) administration of commonly used anesthetics, including midazolam, pentobarbital/ thiopental, propofol, and ketamine in the treatment of status epilepticus (SE). Anesthetics should be reserved as third-line therapy for the treatment of SE when benzodiazepines and other second-line agents fail to terminate the seizure. We have reviewed the literature related to the treatment of status epilepticus, refractory status epilepticus, super-refractory status epilepticus, anesthetics, midazolam, pentobarbital/thiopental, propofol, and ketamine. This paper focuses on the pharmacology, dosages, major side effects, and clinical use of IV anesthetics in the ...


Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre 2020 University of Southern Mississippi

Using Collaborative Objective Simulation Clinical Evaluation With Undergraduate Nursing Students And Nurse Anesthesia Students Labor Epidural Placement In An Active Labor Patient, Chaka K. Jackson, Aisha Pierre

Doctoral Projects

Developing interdisciplinary teamwork and patient communication skills are essential for the student registered nurse anesthetist (SRNA) to provide quality patient care when administering epidural anesthesia. The synthesis of the evidence revealed limited available information on simulation use for SRNA epidural administration and collaboration. This doctoral project examined the effectiveness of learning through traditional simulation to enhance communication and collaboration between the Bachelor of Science in Nursing (BSN) and the Nurse Anesthesia Program (NAP) students. The BSN and NAP students were provided with a simulation environment to care for a laboring patient while improving patient safety and quality outcomes. The project ...


The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High 2020 University of Nebraska Medical Center

The Clinical Relevance Of Cement Volume In Percutaneous Vertebral Augmentation, Ravi G. Mirpuri, Madhuri Are, Virginia Hardie, Michael J. Warden, Robin High

Graduate Medical Education Research Journal

Introduction: Vertebroplasty and Kyphoplasty are two forms of percutaneous vertebral augmentation (PVA), in which polymethylmethacrylate cement is used to stabilize vertebral compression fractures (VCF). This study sought to evaluate the relationship between cement volume and clinical outcomes, including pain reduction, opioid use, and complication rate.

Methods: Retrospective chart review produced 88 patients who received PVA at a tertiary care outpatient pain clinic. Cement volume, type of PVA, gender, level (thoracic vs lumbar) were collected, as well as clinical outcomes of numeric pain score (NPS) reduction, opioid percent change (OPC), and complications. Both pre-procedure and post-procedure (between 2-4 weeks) data were ...


Ponv Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance, Karl A. Krieser, John B. Riley III, Jospeh E. Baus, Julie T. Hoffman, James N. Sullivan MD, Robert L. Lobato 2020 University of Michigan

Ponv Prophylaxis Failure Disproportionately Affects Female Patients, Despite Intraoperative Computerized Decision Support Guidance, Karl A. Krieser, John B. Riley Iii, Jospeh E. Baus, Julie T. Hoffman, James N. Sullivan Md, Robert L. Lobato

Graduate Medical Education Research Journal

Objectives: To compare postoperative nausea and vomiting (PONV) prophylaxis treatment and outcomes based on patients’ sex, using a retrospective cohort. The setting was the operating room and post-anesthesia care unit of a tertiary care university medical center.

Patients: A total of 678 adult male and female patients with American Society of Anesthesiologist (ASA) scores of 1-4 underwent surgery with general anesthesia. All patients received preoperative PONV risk assessment. PONV prophylaxis was administered at the discretion of the anesthesia care team members with guidance from a computerized decision support system.

Measurements: Adequacy of prophylaxis was retrospectively determined based on individual patient ...


