Anesthesiology Commons^™

Reporter's Occupation And Source Of Adverse Device Event Reports Contained In The Fda's Maude Database, Kevin T. Kavanagh, Raeford E. Brown, Steve S. Kraman, Lindsay E. Calderon, Sean P. Kavanagh

Anesthesiology Faculty Publications

Introduction: A review of the medical device adverse events submitted to the United States Food & Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was undertaken to determine the major sources of the information.

Methods: The reporter’s occupation and source of the medical device report were determined for acquisition dates Jan 1, 1997 to Dec 31, 2018. A total of 7,766,737 adverse event records were analyzed.

Results: 96.6% of reports originated with the manufacturer. Patients (patients/family/friend) were the most frequent submitter of reports directly to the FDA, almost five times as often as physicians. Nurses submitted reports …

Anesthetic Considerations For Patients Under The Influence Of Marijuana And/Or Cannabidiol: Anesthesia Interactions And Implications, Alexa Schimmel

Nurse Anesthesia Student Capstones

This manuscript investigates the use of marijuana, including edibles and cannabidiol (CBD), and its effects on anesthesia. This topic of research is very recent without an abundance of information. Various articles discuss the route of marijuana use including inhalation, ingestible and extracts of the plant, including CBD. For this manuscript, the term marijuana will pertain to both inhaled and ingested marijuana unless otherwise noted; ingestible marijuana is also known as edibles. This manuscript explains the mechanism of action of marijuana and CBD, the general guidelines for the use and how each affect the administration and impact of anesthesia.

Augmented Mean Arterial Blood Pressure And Vasopressor Selection In Patients With Spinal Cord Injury, Jayme Schroeder

Nurse Anesthesia Student Capstones

Blood pressure management in the acute period following spinal cord injury is a critical concern; one that anesthesia and critical care providers are often able to directly measure and regulate. It has been hypothesized that supraphysiologic blood pressure maintenance during this acute phase may improve recovery, however there is limited high-quality evidence to reinforce and guide management. Based on included prospective and retrospective studies, which provide the highest level of evidence available, The American Association of Neurologic Surgeons does provide the following level III recommendation: MAP goals of 85–90 mm Hg for 5–7 days post-injury should be considered. With regard …

Carbon Dioxide Embolisms During Laparoscopic Surgery, Leanne M. Jobin

Nurse Anesthesia Student Capstones

With the advancement of technology over the past few decades, laparoscopic surgery has significantly increased in popularity among many surgical subspecialties including: general surgery, gynecology, and urology. Many procedures that traditionally required open access with large incisions have been replaced with laparoscopic approaches as it offers many advantages such as, faster recovery, less postoperative pain, and shorter hospital stays. Despite its many advantages, it creates numerous anesthesia challenges and considerations when caring for patients undergoing laparoscopic procedures. Among these challenges, are carbon dioxide embolisms. This manuscript involves research and previous case studies that were conducted on carbon dioxide embolisms during …

Perioperative Glycemic Control And Its Outcome In Patients Following Open Heart Surgery, Khalid M Siddiqui, Muhammad Ali Asghar, Muhammad F. Khan, Fazal Wahab Khan

Department of Anaesthesia

Background: Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population.
Materials and methods: Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016.
Results: …

Htx-011 Reduced Pain Intensity And Opioid Consumption Versus Bupivacaine Hcl In Bunionectomy: Phase Iii Results From The Randomized Epoch 1 Study., Eugene R. Viscusi, Joseph S. Gimbel, Richard A. Pollack, Jia Hu, Gwo-Chin Lee

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVES: There is a need for local anesthetics that provide consistent analgesia through 72 hours after surgery. This study evaluates the use of HTX-011 (bupivacaine and meloxicam in Biochronomerpolymer technology), an extended-release, dual-acting local anesthetic, in reducing both postoperative pain over 72 hours and postoperative opioid use when compared with bupivacaine hydrochloride (HCl) and saline placebo. Inclusion of low-dose meloxicam in HTX-011 is designed to reduce local inflammation caused by surgery, potentiating the analgesic effect of bupivacaine. Previously, significant synergy has been observed with bupivacaine and meloxicam with both given locally together.

