Anesthesiology Commons^™

Routine Evaluation With Gastric Ultrasound To Reduce Gastric Aspiration (Regurga), Joel Jackson

Doctor of Nursing Practice Scholarly Projects

When a patient undergoes anesthesia, there are inherent risks that the providers should protect the patient from. Despite adherence to fasting guidelines established by the American Society of Anesthesiologists (ASA), patients undergoing anesthesia continue to experience intrapulmonary aspiration of gastric contents. There are several factors that delay gastric emptying, including coexisting disease, trauma, pain, and opioid use. Gastric ultrasound assessment of the gastric antrum is a relatively new technology in anesthesia and can be used to assess the gastric antrum and provide information to anesthesia providers regarding the risk of aspiration in the perioperative period. The primary aim of this …

A Case Report And Review On The Anesthetic Considerations Of Anterior Mediastinal Masses, Carter A. Schulz, Joshua D. Mohs, Andrew M. Reuter

Aesculapius Journal (Health Sciences & Medicine)

Case summary: A 15-year-old female presented with chest pain, dyspnea, and weight loss. A chest X-ray and subsequent CT scan revealed a large anterior mediastinal mass with cervical lymphadenopathy and pericardial effusion. Two biopsies under general anesthesia were performed, with the latter confirming classic Hodgkin lymphoma, nodular sclerosis subtype.

Discussion: This case underscores the significant clinical challenges posed by anterior mediastinal masses due to their proximity to vital cardiovascular and respiratory structures. Physiologic changes during general anesthesia can exacerbate these challenges. Preoperative assessment, including imaging and symptom evaluation, is crucial to guide operative planning. It is key to individualize the …

Drug-Free Noninvasive Thermal Nerve Block: Validation Of Sham Devices, Michael Fishman, Ahish Chitneni, Alaa Abd-Elsayed, Samuel Grodofsky, Ashley Scherer, Brendan Schetzner, Malvina Klusek, Stephen Popielarski, Stephen Meloni, Steven Falowski, Philip Kim, Konstantin Slavin, Stephen Silberstein

Department of Jefferson Headache Center papers and presentations

Headache is a leading cause of disability and suffering. One major challenge in developing device treatments is demonstrating their efficacy given devices' often-high placebo rate. This paper reviews the importance of validating sham devices as part of finalizing the design for larger-scale prospective randomized controlled trials in patients with chronic headache as well as the results of a prospective, single-blind trial to validate two potential sham noninvasive thermal nerve block devices. Study participants were trained to self-administer thermal nerve block treatment using sham devices in an office visit. Two different sham systems with different temperature profiles were assessed. Devices were …

Perioperative Chest X-Ray Interpretation For Anesthesia Providers, Kaitlyn Brown, Jessica Parsons

Doctoral Projects

Currently, a knowledge gap exists among anesthesia providers regarding perioperative chest x-ray (CXR) appropriateness and interpretation (Collins, 2022). The Council on Accreditation (COA) requires that students graduating from a nurse anesthesia program (NAP) interpret a minimum of five CXRs before program completion (Council on Accreditation [COA], 2020). This DNP project aimed to address the knowledge gap by offering an easily accessible online forum that guides anesthesia providers on CXR indications in surgical patients, and in identifying pathologies and invasive line and tube placement using CXR.

The authors created four learning modules regarding perioperative CXRs using Microsoft PowerPoint presentations with animation …

The Analgesic Efficacy Of Ultrasound-Guided Transversus Abdominis Plane Block Vs. Local Anesthetic Infiltration Technique In Major Gynecologic Surgery: A Randomized Controlled Trial, Samina Ismail, Akbar A. Mistry, Ali S. Siddiqui, Aliya Aziz, Nadeem Zuberi

Department of Anaesthesia

Background and aim: Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial.
Material and methods: Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia …

Angiotensin Ii In Liver Transplantation (Anglt-1): Protocol Of A Randomised, Double-Blind, Placebo-Controlled Trial., Michael Bokoch, Amy Tran, Erika Brinson, Sivan Marcus, Meghana Reddy, Elizabeth Sun, Garrett Roll, Manuel Pardo, Scott Fields, Dieter Adelmann, Rishi Kothari, Matthieu Legrand

Department of Anesthesiology Faculty Papers

INTRODUCTION: Catecholamine vasopressors such as norepinephrine are the standard drugs used to maintain mean arterial pressure during liver transplantation. At high doses, catecholamines may impair organ perfusion. Angiotensin II is a peptide vasoconstrictor that may improve renal perfusion pressure and glomerular filtration rate, a haemodynamic profile that could reduce acute kidney injury. Angiotensin II is approved for vasodilatory shock but has not been rigorously evaluated for treatment of hypotension during liver transplantation. The objective is to assess the efficacy of angiotensin II as a second-line vasopressor infusion during liver transplantation. This trial will establish the efficacy of angiotensin II in …

Decreasing Perioperative Medication Errors With Standardized Labeling Education, Stephanie Mccain, Emily Almond, Anna Wong, Julie Bonom

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

BACKGROUND: Medication errors are prevalent within the perioperative setting (Wahr et al., 2017). The anesthesia provider is the sole professional in charge of the medication process in the operating room, which results in fewer safety checks than in other healthcare settings (Nanji et al., 2016).

