Anesthesiology Commons^™

Risk Factors Associated With Platelet Transfusions In Patients Undergoing Atrial Septal Defect And Ventricular Septal Defect Repair, Louis Do, Maxwell James, Matt Lilien, Katie Liu, Laura Downey

Research Day

Introduction:

Pediatric patients often require platelet transfusions after cardiac surgery to treat cardiopulmonary bypass (CPB) induced platelet dysfunction.1 While platelet transfusions are often necessary to treat post-CPB coagulopathy, they have the highest rate of adverse events of blood component therapy in pediatric patients.2 Therefore, we sought to identify perioperative risk factors for platelet transfusions in pediatric patients undergoing atrial septal (ASD) and ventricular septal defect (VSD) repairs in order to identify modifiable factors that may aid in decreasing unnecessary transfusions at our institution.

Methods:

In this retrospective study, we analyzed the Society of Thoracic Surgeon’s Congenital Heart Surgery Database of …

Improving In Pacu Sign-Out Times, Manan Karki, Todd A. Glenski, Christian M. Taylor

Research Days

The post anesthesia care unit (PACU) provides specialized care to post-surgical patients recovering from anesthesia. Patients are discharged from the PACU to other clinical units or home after they are deemed stable depending on the type of surgery. A delayed discharge from the PACU can occur due to varied reasons which can affect the dynamic patient flow, have implications on pediatric population (e.g., anxiety due to parental separation), and increase the overall cost of service.

This quality improvement project looks at possible causes to PACU sign-out delays and helps develop countermeasures to improve the efficiency of signouts once patients are …

Utilizing The Anatomage Virtual Dissection Table For Learning Neuroanatomical Structures In Nurse Anesthesia Programs, Domenica Camaci-Douleh, Nicole Gorris

Doctor of Nursing Practice Projects

Certified registered nurse anesthetists are responsible for developing expertise in neuraxial anesthesia. A thorough understanding of anatomy and physiology is essential in the performance of subarachnoid and epidural blocks. Although cadaveric dissection is considered the gold standard for learning anatomy, student use of cadavers can become limited due to supervisory, ethical, accessibility, and financial constraints (Periya and Moro, 2019). In recent years, the evolution of technology has produced a virtual option for cadaver dissection (Washmuth et al., 2020). The anatomage virtual dissection table is a tool that could be used to increase knowledge of neuroanatomical structures and their spatial relationships …

Developing An Advocacy Campaign To Minimize Barriers To Srna Political Awareness, Alejandra Villescas

Doctor of Nursing Practice Projects

Continuous advocacy and political participation have secured better working conditions and recognition of certified registered nurse anesthetists (CRNAs), translating into better patient care. This project aimed to launch an advocacy campaign targeting student registered nurse anesthetists (SRNAs). A pre-lesson survey was designed to identify SRNAs’ political participation barriers and assess their political literacy. Additionally, a lesson was developed to help SRNAs’ understand CRNA advocacy. To evaluate the educational tool, a post-lesson survey was created. These materials were distributed via email to all SRNAs (n=320) enrolled in a CRNA program in Illinois. Only 51 students completed the pre-lesson survey, and 39 …

Utilizing Gastric Point-Of-Care Ultrasound Assessment For Patients With Questionable Npo Status, Carolina Botero

Doctor of Nursing Practice Projects

Perioperative aspiration is a rare but serious complication with high morbidity and mortality for patients. This event often occurs from anesthetic depression of protective airway reflexes. NPO guidelines are implemented before anesthesia to eliminate the presence of any gastric contents. However, patients with certain comorbidities may still persist with a full stomach before an anesthetic. Patients may complicate matters further by not following NPO instructions, the patient’s NPO status may be unknown, or the timing of surgery may prevent adequate NPO times. In these situations, the anesthesia provider is faced with the difficult decision to alter, delay or potentially cancel …

