Anesthesiology Commons^™

Perioperative Methadone Use And Postoperative Pain Control In Adult Patients Undergoing Elective Spinal Fusion Surgery, Amelia Haney

Nurse Anesthesia Student Capstones

Patients undergoing elective spinal fusion surgeries often experience moderate to severe postoperative pain (Murphy et al., 2017). The use of perioperative methadone has been suggested as an effective adjunct for patients to reduce postoperative pain, decrease opioid use, and improve patient satisfaction (Murphy et al., 2017). Traditional opioid management of orthopedic spine surgeries include intermittent injections or patient-controlled analgesia devices. These approaches may cause fluctuating levels of opioids or require patient education and cooperation to be effective (Murphy & Szokol, 2019). Methadone has a much longer elimination half-life when compared to other opioids, and therefore may provide patients with a …

Benefits Of Ketamine Versus Propofol In Acute Traumatic Brain Injuries With Elevated Intracranial Pressure, Marissa Diloreto

Nurse Anesthesia Student Capstones

Ketamine is a widely used medication that can be administered for the delivery of anesthesia as well as analgesia while supporting hemodynamics. A commonly taught concept based on early research is that ketamine should not be administered to those with acute brain injuries. Early research had stated that ketamine can cause a dangerous increase in intracranial pressure (ICP) and thus a decrease in cerebral perfusion and oxygenation in those with traumatic brain injuries (TBI) (Takeshita et al., 1972). More recent research has shown that ketamine may be efficacious for patients with TBIs and can decrease ICP (Dengler et al., 2022). …

The Role Of Intraoperative Esmolol Vs Ketamine In Laparoscopic Cholecystectomy, Rebekah Bitar

Nurse Anesthesia Student Capstones

As the understanding of opioid dependence mechanisms and origins in the adult population continues to evolve in the United States, so does the pursuit of alternative avenues for analgesia. Many opioid substance-use disorder patients can trace the origins of their dependence to routine prescription and administration of opioids during surgical procedures (Bohringer et al., 2020). One such procedure where opioids are frequently utilized for intraoperative and postoperative analgesia is laparoscopic cholecystectomy. Incidence of gall bladder disease is closely related to obesity (Hines & Marschall, 2018). Gallstone disease continues to be a common and costly health problem affecting 10 to 20% …

The Effects Of Mindfulness On Stress Reduction And Academic Performance In Students Studying Health Sciences, Julia Montalto

Nurse Anesthesia Student Capstones

Students studying health sciences are often consumed by rigorous curricula and demanding clinical schedules. The extensive concentration and commitment required of these students can be exhausting. This can lead to stress, poor academic performance, substance use and a decreased quality of life (Fauzi et al., 2021, Flowers & Bernard, 2020, Gao et al., 2022, & Melaku et al., 2015). Recent trends in academia have led to an integration of mindfulness-based stress reduction (MBSR) programs into the curriculum of graduate and undergraduate schools. Studies have shown that a consistent practice of some form of mindfulness is associated with a decrease in …

Ketorolac: To Bleed Or Not To Bleed? That Is The Question, Elisabeth E. Stewart

Nurse Anesthesia Student Capstones

Ketorolac is a readily available, inexpensive, moderate to severe pain management adjunct. As opioids lost favor, ketorolac gained popularity, as an opioid-sparing alternative (Corsini et al., 2021). Anecdotally, surgeons have been resistant to intra-operative intravenous ketorolac due to perceived bleeding risks. As such, this review seeks to evaluate the literature to determine whether ketorolac administration is associated with clinically significant bleeding in adult breast surgery patients. The results demonstrated conflicting evidence for ketorolac use. No literature has established a causal relationship between ketorolac and clinically significant bleeding. Future research avenues include geriatric, pediatric, labor and delivery, dosing, and randomized control …

Neurotoxic Effects Of General Anesthesia On The Developing Brain And The Use Of Spinal Anesthesia As An Alternative Approach For The Neonate And Infant Undergoing Genitourinary Surgery, Makaela E. Delucca

Nurse Anesthesia Student Capstones

Spinal anesthesia (SA) in the child under two years old is an excellent option when undergoing short genitourinary procedures. The use of SA in this patient population can avoid the potential deleterious neurocognitive effects on the developing brain that general anesthesia (GA) poses. A comprehensive literature review was conducted via retrospective case study, case control study, integrated review, and prospective study. The objective of this literature review is to examine the potential long-term neurotoxic effects of GA in the infant, as well as the benefits of SA. GA in the younger population has been shown to produce lower gray matter …

Crna Decision-Making Within The Anesthesia Care Team, Cindi L. Dabney

Theses and Dissertations (ETD)

This research focused on Certified Registered Nurse Anesthesiologists’ (CRNAs’) perspectives on the value placed on their decision-making skills within the Anesthesia Care Team (ACT). The emphasis of the study was to examine CRNA’s perspectives on the strengths, challenges, conflict resolutions, and any other information they were willing to divulge when working with physician anesthesiologists in the ACT model. An electronic survey questionnaire was sent to practicing CRNAs, primarily in the southeast region of the United States, with 171 informants completing the questionnaire. Data analysis included demographic information of the convenience sample that included age, gender, initial educational preparation as a …