METHODS: EPOCH 1 was a randomized, …

Packed Red Blood Cell Transfusion Associates With Acute Kidney Injury After Transcatheter Aortic Valve Replacement, Akeel M. Merchant, Javier A. Neyra, Abu Minhajuddin, Lauren E. Wehrmann, Richard A. Mills, Sarah K. Gualano, Dharam J. Kumbhani, Lynn C. Huffman, Michael E. Jessen, Amanda A. Fox

Internal Medicine Faculty Publications

Background: Acute kidney injury after cardiac surgery significantly associates with morbidity and mortality. Despite not requiring cardiopulmonary bypass, transcatheter aortic valve replacement patients have an incidence of post-procedural acute kidney injury similar to patients who undergo open surgical aortic valve replacement. Packed red blood cell transfusion has been associated with morbidity and mortality after cardiac surgery. We hypothesized that packed red blood cell transfusion independently associates with acute kidney injury after transcatheter aortic valve replacement, after accounting for other risk factors.

Methods: This is a single-center retrospective cohort study of 116 patients undergoing transcatheter aortic valve replacement. Post-transcatheter aortic valve …

Coaching Operating Room To Pacu Handoff With A Standardized, Multidisciplinary Checklist, Courtney L. Devin, Md, Kathleen Grife, Rn, Ms, Marissa Weber, Md, Richard F. Schmidt, Md, Megan P. Lundgren, Md, Scott W. Cowan, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Purpose

To pilot a standardized multidisciplinary bedside handoff for any patient admitted to the post-anesthesia care unit (PACU) from the operating room.

Robotic-Assisted Versus Video-Assisted And Open Thoracic Surgery: Outcomes, Advantages, And Costs, Ananth Thitte

Nurse Anesthesia Student Capstones

Thoracic surgery via video assisted thoracoscopic surgery (VATS) began in the early 1990s, as a minimally invasive alternative to open thoracotomy for performing lobectomies, wedge resections, and segmentectomies. It initially showed improved morbidity and mortality, decreased pain, and decreased length of stay when compared to traditional open thoracotomy (Zhang & Gao, 2015). To its detriment, VATS has a steep learning curve and manipulation of instruments has been described as non-intuitive. The video camera used provides a two-dimensional image, with limited depth perception compared to the naked eye in an open procedure. Due to these shortcomings, and in spite of its …

Vaping And Anesthesia, Wen Wang

Nurse Anesthesia Student Capstones

Electronic cigarettes (ECs) are a fast-growing class of Electronic Nicotine Delivery Systems (ENDS) which were first put on the market 15 years ago. These devices have been advertised as safer alternatives to conventional cigarettes and a tool for smoking cessation by their manufacturers regardless of inadequate safety data (Kalkhoran, 2016). Since ECs have only been on the market for one and half decades, data on short-term health effects from inhaling EC aerosols are inadequate, and data regarding long-term health effects are very limited. Despite insufficient safety data, the use of ECs has increased exponentially since they were put on the …

Amniotic Fluid Embolism In The Parturient Patient, Vanessa Pasquariello

Nurse Anesthesia Student Capstones

An amniotic fluid embolism (AFE) occurs when amniotic fluid enters maternal circulation, causing a physical obstruction or an anaphylactoid reaction, both of which are often detrimental to the parturient patient. This paper reviews a series of studies to examine the incidence, risk factors, presentation, and management of an AFE in the healthcare setting. Diagnosing an AFE remains difficult as a universal diagnostic criterion does not exist (aside from in reported research); thus, its identification is often made when another differential diagnosis fails to manifest. The presentation of the following biomarkers: squamous cell carcinoma antigen, CK13, and CK10/13 can aid in …

Special Considerations For Clinical Trials In Fibrodysplasia Ossificans Progressiva (Fop)., Edward C Hsiao, Maja Di Rocco, Amanda Cali, Michael Zasloff, Mona Al Mukaddam, Robert J Pignolo, Zvi Grunwald, Coen Netelenbos, Richard Keen, Genevieve Baujat, Matthew A Brown, Tae-Joon Cho, Carmen De Cunto, Patricia Delai, Nobuhiko Haga, Rolf Morhart, Christiaan Scott, Keqin Zhang, Robert J Diecidue, Clive S Friedman, Fredrick S Kaplan, Elisabeth M W Eekhoff

Department of Anesthesiology Faculty Papers

Clinical trials for orphan diseases are critical for developing effective therapies. One such condition, fibrodysplasia ossificans progressiva (FOP; MIM#135100), is characterized by progressive heterotopic ossification (HO) that leads to severe disability. Individuals with FOP are extremely sensitive to even minor traumatic events. There has been substantial recent interest in clinical trials for novel and urgently-needed treatments for FOP. The International Clinical Council on FOP (ICC) was established in 2016 to provide consolidated and coordinated advice on the best practices for clinical care and clinical research for individuals who suffer from FOP. The Clinical Trials Committee of the ICC developed a …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

