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Anesthesia and Analgesia Commons

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Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom DNP, Michael Godbold MD 2022 University of Tennessee, Knoxville

Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom Dnp, Michael Godbold Md

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Patient Temperature measurement postoperatively reveals that hypothermia occurs in surgical patients 25-90% of the time. Unintended perioperative hypothermia can be linked to many negative patient outcomes such as increased incidence of surgical site infection (SSI), delayed wound healing and increased length of hospital stay, to mention a few. Any single or combination of the aforementioned issues can eventually lead to an increase in patient morbidity and mortality. The purpose of this proposed quality practice improvement project is to increase the compliance of hypothermia prevention strategies, specifically forced air warming, at the implementation site. The targeted practice improvement is aimed at ...


Anesthesia-To-Post Anesthesia Care Unit Handoff Standardization, Cassie Lee Bivens, Mark Timothy Cresap, Steven Michael Halcomb, Maureen Essie Taylor 2022 University of Tennessee, Knoxville

Anesthesia-To-Post Anesthesia Care Unit Handoff Standardization, Cassie Lee Bivens, Mark Timothy Cresap, Steven Michael Halcomb, Maureen Essie Taylor

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

The exchange of medical information from one medical professional to another is known as the handoff. Communication errors during the transition period of handoffs can lead to medication errors, delays in care, high stress within the work environment, and increased burnout of the nursing staff. Approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to healthcare communication failures from 2012 to 2017. One of the areas of the hospital where effective handoffs are critically important, given the high frequency, is in the post-anesthesia care unit (PACU). Major organizations such as the Joint ...


Quality Improvement: Education And Implementation Of Proper Narcotic Handling Practices By Nurse Anesthetists, Shelby Stevenson, Anne Hendershott, Alexis Asprah 2022 University of Tennessee, Knoxville

Quality Improvement: Education And Implementation Of Proper Narcotic Handling Practices By Nurse Anesthetists, Shelby Stevenson, Anne Hendershott, Alexis Asprah

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Medication errors are estimated to occur once in every 150-300 surgeries (Wahr et al., 2017, p. 36). Unsafe injection practices can lead to increased morbidity and mortality, diminish the overall quality of life for patients, and contribute to substantial increases in healthcare costs. A large majority of unsafe injection practices are caused by a lack of education or mistaken beliefs regarding safe injection practices. Educational reinforcement of safe narcotic handling techniques has significant potential to increase the appropriate use of narcotic syringes among nurse anesthesia providers. The long-standing impact of this project could lead to a reduced number of ‘never ...


Dexmedetomidine To Reduce Ponv, Amanda Johnson SRNA, Joshua Lawrence SRNA, Staci Martinez SRNA, Taylor Mayberry SRNA, Dwayne Accardo DNP, CRNA, APRN 2022 University of Tennessee Health Science Center

Dexmedetomidine To Reduce Ponv, Amanda Johnson Srna, Joshua Lawrence Srna, Staci Martinez Srna, Taylor Mayberry Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.

Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative ...


Development Of A Protocol To Manage Postdural Puncture Headache, Ashley M. Shulman, Lynexis P. McVey 2022 Southern Illinois University Edwardsville

Development Of A Protocol To Manage Postdural Puncture Headache, Ashley M. Shulman, Lynexis P. Mcvey

Doctor of Nursing Practice Projects

In obstetric laboring patients, neuraxial anesthesia is a common form of analgesia. However, neuraxial procedures are not without risk. Accidental dural puncture (ADP) is a potential risk with any epidural procedure. Patients who experience ADP are at a greater risk of developing postdural puncture headache (PDPH). The presentation of PDPH is commonly described as a dull, throbbing, headache worsening upon standing and relieved with supine positioning (Patel et al., 2020). Symptoms of PDPH may range from mild to debilitating and develop within five days of ADP. A variety of treatment options exist for PDPH ranging from conservative to invasive. The ...