Management Of Ineffective Epidural For Cesarean Section, Miriam Ndenecho

Doctor of Nursing Practice Projects

In the United States, epidural anesthesia is used for approximately 29-44% of cesarean sections (Carvalho, 2012). A failed or inadequate labor epidural is challenging to manage, especially when a cesarean section is imminent. A failed labor epidural is defined as insufficient pain relief within 45 min after placement, accidental dural puncture, re-siting or abandoning the procedure, and patient dissatisfaction at follow-up (Ismail et al., 2021). This project examined established best practices for managing a parturient with an ineffective labor epidural that requires a cesarean section. The literature review provided zero practice guidelines for the management of failed epidural for cesarean …

Development Of Neuraxial Anesthesia Educational Videos For Nurse Anesthesia Students, Mackenzie Schutt, Kaylie Lajeunesse

Doctor of Nursing Practice Projects

Development of Neuraxial Anesthesia Educational Videos for Nurse Anesthesia Students

Kaylie LaJeunesse, BSN, RN, SRNA & Mackenzie Schutt, BSN, RN, SRNA

Performance and evaluation of anesthetic procedures, specifically neuraxial anesthesia, are core components of nurse anesthesia curriculums. Teaching methods must provide nurse anesthesia students with the proper tools and knowledge to perform skills confidently and proficiently. Traditional teaching methods have fallen short of providing the necessary instruction for optimal student success. Incorporating video-learning resources on neuraxial anesthesia into course curriculums can significantly improve nurse anesthesia practice by better-preparing students for the clinical setting. Video learning increases student engagement and facilitates …

Perioperative Ketamine Use For Post Mastectomy Pain, Alessia Cooney, Jaylyn Thompson, Naomi Watkins-Granville

Rowan-Virtua Research Day

PMPS is defined as chronic neuropathic pain following breast cancer procedures in the ipsilateral arm, chest wall, axilla or shoulder.1-3 Approximately 20 to 50% of post mastectomy patients suffer from Post Mastectomy Pain Syndrome (PMPS).1 With more than 3.8 million breast cancer survivors, due to advances in treatment, there is increased importance in findings ways to better manage the quality of life of breast cancer survivors.1,4 Ketamine induces analgesic effects through its non-competitive antagonism of NDMA receptors.5 Low doses of ketamine infusion (20–30 mg x h−1) have been shown to produce analgesia in neuropathic pain states with benefits lasting up …

Evaluation Of Hydrocortisone, Vitamin C, And Thiamine For The Treatment Of Septic Shock: A Randomized Controlled Trial (The Hyvits Trial), Adham Mohamed, Mohamed Abdelaty, Mohamed O. Saad, Ahmed Shible, Hassan Mitwally, Abdel-Rauof Akkari, Abdurrahmaan Elbuzidi, Awadh Bintaher, Ahmed Hashim, Marcus Lance

Anaesthesiology, East Africa

Purpose: The aim of the study is to evaluate the effect of combined hydrocortisone, vitamin C, and thiamine (triple therapy) on the mortality of patients with septic shock.

Methods: This multicenter, open-label, two-arm parallel-group, randomized controlled trial was conducted in four intensive care units in Qatar. Adult patients diagnosed with septic shock requiring norepinephrine at a rate of ≥0.1 μg/kg/min for ≥6 h were randomized to a triple therapy group or a control group. The primary outcome was in-hospital mortality at 60 days or at discharge, whichever occurred first. Secondary outcomes included time to death, change in Sequential Organ …

Adjuncts And Additives To Regional Anesthesia, Kaisi Dye, Kelcie Brunnert

Doctor of Nursing Practice Projects

With regional anesthesia becoming increasingly popular, an emphasis has been placed on choosing appropriate adjunct medications to local anesthetics for prolonging peripheral nerve blocks- lengthening postoperative pain control and decreasing perioperative narcotic usage. This project aimed to increase provider knowledge of the proven efficacy of block and adjunct selection for breast, shoulder, and knee surgeries with intended results being prolonged block duration and increased patient satisfaction post-operatively. A focused lecture along with a Likert-scale questionnaire and quiz were administered to a small sample of anesthesia providers at a rural Illinois hospital. Half (55.6%) of the providers showed evidence of knowledge …