Importance Of Clinical Practice Guidelines (Cpgs) In Anesthesia: Who Is Responsible For Implementing It?, Fazal Hameed Khan, Yamna Sohail

Department of Anaesthesia

Clinical practice guidelines (CPGs) incorporate and support clinical decisions. CPGs can improve clinicians’ and patients’ decision-making by explicitly describing and evaluating the scientific evidence, based on the potential benefits and risks underpinning clinical recommendations, making them relevant to the specific patient encounter. The number of clinical research publications have increased to the point that new medical knowledge is expected to be double every 72 days. Consequently, clinicians depend heavily on the available evidence that has been condensed into clinical CPGs by the representative institutions or societies. CPGs can have potential benefits and harms. Different groups have different opinions on whether …

Educational Curriculum For Peripheral Nerve Stimulation Developed By The North American Neuromodulation Society., Hemant Kalia, Alaa Abd-Elsayed, Mark Malinowski, Adam Burkey, Rany T Abdallah, Eellan Sivanesan, Tariq Malik, Reda Tolba, Yashar Eshraghi, Kris Ferguson, Maricela Schnur, Ahmed Raslan, Maged Guirguis, Marc Russo, Konstantin V Slavin

Neuroscience Articles

BACKGROUND: Peripheral nerve stimulation (PNS) is an effective neuromodulation therapy for chronic neuropathic and nociceptive pain. Although the total number of PNS implantations has increased over the last decade, no curriculum exists to guide training and learning of this therapy. The goal of the North American Neuromodulation Society (NANS) education committee is to develop a series of competency-based curriculums for neuromodulation therapies. The PNS curriculum is the latest part of such series, following the curriculums for spinal cord stimulation and intrathecal drug delivery system.

MATERIALS AND METHODS: A multidisciplinary task force (anesthesiology, physical medicine and rehabilitation, neurosurgery, preventive medicine and …

Central Pattern Generator And Control Of Breathing (Ośrodkowy Generator Wzorca I Kontrola Oddychania), Jaroslaw Richard Romaniuk

Faculty Scholarship

Fifty years ago, Clark and Euler published a model of the neural control of respiration that stimulated modern studies on the central generator of the rate and depth of breathing. These studies led to new discoveries concerning both anatomical localization and functional characteristics of respiratory central pattern generator (CPG), and as a result our knowledge has greatly changed. This article describes the history of respiratory CPG research and, more specifically, explains how studies concerning the regulation of breathing parameters affect the creation of new hypotheses and theoretical models of the neural control of respiration. Comparing studies on the generators of …

Tocilizumab For Severe Covid-19 Infection And Multisystem Inflammatory Syndrome In Adults And Children, Amber N. Edinoff, Edward Sanders Alpaugh, Olivia Newgaard, Irza Wajid, Rachel J. Klapper, Elyse M. Cornett, Adam M. Kaye, Praneet Iyer, Alan D. Kaye

School of Medicine Faculty Publications

Coronavirus disease 2019 (COVID-19) rapidly emerged as a global pandemic, placing imminent stress and burden on healthcare resources and workers worldwide. Many patients who present with a severe COVID-19 infection are at high risk of developing severe acute respiratory distress syndrome (ARDS), leading to a vast number of patients requiring mechanical ventilation and a high mortality rate. Similar to Middle East respiratory syndrome, COVID-19 demonstrates an initial viral replication phase that manifests as a variety of symptoms typically flu-like in nature, followed by a profound inflammatory response leading to rapid production of cytokines and uncontrolled inflammation. There have also been …

The Effect Of A Magnetic Resonance Imaging Sedation Protocol On Increasing Sedation Related Adverse Event Reporting Frequency And Anesthesia Utilization In The Henry Ford Health System, Bohdan Matsko, Mousab Eteer Md, Khalid Eteer Md, Muhammad Ibrahim Md

Medical Student Research Symposium

INTRODUCTION: Procedural sedation is intended to help patients minimize body movement and successfully complete an MRI scan. Although MRI sedation is becoming increasingly more common, it is associated with complications. There has been anecdotal evidence of MRI sedation adverse events occurring at relatively high frequency at HFHS in the past, although such events often went unreported. The study aim is to address this rising concern by instituting a protocol system that also intends to increase the reporting of MRI sedation adverse events.