LOCAL PROBLEM: The proposed scholarly project aimed to reduce medication errors at an academic medical center in the Southeast using an educational module focused on standardized narcotic syringe labeling. The participants were anesthesia providers in the operating room at the project site.

METHODS: The Evidence-Based Practice Improvement model was used to guide the development, implementation, …

Early Goal-Directed Hemostatic Therapy For Severe Acute Bleeding Management In The Intensive Care Unit: A Narrative Review, Tomaz Crochemore, Görlinger Klaus, Marcus Lance

Anaesthesiology, East Africa

This is a narrative review of the published evidence for bleeding management in critically ill patients in different clinical settings in the intensive care unit (ICU). We aimed to describe “The Ten Steps” approach to early goal-directed hemostatic therapy (EGDHT) using point-of-care testing (POCT), coagulation factor concentrates, and hemostatic drugs, according to the individual needs of each patient. We searched National Library of Medicine, MEDLINE for publications relevant to management of critical ill bleeding patients in different settings in the ICU. Bibliographies of included articles were also searched to identify additional relevant studies. English-language systematic reviews, meta-analyses, randomized trials, observational …

Implementation Of A Single-Patient-Use Airway Taping Product In The Operating Room, Savannah Sierra Nicole Craig, Kaitlin D. Burrell, Jennifer Patrick

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

BACKGROUND: Anesthesia providers use adhesive tape to secure advanced airway devices. Rolls of adhesive tape serve as reservoirs for pathogens. Rolls of tape do not have instructions on how they are to be reused, cannot be disinfected, and should not be repurposed. The re-use of rolls of tape poses a risk to patient safety.

LOCAL PROBLEM: The project facility was an academic medical center in the Southeast region of the United States. The facility does not have taping practice guidelines in place. Rolls of tape are handled without gloves, used by several providers, placed on multiple patients’ faces, and stored …

Implementation Of Standardized Handoff Report In The Post Anesthesia Care Unit, Christie Faye Cox, Godsy Raju, Alyssa Garcia, Nicole Odom, Jennifer Patrick

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

BACKGROUND: Handoff communication is a critical event as it involves the transfer of patient details, authority, and responsibility from one clinician to another. The variations in handoff can lead to increased opportunities for clinician error due to the distinct possibility of the anesthesia providers omitting critical patient information.

LOCAL PROBLEM: The site for this quality improvement project is an academic medical center in the Southeastern region. The purpose of this quality improvement project was to implement a standardized anesthesia handoff tool for anesthesia providers. The aim of this project was after one month of implementation, the mean anesthesia …

Anesthetic Management Of Clamshell Thoracotomy For Large Tumor, Kasey Brooks, Nathaniel Lata

Posters

No abstract provided.

The Implementation Of A Pectus Bar Insertion Eras Pathway, Todd A. Glenski, Emily Weisberg, Christian M. Taylor, Brandon Layton, Andrea Melanson, Sameer Lalani

Posters

No abstract provided.

Role Of A Multidisciplinary Pulmonary Embolism Response Team And Impact Of Interventional Therapy In The Management Of Patients With Intermediate-High Risk Pulmonary Embolism, Juan N Pulido, Robert Fletcher, Michelle A. Poitevin, Kristina Pratt, Paul P Huang, Eric J Lehr, George P Pappas

Articles, Abstracts, and Reports

Background: Despite emerging interventional options for pulmonary embolism (PE), the mortality rate for intermediate high-risk PE (IHR-PE) remains high and the optimal therapeutic approach unclear due to a lack of robust outcomes data. We describe the outcomes of patients presenting with IHR-PE managed by a multidisciplinary PERT program with all available reperfusion options.

Methods: This single center retrospective study included EMR data from patients that were a part of the multidisciplinary PERT program from January 2012 to June 2023. PERT was activated if risk of death was intermediate or higher. The simplified pulmonary embolism severity index (sPESI) and Bova score …

Peripheral Nerve Catheter Securement: A Narrative Literature Review, Joshua M. Wiesel, Bernadette R. Findlay, Li Ching Ooi, Jennifer A. Stevens, Renata Hadzic

Journal of Perioperative Nursing

Peripheral nerve catheters are commonly used to provide analgaesia and improve patient outcomes. Catheter dislodgment, displacement or leakage can result in premature cessation of analgaesic effect. There are currently no published guidelines for how to secure peripheral nerve catheters.