Implementation Of A Glidescope Educational Program For Novice Student Registered Nurse Anesthesiologists, Joshua F. Snodgrass, Brian Bendel

Doctor of Nursing Practice Projects

GlideScope Video laryngoscopy carries a higher risk of injury to the pharyngeal cavity than direct laryngoscopy. Verathon is aware of this risk and has developed a proprietary “Four-step method” to mitigate it. This project aimed to reduce injuries related to GlideScope video laryngoscopy by providing first-year nurse anesthesiologists at Southern Illinois University Edwardsville with didactic and simulation education related to GlideScope video laryngoscopy and injury prevention. Didactic education was provided via a pre-recorded PowerPoint presentation. Simulation education was provided with the GlideScope and airway trainer manikins. The participants completed an identical 8-question pre-test and post-test to assess for knowledge gain …

Acute Lithiasis Cholecystitis; Particularities Of Diagnosis And Treatment In The Elderly, Adrian Silaghi, Bogdan Socea, Petrisor Banu, Vlad Dumitru Baleanu, Dragos Epistatu, Ioana Paunica, Vlad Denis Constantin

Journal of Mind and Medical Sciences

Objectives. The incidence of acute cholecystitis increases with age, when patients usually associate additional comorbidities. Such comorbidities and the late presentation to the doctor make the treatment more complex, associating higher rates of complications. The present study aims to evaluate the methods of diagnosis and treatment applied to a group of older patients with acute cholecystitis. Materials and Methods. 585 patients were enrolled in the study between 2019 and 2023. The inclusion criteria in the study were represented by the presence of the diagnosis of acute cholecystitis in patients over 65 years of age, while patients who presented complex locoregional …

Management Of Anxiety And Depression In Post Coronary Artery Bypass Graft Surgery, Mansour Jannati, Amir Aslani

Journal of Mind and Medical Sciences

Depression and anxiety are common events in 30-40 percent of post coronary artery bypass graft (CABG) surgery patients. Depression symptoms in patients with CAD are expected to be significantly more, comparing the public incidence rate. Impaired remedy after coronary artery events may partly be attributed to depression and anxiety. If anxiety continues, it may lead to elevate metabolism and oxygen consuming. High level of anxiety increases the pain sensation in post CABG patients. This paper aimed to review results and findings of previous studies in the field of anxiety and depression management of post coronary artery bypass graft surgery. Up …

Diagnosis And Management Of Colon Cancer Patients Presenting In Advanced Stages Of Complications, Vlad Denis Constantin, Adrian Silaghi, Dragos Epistatu, Anca Silvia Dumitriu, Stana Paunica, Daniela Gabriela Bălan, Bogdan Socea

Journal of Mind and Medical Sciences

Colorectal cancer is an important health problem with a significant impact on the individual and society. Malignancy (including colorectal cancer) is usually slightly symptomatic in its initial stages. This causes cancer to be discovered in some patients accidentally (either through screening tests in predisposed individuals or during routine investigations for other diseases), while in other patients the colorectal cancer is discovered in late stages, when the symptoms are much more intense due to complications. Unfortunately, such advanced cases of the disease have high rates of morbidity and mortality even with treatment. Current treatment methods are usually complex, interdisciplinary, causing significant …

Tips And Tricks For Laparoscopic Cholecystectomy In The Patient With Ventriculoperitoneal Shunt; A Case Report, Carmen Popa, Andrei Moisin, Mihai Faur, Mihaela Racheriu, Ramona Coca, Cristian Mihai Branescu, Tiberiu Trotea, Denisa Tănăsescu

Journal of Mind and Medical Sciences

Laparoscopic surgery in patients with ventriculo-peritoneal shunt is challenging in terms of technical approach. The severity of possible complications and the lack of studies on this association increase the surgeon's discomfort with such surgery. The main complications that may occur are increased intracranial pressure, secondary pneumo-peritoneum pneumocephalus, encephalitis and the risk of catheter injury during laparoscopic procedures. We present the case of a 56-year-old patient operated in 2004 for a basilar artery top aneurysm with subarachnoid hemorrhage and secondary hydrocephalus, for which a ventriculo-peritoneal shunt was fitted. This patient presented in our clinic with diffuse abdominal pain, more accentuated in …