METHODS: This Quality improvement (QI) project is established based on the Lean Six Sigma process improvement methodology. The …

The Effect Of Anesthetic Drugs During Craniotomy On Patient Outcomes, Thomas Vander Woude, Timothy Nold, Katherine Nowak, Donald Penning

Medical Student Research Symposium

Glioblastoma remains an aggressive, highly malignant brain cancer with poor prognosis despite treatment options including surgery, radiotherapy, and chemotherapy. The objective of this retrospective chart review study was to evaluate if there is a correlation between the type and dose of anesthetic drugs administered during craniotomy surgery for glioblastoma and the time to first postoperative tumor progression and mortality. Based on preliminary data in mice, it was hypothesized that the use of propofol during surgery is associated with slower tumor progression and lower mortality, when compared with other anesthetic drugs. In the observed time frame, 133 patients were diagnosed with …

A New Wave Of The Overdose Epidemic Arises During The Covid-19 Pandemic, Tolga Suvar Md, Asokumar Buvanendran Md, Stephen Music Do, Wilson M. Compton Md, Mpe

Advances in Clinical Medical Research and Healthcare Delivery

Abstract

Objective:

The goal of this manuscript is to highlight the notoriety of the overdose epidemic which has been masked by the Coronavirus pandemic.

Methods:

A thorough literature review of PubMed and the latest statistics from the Centers for Disease Control and Prevention (CDC) was performed for the most relevant and updated data regarding overdose deaths.

Conclusion:

The global health crisis known as the Coronavirus Disease 2019 (COVID-19) pandemic collided with the opioid epidemic in March of 2020, with devastating consequences for the United States. By overwhelming the healthcare system, the pandemic impacted patients who require continued mental health services, …

Metallic Implant-Related Osteosarcoma, Frawa Mohsin, Mustafa Bin Ali Zubairi, Kulsoom Fatima, Muhammad Asad Diwan

Department of Radiology

Orthopedic metallic prostheses are commonly used in the current practice of orthopedic surgery. Although, biomaterials used in these implants are generally considered to be biologically inert, there have been consequences of foreign body reactions and potential carcinogenesis. Majority of implant-related malignancies are high grade, and develop in bone or soft tissue around the implant site. No clear association has been identified between the biomaterial implanted and the type of sarcoma. We report the case of a 36-year-old male who underwent intramedullary nailing of femur for mid-shaft fracture secondary to trauma and presented with osteogenic sarcoma of femur 14 months later.

Measuring The Patient Safety Culture At A Tertiary Care Hospital In Pakistan Using The Hospital Survey On Patient Safety Culture (Hsopsc), Fasih Ali Ahmed, Fozia Asif, Tahir Munir, Sohail Haleem, Zehra Feroze Ali, Asim Belgaumi, Hasnain Zafar, Asad Latif

Department of Anaesthesia

Background: Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).
Methods: The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and …

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High-Risk Patients Attending The Preanaesthesia Assessment Clinic In A Tertiary Referral Hospital In Sub-Saharan Africa: A Diagnostic Accuracy Study, Brian Misoi, Vitalis Mung’Ayi, Rajpreet Bal, Shamshudin Mohammedali

General Surgery, East Africa

Objectives: The use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the diagnostic accuracy of one such questionnaire in identifying high-risk patients in a Sub-Saharan population.

Design: Diagnostic accuracy study

Setting: The study was conducted in a preanaesthesia assessment clinic in a tertiary referral hospital in SubSaharan Africa. Participants The study had a sample size of 128, including all patients above the age of 18 scheduled for elective surgery under any modality of anaesthesia other than local anaesthesia presenting to the …

Complications Of Cardiopulmonary Bypass From An Anesthesia Perspective: A Clinical Review, Alex Roberts, Elizabeth C. Duncan, Paul Hargrave, David Redding Kingery, Josh Barnes, Derek L. Horstemeyer, Russell F. Stahl

HCA Healthcare Journal of Medicine

Cardiopulmonary bypass (CPB) is frequently used for open heart surgery and other procedures that utilize temporary substitution or support of heart and lung function. While it is widely accepted as the predominant method to carry out these procedures, it is not without possible complications. CPB can be seen as the ultimate “team sport” as it includes and is dependent on contributions from multiple professionals including anesthesiologists, cardiothoracic surgeons, and perfusion technicians. In this clinical review paper, we examine possible complications of CPB, primarily from the perspective of the anesthesiologist, and how to troubleshoot them if they arise, which often requires …

New Synthetic Opioids: Clinical Considerations And Dangers, Amber Edinoff, David Martinez Garza, Stephen Vining, Megan Vasterling, Eric Jackson, Kevin Murnane, Adam Kaye, Richard Fair, Yair Jose Lopez Torres, Ahmed Badr, Elyse Cornett, Alan Kaye

School of Medicine Faculty Publications

Since the early 2010s, synthetic opioids have significantly contributed to overall opioid-related overdose mortalities. For point of reference, of the 68,630 opioid-related deaths recorded in 2020, 56,516 involved synthetic opioids. During much of this period, fentanyl has been the most commonly used synthetic opioid. This time when fentanyl was the most popular opioid has been called the “third wave” of the opioid crisis, partly because it led to a sharp rise in deaths from overdoses. Other synthetic opioids, such as carfentanil, protonitazene, and isotonitazene, have also become more widely diverted for nonmedical used. Carfentanil is an even more potent fentanyl …

Caesarean Section For Placenta Previa: A Retrospective Cohort Study Of Anaesthesia Techniques, Samina Ismail, Saima Rashid

Department of Anaesthesia

Objective: Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.
Methods: This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.
Results: Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, …