This narrative review explores and integrates the available research into the efficacy of peripheral nerve catheter securement products and techniques to reduce catheter dislodgement and displacement.

All studies looking at peripheral nerve catheter securement methods were included from inception until 19 October 2022 across PUBMED, Scopus, Ovid, Google Scholar, EMBASE and The Cochrane Library. The Jadad scale and Newcastle–Ottawa scale were …

Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness In Non-Intubated Septic Patients A Prospective Observational Study, Anne Githaiga, Wangari Siika, Jeilan Mohamed, Vitalis Mung’Ayi, Idris Chikophe

Anaesthesiology, East Africa

Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed.

Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa.

Methodology: A prospective observational study which recruited non-intubated …

Who O2cov2: Oxygen Requirements And Respiratory Support In Patients With Covid-19 In Low-And-Middle Income Countries—Protocol For A Multicountry, Prospective, Observational Cohort Study, Pryanka Relan, Srinivas Murthy, John Marshall, Djillali Annane, Sylvie Chevret, Yaseen Arabi, Wangari Siika, Sara Dominguez Rodriguez, Pauline Convocar, Janet Diaz

Anaesthesiology, East Africa

Introduction: SARS-CoV-2 has been identified as the cause of the disease officially named COVID-19, primarily a respiratory illness. COVID-19 was characterised as a pandemic on 11 March 2020. It has been estimated that approximately 20% of people with COVID-19 require oxygen therapy. Oxygen has been listed on the WHO Model List of Essential Medicines List and Essential Medicines List for Children for almost two decades. The COVID-19 pandemic has highlighted, more than ever, the acute need for scale-up of oxygen therapy. Detailed data on the use of oxygen therapy in low-and-middle income countries at the patient and facility level are …

Management And Outcomes Of Pregnant Icu Patients With Severe Covid-19 Pneumonia In Qatar: A Retrospective Cohort Study, Hayat Elfil, Mogahed Ismail Hassan Hussein, Layla J. M. Kily, Sohel M. G. Ahmed, Mohammed Janish, Salwa M. Abuyaqoub, Huda A. Saleh, Marcus Lance

Anaesthesiology, East Africa

Introduction: Pregnant women are considered a high-risk group for COVID-19 due to their increased vulnerability to viral infections. The impact of COVID-19 on pregnant women is not well understood, and there is a need for data on managing severe COVID-19 in pregnant patients. This retrospective descriptive cohort study described the characteristics, hospital stay, interventions, and outcomes of pregnant patients admitted to the intensive care units (ICUs) with severe COVID-19 pneumonia in Qatar.

Methods: Data were collected from medical records and chart reviews of pregnant women admitted to Hamad Medical Corporation (HMC) with COVID-19 pneumonia from March 01, 2020, to July …

Organisation, Staffing And Resources Of Critical Care Units In Kenya, Wambui Mwangi, Ronnie Kaddu, Carolyne Njoki Muiru, Nabukwangwa Simiyu, Vishal Patel, Demet Sulemanji, Dorothy Otieno, David Misango, Wangari Siika, Rashan Haniffa

Anaesthesiology, East Africa

Objective: To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors.

Materials and methods: An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care.

Results: The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A …

Rare Event Of Intraoral Kinking Of Endotracheal Tube Upon Prone Positioning In A Patient Undergoing Posterior Fossa Surgery, Sonali Turki, Amiya K. Barik, Amit Sharma, Abhishek Arya

International Journal of Health and Allied Sciences

Prone position is commonly employed for many surgical procedures including neurosurgeries, spine surgeries, urological procedures, and in refractory ARDS patients. An endotracheal tube is a conduit to provide a secured airway to the patient. But in case of any equipment failure, it can cause catastrophic events. Intra-oral kinking is a rarer event. It can pose a major troubleshooting standstill owing to the inaccessible view of the kinked portion and the rarity of its occurrence to cross the clinician’s mind in the emergency scenario. We thus report this as the first such case of intraoral kinking against the soft palate in …

Noninvasive Continuous Monitoring To Improve Outcome Of Preeclamptic Women Undergoing Spinal Anesthesia For Cesarean Section, Andrea M. Regan, Molly Amin, Josue Brainin Md

Department of Health Sciences Faculty Proceedings, Presentations, Posters, Speeches, Lectures, etc.

Spinal induced hypotension is a common side effect and occurs in up to 33% of patients. Preeclamptic women have a high risk of severe hypotension related to spinal anesthesia while undergoing cesarean section Hypotension, short or cumulative episodes, increase nausea and vomiting in parturient and can potentially result in fetal acidosis, hypoxic-ischemic encephalopathy(HIE), and lower Apgar scores. The recommend standard of care is a minimum of five-minute interval blood pressure monitoring which risks late detection and treatment of hypotension. ClearSight® noninvasive continuous hemodynamic monitoring decreases the risk of hypotension-associated complications in mother and fetus and improves maternal nausea and vomiting …