Evidence-Based Practice Guidelines For The Optimal Assessment Of The Airway In Predicting Difficult Intubation, Meredith Louden

Doctor of Nursing Practice Scholarly Projects

Adverse respiratory events are the most common injuries in anesthesia; difficult intubation and ventilation contribute to most cases. Injuries following inadequate airway management include cerebral hypoxia, aspiration, and cardiac arrest. Despite the risk and consequences following inadequate airway management, most medical facilities lack standardized airway assessments for anesthesia providers. Current evidence implicates that ultrasound measurement of the hyomental distance demonstrates the highest specificity and accuracy in predicting difficult intubation. The traditional approach to conducting airway assessments includes Mallampati classification, which shows high specificity for predicting difficult airways only when combined with other airway assessments. The purpose of this evidence-based project …

Pectoralis Nerve Block Compared To Thoracic Paravertebral Nerve Block In The Mastectomy Patient: Evidence-Based Practice Recommendations, Eric Boyer

Doctor of Nursing Practice Scholarly Projects

Patients undergoing a mastectomy are at increased risk of becoming opioid dependent. Most patients undergoing a mastectomy are diagnosed with breast cancer, and the use of opioids is known to aid in cancer metastasizing due to the suppression of the body's natural killer cells. In addition, regional anesthesia, also known as a nerve block, has long provided a reduction in sensation by blocking the nerve pathway, thus numbing the feeling of pain in the operative area. The Pectoralis nerve block (PECS) and the Thoracic Paravertebral block (TPVB) are used in patients undergoing a mastectomy to help reduce the severity of …

Plethysmography Variation Index (Pvi) Utility In Guiding Goal-Directed Fluid Therapy During Major Abdominal Surgery, Ricky Malo

Nurse Anesthesia Student Capstones

When considering intra-operative MAP maintenance, preload is a significant driving factor of stroke volume and therefore cardiac output. In major abdominal surgeries, large fluid shifts are common and accurate fluid resuscitation is extremely important to maintain hemodynamic stability and promote optimal patient outcomes. Invasive methods of measuring fluid status range from esophageal doppler derived flow time (FTc) and arterial line-derived metrics such as stroke volume variation (SVV) and pulse pressure variation (PPV). However, invasive means are not always warranted for every surgical procedure or patient and there is a higher potential risk for complication. Plethysmography Variation Index (PVI) has been …

Perioperative Pain Management In Morbidly Obese Patients Undergoing Bariatric Surgery, Jean-Louis Luther

Nurse Anesthesia Student Capstones

Patients with morbid obesity are a growing patient population. These patients present a unique set of challenges in healthcare management. These unique challenges have been a long-standing concern to anesthesia providers in appropriately managing postoperative pain with opioids. Multimodal analgesia strategies have been adopted by many providers to minimize opioid-related side effects that are highly desirable in bariatric surgical procedures. The literature reviewed for this manuscript highlights the challenges this population presents to anesthesia providers, as well as conclusively supports alternative approaches utilizing multimodal pain management.

Impact Of Intrathecal Morphine On Patient Outcomes In Major Abdominal Surgery, Tori E. Howe

Nurse Anesthesia Student Capstones

Colorectal enhanced recovery after surgery (ERAS) guidelines for patients undergoing major abdominal surgeries have started to include intrathecal morphine (ITM) as part of the protocol to improve patient outcomes. There is interest amongst other abdominal surgical disciplines in expanding the use of ITM. When used as a single bolus, ITM has shown to have an intravenous (IV) opioid sparing effect postoperatively, as well as improved pain scores for up to 24 hours (Koning et al., 2020). However, ITM coincides with unique considerations and side effects. There is a dose-dependent concern of ITM causing respiratory depression postoperatively that necessitates additional monitoring …