A Review Of The Effectiveness Of Osteopathic Manipulative Medicine At Alleviating Pregnancy-Related Pain, Alexandria Lomanno, Olivia Choi, Danielle Cooley 2022 Rowan University

A Review Of The Effectiveness Of Osteopathic Manipulative Medicine At Alleviating Pregnancy-Related Pain, Alexandria Lomanno, Olivia Choi, Danielle Cooley

Stratford Campus Research Day

Globally, more than a quarter of pregnant patients experience low back pain (LBP) during pregnancy with additional complaints of pelvic girdle pain (PGP) and other somatic dysfunctions. Though the standard of care for LBP in pregnancy is often analgesics, concerns about potential side effects that may cause lasting harm to the fetus may preclude pregnant patients from taking pain medications. Osteopathic Manipulative Medicine (OMM) is a nonpharmacologic treatment option that is routinely used for LBP in non-pregnant patients. Given the low risk of adverse effects, OMM may prove to be beneficial for pregnant patients suffering from LBP or PGP.


Association Of Perceived Early Adequate Analgesia And Chronic Pain Severity, Sean Coulson, Sameer Akhtar, Brian Thomas, Aleesa Mobley 2022 Rowan University

Association Of Perceived Early Adequate Analgesia And Chronic Pain Severity, Sean Coulson, Sameer Akhtar, Brian Thomas, Aleesa Mobley

Stratford Campus Research Day

Purpose: Establish if early adequate pain control is protective in the development of chronic pain syndromes.

Data collected via survey to patients being treated for chronic pain at the Neuromuscular Institute at RowanSOM

Data (small n) suggests patients with chronic pain have poorly controlled pain levels at the time of the acute event.

Anticipate with increased sample size will see a correlation between chronic pain prevalence and severity and perceived early adequate analgesia following the acute event.


Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna McCleskey BSN, RN, SRNA, Landon McDonald MSN, RN, CNL, Tim Moore BSN, RN, SRNA, Jamie Pitcock BSN, RN, SRNA, Dwayne Accardo DNP, CRNA, APRN 2022 University of Tennessee Health Science Center

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.


Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett RN, SRNA, Montana Betts RN, SRNA, Christhian De Ochoa RN, SRNA, Maciej Chec RN, SRNA, Dwayne Accardo DNP, CRNA, APRN 2022 University of Tennessee Health Science Center

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five ...


Pain Management In Postoperative Pediatric Craniotomy Patients: A Scoping Review, Jessica M. Hiltenbrand BSN, RN, Sydney A. Scarbrough BSN, RN, Kaitlyn E. Shirley BSN, RN, Michelle Rickard DNP, CPNP-AC 2022 University of Tennessee Health Science Center

Pain Management In Postoperative Pediatric Craniotomy Patients: A Scoping Review, Jessica M. Hiltenbrand Bsn, Rn, Sydney A. Scarbrough Bsn, Rn, Kaitlyn E. Shirley Bsn, Rn, Michelle Rickard Dnp, Cpnp-Ac

Doctor of Nursing Practice Projects

Purpose/Background The pediatric craniotomy procedure is a complex and painful procedure that requires adequate pain management and frequent neurological assessments. Generally, evidence for pediatric pain management is severely lacking in research, and evidence for pediatric craniotomy patients is lacking even further. This scoping review aims to collect, condense, and review the current data in order to fuel future studies to establish more data, protocols, and evidence-based recommendations for analgesia in the pediatric craniotomy patient population.

Methods The studies selected were peer-reviewed, published in a medical or nursing journal, included study ages 0-21 years, or provided evidence on pediatric analgesia ...


Comparing The Effectiveness Of Perioperative Ketorolac To Opioids: A Scoping Review, Kruze T. Vanderford BSN, CCRN, SRNA, Abbie E. Walter BSN, CCRN, SRNA, Anastasiya V. Woodard BSN, CCRN, SRNA, Dwayne Accardo DNP, CRNA, APRN 2022 University of Tennessee Health Science Center

Comparing The Effectiveness Of Perioperative Ketorolac To Opioids: A Scoping Review, Kruze T. Vanderford Bsn, Ccrn, Srna, Abbie E. Walter Bsn, Ccrn, Srna, Anastasiya V. Woodard Bsn, Ccrn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Abstract Purpose/Background Opioids are commonly administered in the perioperative period to manage surgical pain. However, the ongoing opioid epidemic in the United States makes it necessary to evaluate other modalities of pain management that do not cause respiratory depression, nausea, vomiting and addiction. Ketorolac is a nonsteroidal anti-inflammatory drug that can manage pain safely and effectively. This scoping review examines the available literature on the effectiveness and feasibility of using ketorolac to minimize perioperative opioid use.