Evaluation Of Noninvasive Respiratory Volume Monitoring In The Pacu Of A Low Resource Kenyan Hospital, Kendall Burdick, Muchai Stephen Thuo, Xiaoke Sarah Feng, Matthew S. Shotwell, Joseph J. Schlesinger 2020 University of Massachusetts Medical School

Evaluation Of Noninvasive Respiratory Volume Monitoring In The Pacu Of A Low Resource Kenyan Hospital, Kendall Burdick, Muchai Stephen Thuo, Xiaoke Sarah Feng, Matthew S. Shotwell, Joseph J. Schlesinger

Open Access Publications by UMMS Authors

This research aims to evaluate the use of the noninvasive respiratory volume monitor (RVM) compared to the standard of care (SOC) in the Post-Anesthesia Care Unit (PACU) of Kijabe Hospital, Kenya. The RVM provides real-time measurements for quantitative monitoring of non-intubated patients. Our evaluation was focused on the incidence of postoperative opioid-induced respiratory depression (OIRD). The RVM cohort (N = 50) received quantitative OIRD assessment via the RVM, which included respiratory rate, minute ventilation, and tidal volume. The SOC cohort (N = 46) received qualitative OIRD assessment via patient monitoring with oxygenation measurements (SpO2) and physical examination. All diagnosed cases of OIRD ...


Considerations For Epidural Blood Patch And Other Postdural Puncture Headache Treatments In Patients With Covid-19, Pascal Scemama, Fadi Farah, Glen Mann, Roman Margulis, Karina Gritsenko, Naum Shaparin 2020 University of Massachusetts Medical School

Considerations For Epidural Blood Patch And Other Postdural Puncture Headache Treatments In Patients With Covid-19, Pascal Scemama, Fadi Farah, Glen Mann, Roman Margulis, Karina Gritsenko, Naum Shaparin

COVID-19 Publications by UMMS Authors

BACKGROUND: A primary concern in the use of EBP in these patients is the possibility of seeding the virus in the CNS. Another important concern is related to the known hypercoagulable state in COVID-19 positive patients and associated organ dysfunction that may alter the metabolism of anticoagulants. The safety of the providers performing the EBP, the position of the patient and choices for image guidance (blind, fluoroscopic) are also key considerations to review. It is also important to explore the current state of knowledge about using allogenic instead of autologous blood as well as emerging techniques to eliminate the coronavirus ...


Prescription Analgesia And Adjuvant Use By Pain Severity At Admission Among Nursing Home Residents With Non-Malignant Pain, Kate L. Lapane, Anne L. Hume, Reynolds A. Morrison, William M. Jesdale 2020 University of Massachusetts Medical School

Prescription Analgesia And Adjuvant Use By Pain Severity At Admission Among Nursing Home Residents With Non-Malignant Pain, Kate L. Lapane, Anne L. Hume, Reynolds A. Morrison, William M. Jesdale

Population and Quantitative Health Sciences Publications

OBJECTIVE: We estimated the use of prescribed analgesics and adjuvants among nursing home residents without cancer who reported pain at their admission assessment, in relation to resident-reported pain severity.

METHODS: Medicare Part D claims were used to define 3 classes of analgesics and 7 classes of potential adjuvants on the 21st day after nursing home admission (or the day of discharge for residents discharged before that date) among 180,780 residents with complete information admitted between January 1, 2011 and December 9, 2016, with no cancer diagnosis.

RESULTS: Of these residents, 27.9% reported mild pain, 46.6% moderate pain ...


Managing Chronic Pain Through Advancements In Transcranial Brain Stimulation Technology Currently Used For Depression, Ashley N. Skinner 2020 University of South Dakota

Managing Chronic Pain Through Advancements In Transcranial Brain Stimulation Technology Currently Used For Depression, Ashley N. Skinner

Honors Thesis

The purpose of this thesis is to bring attention to alternatives to using analgesics or painkillers and potentially addictive opioid analgesics. Transcranial Magnetic Stimulation (TMS) has been proven successful in treating medication-resistant depression. This literature review will look at the links between pain and depression and examine adaptations to TMS coils in hopes of being able to stimulate the regions of the brain that interpret pain. By looking at current advancements in TMS, we can work towards adapting TMS to stimulate deeper regions. The final section of this thesis will examine how making these alternatives more popular will impact pain ...


Innovative Treatment Of Burn Wounds With Banana Leaf Dressing: A Case Report, Kanakadurga Poduri, Brian Tucker, Pritesh Patel 2020 HCA Healthcare

Innovative Treatment Of Burn Wounds With Banana Leaf Dressing: A Case Report, Kanakadurga Poduri, Brian Tucker, Pritesh Patel

Physical Medicine & Rehabilitation

No abstract provided.