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 outcomes, …

Improving Nurse Anesthetist Intraoperative Handoff Process By Developing And Implementing An Evidence-Based, Facility-Specific Cognitive Aid, Jason Silva, Myron Arnaud

Journal of Nursing & Interprofessional Leadership in Quality & Safety

Miscommunication or non-transfer of pertinent patient information during intraoperative handoffs between anesthesia providers creates patient safety risks. An evidence-based facility-specific cognitive aid was developed and introduced to nurse anesthetists in an anesthesiology department of a large academic hospital with the aim of improving the intraoperative patient handoff process. The program used a handoff cognitive aid that addressed five pertinent patient information points. A secondary measure was evaluation of provider satisfaction. Twenty-four nurse anesthetists utilized the handoff cognitive aid during handoffs in the course of a 4-week pilot program. Eighty-eight nurse anesthetist handoffs were observed (23 with and 65 without the …

Improving Perioperative Warming Of Surgical Patients: Implementation Of A Warming Protocol, Maghy Schrage

Doctor of Nursing Practice Projects

Despite the ample amount of knowledge and interventions available to keep patients warm in the operating room, the issue of inadvertent perioperative hypothermia continues to be a problem affecting surgical patients. Unfortunately, even a mild degree of hypothermia can increase a patient’s chance for negative outcomes such as surgical site infections, bleeding, and higher risk for mortality. The project involved development of a warming protocol/guideline for a small community hospital. The implementation process consisted of two separate presentations tailored to educate both nursing and anesthesia staff about the importance of warming patients, reimbursement initiatives, and appropriate interventions.

The project study …

Letter To The Editor: Ketamine For Pain Management: Let's Not Neglect Practical Concerns, Steven P. Cohen, Eric S. Schwenk, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

We read with interest the recent article on ketamine by Bell and Kalso.1 In recent years, the use of ketamine to treat chronic pain and depression has exploded, and this article represents an easy-to-follow overview of this often misunderstood medication.

Increasing Doses Of Intraoperative Hydromorphone Do Not Reduce Postoperative Pain, Craig S. Curry, Michael B. Henry, Wendy Craig, Janelle M. Richard, Denham S. Ward

MaineHealth Maine Medical Center

Introduction:

• Intermediate and long acting opioids are given intraoperatively to reduce pain during emergence from anesthesia.

• Recent evidence suggests that intraoperative opioids have inconsistent effects on nociception and pain in the immediate postoperative period.

• Multiple potent, short-acting opioids such as remifentanil, sufentanil and fentanyl have been shown to produce dose-related increases in pain scores and opioid consumption in the immediate postoperative recovery period.

• Intraoperative doses of longer acting opioids such as morphine and methadone6 have been shown to reduce pain scores and narcotic requirements in the immediate postoperative period.

• Hydromorphone is an intermediate duration narcotic …

Cuff-Less Methods For Blood Pressure Telemonitoring., Dylan M. Bard, Jeffrey I. Joseph, Noud Van Helmond

Department of Anesthesiology Faculty Papers

Blood pressure telemonitoring (BPT) is a telemedicine strategy that uses a patient's self-measured blood pressure (BP) and transmits this information to healthcare providers, typically over the internet. BPT has been shown to improve BP control compared to usual care without remote monitoring. Traditionally, a cuff-based monitor with data communication capabilities has been used for BPT; however, cuff-based measurements are inconvenient and cause discomfort, which has prevented the widespread use of cuff-based monitors for BPT. The development of new technologies which allow for remote BP monitoring without the use of a cuff may aid in more extensive adoption of BPT. This …

Changing Healthcare Provider And Parent Behaviors In The Pediatric Post‐Anesthesia‐Care‐Unit To Reduce Child Pain: Nurse And Parent Training In Postoperative Stress (Np‐Tips), Brooke N. Jenkins, Michelle Fortier, Robert S. Stevenson, Mai Makhlouf, Paulina Lim, Remy Converse, Zeev N. Kain

Psychology Faculty Articles and Research

Background

Children who undergo surgery experience significant pain in the post anesthesia care unit. Nurse and parent behaviors in the post anesthesia care unit directly impact child postoperative pain. Therefore, we have developed and evaluated (Phase 1) and then tested (Phase 2) the feasibility of a new intervention (Nurse and Parent Training in Postoperative Stress) to alter parent and nurse behaviors in a way consistent with reducing child postoperative pain.

Methods

In Phase 1, a multidisciplinary team of experts (physicians, nurses, and psychologists) developed an empirically‐based intervention which was then evaluated by experienced nurses (N = 8) and parents …