Methods A comprehensive literature review was performed between October 2020 and September 2021 utilizing five scholarly databases: GoogleScholar ™, PubMed, Ovid, Cochrane Library, and ...


Effectiveness Of Perioperative Ketamine Vs. Opioid Analgesia On Extubation Time And Total Perioperative Opioid Requirement, Robert H. Gray SRNA, Sarah S. Hardesty SRNA, Heidi E. Higginbotham SRNA, Charles A. Hoyt II, SRNA, Dwayne Accardo DNP, CRNA 2022 University of Tennessee Health Science Center

Effectiveness Of Perioperative Ketamine Vs. Opioid Analgesia On Extubation Time And Total Perioperative Opioid Requirement, Robert H. Gray Srna, Sarah S. Hardesty Srna, Heidi E. Higginbotham Srna, Charles A. Hoyt Ii, Srna, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Opioid analgesics are a primary source of pain control in the perioperative patient. However, all opioids decrease ventilatory drive secondary to mu2 receptor agonism in the brainstem. Ventilatory depression delays extubation after mechanical ventilation in post-operative patients, thus increasing the risk of complications such as ventilator-associated pneumonia and barotrauma. Non-opioid analgesics such as ketamine have been considered for use in order to reduce this risk. Ketamine is a noncompetitive N-methyl-D-aspartate receptor-antagonizing sedative that bears analgesic properties while preserving respiratory drive. Research suggests that ketamine provides effective perioperative pain control and decreases postoperative extubation time when given alone or ...


Reducing Pediatric Procedural Pain Using Virtual Reality, Emily Davis, Carmen Bandy 2022 Murray State University

Reducing Pediatric Procedural Pain Using Virtual Reality, Emily Davis, Carmen Bandy

Scholars Week

Above all else, children require stability in their lives in order to develop a healthy perspective of the world. Feelings of instability can come from something as small as a change in schools. In the practice of pediatric medicine it is especially important to avoid these feelings of instability, which can lead children to develop healthcare-anxiety. Healthcare settings can be exceptionally emotionally taxing to children, because the children have a complete lack of control over their environment. This lack of control combined with fear and potentially pain can be incredibly distressing. While it is easy to disregard a child’s ...


Managing Concurrent Discitis And Epidural Abscess Following Tfesi Arising From Unlikely Bacterial Species: The Importance Of Post-Procedure Education, Adlai Pappy, Robert Louis, Vinita Singh 2022 Brigham and Women’s Hospital Department of Anesthesiology and Pain Medicine

Managing Concurrent Discitis And Epidural Abscess Following Tfesi Arising From Unlikely Bacterial Species: The Importance Of Post-Procedure Education, Adlai Pappy, Robert Louis, Vinita Singh

Advances in Clinical Medical Research and Healthcare Delivery

Introduction:

Transforaminal epidural steroid injection (TFESI) can provide pain relief when patients’ radicular pain is refractory to medication and physical therapy. However, it is important that clinicians understand potential signs and symptoms of TFESI complications to prevent long-term sequelae. Literature has not documented both discitis and an epidural abscess concurrently following a lumbar TFESI.

Case:

We present a patient with stage 3c melanoma on the right lower extremity (RLE) with worsening lower extremity and foot pain. The pain was refractory to his current medication regimen of Gabapentin, and he wanted an alternative to opioids. A right L2-L5 TFESI was performed ...


Pectoralis Nerve Block For Regional Anesthesia: A Safe And Effective Approach To Incision And Drainage Of Axillary Abscesses, Jonathan Hardin, Sanna Ho-Gotshall, Casey L. Wilson 2022 HCA Healthcare

Pectoralis Nerve Block For Regional Anesthesia: A Safe And Effective Approach To Incision And Drainage Of Axillary Abscesses, Jonathan Hardin, Sanna Ho-Gotshall, Casey L. Wilson

South Atlantic Division Research Day 2022

No abstract provided.


Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach 2021 University of Southern Mississippi

Barriers To Preoperative Warming: Best Practice Guideline, Tyler Comans, Zachary Hays, Caleb Leach

Doctoral Projects

The lack of preoperative warming has a direct relationship to perioperative hypothermia complications which include, but are not limited to: increased infection rate, coagulopathies, and increased myocardial oxygen consumption; all contributing to poor patient and facility outcomes. Implementation of an evidence-based educational module with visual aid can potentially increase the utilization of active warming techniques in the preoperative setting by perioperative staff. The DNP Project investigated barriers to preoperative warming by perioperative staff at a large teaching hospital in the southeastern United States. Barriers were assessed by a voluntary survey sent to 87 perioperative staff members. Twenty-two surveys were completed ...


Variation In Pediatric Anesthesiologist Sedation Practices For Pediatric Gastrointestinal Endoscopy, Kayla T. Hartjes, Tracey M. Dafonte, Austin F. Lee, Jenifer R. Lightdale 2021 MassGeneral Hospital for Children

Variation In Pediatric Anesthesiologist Sedation Practices For Pediatric Gastrointestinal Endoscopy, Kayla T. Hartjes, Tracey M. Dafonte, Austin F. Lee, Jenifer R. Lightdale

Open Access Publications by UMass Chan Authors

Background: Despite a worldwide shift toward anesthesiologist-administered sedation for gastrointestinal endoscopy in children, ideal sedation regimens remain unclear and best practices undefined.

Aim: The aim of our study was to document variation in anesthesiologist-administered sedation for pediatric endoscopy. Outcomes of interest included coefficients of variation, procedural efficiency, as well as adverse events.

Methods: IRB approval was obtained to review electronic health records of children undergoing routine endoscopy at our medical center during a recent calendar year. Descriptive and multivariate analyses were used to examine predictors of sedation practices.

Results: 258 healthy children [2-21 years (median 15, (Q1-Q3 = 10-17)] underwent either ...


Transversus Abdominis Plane Block: A Scoping Review, Liam Maher, Leanne Orians, Gabrielle Pappas, Lanny Coker DNSC, CRNA 2021 University of Tennessee Health Science Center

Transversus Abdominis Plane Block: A Scoping Review, Liam Maher, Leanne Orians, Gabrielle Pappas, Lanny Coker Dnsc, Crna

Doctor of Nursing Practice Projects

The purpose of this project is to provide an overview of the literature on the analgesic effects of transverse abdominal plane (TAP) block and its effectiveness in reducing opioid consumption.


Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little DNP, APRN, FNP-BC 2021 University of Tennessee Health Science Center

Intraoperative Administration Of An Nsaid And An Opioid Vs. An Opioid Alone Effect On Postoperative Ileus Development, Brooke H. Ulsh, Delaney N. Vedros, Rebekah G. Whaley, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

The purpose of this DNP project is to examine what is known from existing literature about postoperative ileus development in the adult surgical patient population after receiving intraoperative opioids versus a combination of intraoperative opioids and NSAIDs.


Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris BSN, RN, SRNA, Brooke N. Hatchell BSN, RN, SRNA, Davelin D. Woodard BSN, RN, SRNA, Dwayne Accardo DNP, APRN, CRNA 2021 University of Tennessee Health Science Center

Intraoperative Dexmedetomidine For Reduction Of Postoperative Delirium In The Elderly: A Scoping Review, Gregory B. Harris Bsn, Rn, Srna, Brooke N. Hatchell Bsn, Rn, Srna, Davelin D. Woodard Bsn, Rn, Srna, Dwayne Accardo Dnp, Aprn, Crna

Doctor of Nursing Practice Projects

Background/Purpose: Post-operative delirium leads to significant morbidity in elderly patients, yet there is no regimen to prevent POD. Opioid use in the elderly surgical population is of the most significant risk factors for developing POD. The purpose of this scoping review is to recognize that Dexmedetomidine mitigates cognitive dysfunction secondary to acute pain and the use of narcotic analgesia by decreasing the amount of norepinephrine (an excitatory neurotransmitter) released during times of stress. This mechanism of action also provides analgesia through decreased perception and modulation of pain.

Methods: The authors developed eligibility criteria for inclusion of articles and performed ...


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