Availability Of Pain Medications For Npo Patients, Anna Augustin DO, Kyle Borodunovich DO, Sean Quinonez DO, Furqan Haq, My Myers MD 2019 HCA Healthcare

Availability Of Pain Medications For Npo Patients, Anna Augustin Do, Kyle Borodunovich Do, Sean Quinonez Do, Furqan Haq, My Myers Md

Family Medicine

In recent years, the opioid epidemic has been a key catalyst in changing the medical standards for treating both acute and chronic pain. Instead of relying heavily on narcotics for pain management, practitioners are not encouraged to adapt a non-pharmacologic, non-opioid approach to analgesia. While many guidelines have been set to standardize outpatient pain management, the rules surrounding inpatient analgesia are limited or lacking.


A Case Of Cannot Intubate, Cannot Ventilate, Evan Davidson MD, Su Min Oon 2019 HCA Healthcare

A Case Of Cannot Intubate, Cannot Ventilate, Evan Davidson Md, Su Min Oon

Anesthesiology

69M with a PMH of parotid gland carcinoma status post resection and radiation therapy with extensive reconstruction, G-tube placement, COPD, multiple tracheostomies with takedowns (with refusal permanent tracheostomy over objections of family members) presented for CTR and ulnar tunnel exploration. With plans of MAC, an axillary block was placed and maintained on minimal propofol infusion. After administration of 50 mcg fentanyl due to pain, he was noted to be apnic. Ventilation via mask and #3 LMA failed, as well as placement of an 6 mm ET tube. Eventually, patient was ventilated via emergency surgical cricothyroidotomy. He was discharged on POD4.


A Comprehensive Curriculum Of The History Of Regional Anesthesia, Gustavo Angaramo, James Savage, David Arcella, Manisha S. Desai 2019 University of Massachusetts Medical School

A Comprehensive Curriculum Of The History Of Regional Anesthesia, Gustavo Angaramo, James Savage, David Arcella, Manisha S. Desai

Anesthesiology and Perioperative Medicine Publications

The study of the past with regards to medical history has been an underemphasized component of the medical school curriculum for several reasons.

These have included the lack of direct or immediate clinical impact, the emergence of new disciplines such as medical ethics, expansion of the existing knowledge base, as well as a lack of research grants and funding. The curriculum in graduate medical education struggles to cope with the explosion of new information related to basic and applied sciences. The elimination of questions related to history in certifying examinations could be considered a fatal blow. This study explored the ...


Efficacy And Tolerability Of Adjunctive Intravenous Sodium Nitroprusside Treatment For Outpatients With Schizophrenia: A Randomized Clinical Trial, Hannah E. Brown, Oliver Freudenreich, Xiaoduo Fan, Stephen O. Heard, Donald Goff, George Petrides, Amy Harrington, John M. Kane, Heidi Judge, Bettina Hoeppner, Maurizio Fava, Roy H. Perlis 2019 Harvard Medical School

Efficacy And Tolerability Of Adjunctive Intravenous Sodium Nitroprusside Treatment For Outpatients With Schizophrenia: A Randomized Clinical Trial, Hannah E. Brown, Oliver Freudenreich, Xiaoduo Fan, Stephen O. Heard, Donald Goff, George Petrides, Amy Harrington, John M. Kane, Heidi Judge, Bettina Hoeppner, Maurizio Fava, Roy H. Perlis

Psychiatry Publications

Importance: Antipsychotic medications for the treatment of schizophrenia have limitations, and new treatments are needed. A prior pilot investigation suggested that adjunctive sodium nitroprusside (SNP) administered intravenously had rapid efficacy in the treatment of patients with schizophrenia.

Objective: To determine the efficacy and tolerability of intravenous SNP infused at a rate of 0.5 mug/kg/min for 4 hours in patients with schizophrenia with some degree of treatment resistance.

Design, Setting, and Participants: Multicenter, randomized, double-blind acute treatment study using a sequential parallel comparison design conducted in two 2-week phases at 4 academic medical centers beginning May 20, 2015 ...


The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava 2019 Valparaiso University

The Effect Of The Implementation Of A Quarterly Triad Tool In The Pain Clinic Setting On The Assessment And Mitigation Of Risks In Patients On Chronic Opioid Therapy, Caroline Asava

Evidence-Based Practice Project Reports

The concurrent use of opioids and benzodiazepines (BZDs poses a formidable challenge for clinicians who manage chronic pain. While the escalating use of opioid analgesics for the treatment of chronic pain and the concomitant rise in opioid-related abuse and misuse are widely recognized trends, the contribution of combination use of BZDs, alcohol, and/or other sedative agents to opioid-related morbidity and mortality is underappreciated, even when these agents are used appropriately. Patients with chronic pain who use opioid analgesics along with BZDs have a defined increase in rates of adverse events, overdose, and death, warranting close monitoring. To improve patient ...


Comparison Of Post-Operative Pain Control Modalities For Pectus Excavatum Repair, Charlene Dekonenko 2019 Children's Mercy Hospital

Comparison Of Post-Operative Pain Control Modalities For Pectus Excavatum Repair, Charlene Dekonenko

Presentations

This study compares patient outcomes following pectus excavatum repair using cryoablation, epidural, or patient-controlled analgesia for post-operative pain control. Primary outcome: length of stay
Secondary outcomes: operative time, pain scores, time to only oral analgesics.
Conclusion: Intercostal cryoablation during minimally invasive pectus excavatum repair significantly reduces length of stay and time to oral analgesics alone.


Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown 2019 Southern Illinois University Edwardsville

Utilizing Simulation To Implement Cognitive Aids In The Operating Room, Kaitlyn Brown

Doctor of Nursing Practice Projects

Background: Operating room crises require prompt, efficient action to avoid detrimental outcomes. Research shows that crisis checklists or other cognitive aids assist anesthesia providers in taking prompt action while improving efficiency by decreasing treatment steps missed during critical events.

Objectives: The purpose of this project was to evaluate the effectiveness of incorporating cardiac arrest and malignant hyperthermia crisis checklists into the operating room using high-fidelity simulation-based education.

Methods: Researchers implemented the Stanford Emergency Manual Cognitive Aids for cardiac arrest and malignant hyperthermia to anesthesia staff at a community hospital in southern Illinois with 18 participants. Implementation consisted of an education ...


Children And Their Parents’ Assessment Of Postoperative Surgical Pain: Agree Or Disagree?, Olivia Kaminsky, Michelle Fortier, Brooke N. Jenkins, Robert S. Stevenson, Jeffrey I. Gold, Jeannie Zuk, Brenda Golianu, Sherrie H. Kaplan, Zeev N. Kain 2019 University of California, Irvine

Children And Their Parents’ Assessment Of Postoperative Surgical Pain: Agree Or Disagree?, Olivia Kaminsky, Michelle Fortier, Brooke N. Jenkins, Robert S. Stevenson, Jeffrey I. Gold, Jeannie Zuk, Brenda Golianu, Sherrie H. Kaplan, Zeev N. Kain

Psychology Faculty Articles and Research

Objective

The purpose of this study is to compare postoperative pain scores between children undergoing tonsillectomy and adenoidectomy (T&A) surgery and their parents, identify potential predictors for this disagreement, and determine possible impact on analgesic administration.

Methods

This is a prospective longitudinal study conducted with children undergoing outpatient T&A in 4 major tertiary hospitals and their parents. Children and their parents were enrolled prior to surgery and completed baseline psychological instruments assessing parental anxiety (STAI), parental coping style (MBSS), child temperament (EAS) and parental medication administration attitude questionnaire (MAQ). Postoperatively, parents and children completed at-home pain severity ratings (Faces Pain Scale-Revised, children; Numeric Rating Scale, parents) on postoperative recovery days 1, 2, and 3, reflecting an overall pain level for the past 24 h. Parents also completed a log of analgesic administration. Based on postoperative pain scores, parent-child dyads were classified as overestimators (i.e., parents rated their child's pain higher than children rated their own pain), in agreement (i.e., rating in agreement), or underestimators (i.e., parents rated their child's pain lower than children rated their own pain).

Results ...


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