Anesthesiology Commons^™

Ketamine For Refractory Headache: A Retrospective Analysis., Eric S. Schwenk, Amir C. Dayan, Ashwin Rangavajjula, Marc C. Torjman, Mauricio G. Hernandez, Clinton G. Lauritsen, Stephen D. Silberstein, William B. Young, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVES: The burden of chronic headache disorders in the United States is substantial. Some patients are treatment refractory. Ketamine, an N-methyl-D-aspartate antagonist, provides potent analgesia in subanesthetic doses in chronic pain, and limited data suggest it may alleviate headache in some patients.

METHODS: We performed a retrospective study of 61 patients admitted over 3 years for 5 days of intravenous therapy that included continuous ketamine to determine responder rate and patient and ketamine infusion characteristics. Pain ratings at 2 follow-up visits were recorded. An immediate responder was a patient with decrease of 2 points or greater in the …

Managing Prolonged Pain After Surgery: Examining The Role Of Opioids., Eric S. Schwenk, John-Paul J. Pozek, Eugene R. Viscusi

Department of Anesthesiology Faculty Papers

A notable minority of patients experience persistent postsurgical pain and some of these patients consequently have prolonged exposure to opioids. Risk factors for prolonged opioid use after surgery include preoperative opioid use, anxiety, substance abuse, and alcohol abuse. The window to intervene and potentially prevent persistent opioid use after surgery is short and may best be accomplished by both surgeon and anesthesiologist working together. Anesthesiologists in particular are well positioned in the perioperative surgical home model to affect multiple aspects of the perioperative experience, including tailoring intraoperative medications and providing consultation for possible discharge analgesic regimens that can help minimize …

Tramadol: A Valuable Treatment For Pain In Southeast Asian Countries, Ramani Vijayan, Gauhar Afshan, Khalid Bashir, Mary Cardosa, Madhur Chadha, Pongparadee Chaudakshetrin, Khin Myo Hla, Muralidhar Joshi, Francis O. Javier, Asif Gul Kayani

Department of Anaesthesia

Background: The supply of controlled drugs is limited in the Far East, despite the prevalence of health disorders that warrant their prescription. Reasons for this include strict regulatory frameworks, limited financial resources, lack of appropriate training amongst the medical profession and fear of addiction in both general practitioners and the wider population. Consequently, the weak opioid tramadol has become the analgesic most frequently used in the region to treat moderate to severe pain.
Methods: To obtain a clearer picture of the current role and clinical use of tramadol in Southeast Asia, pain specialists from 7 countries in the region were …

Blood Pressure Measurement Validation Off The Cuff? Comment On "A New Cuffless Device For Measuring Blood Pressure: A Real-Life Validation Study"., Noud Van Helmond, Timothy B. Plante, Jeffrey I. Joseph

Department of Anesthesiology Faculty Papers

No abstract provided.

Investigating Mpm-Iii, Sofa And Delta Sofa Scoring Systems As Predictors Of Mortality At A Tertiary Hospital In Nairobi, Kenya: A Retrospective Cohort Study, Lilian Lukoko

Master of Medicine in Anaesthesiology

Background: Despite major advances, management of critically ill patients worldwide is associated with high mortality rates. Assessment of disease severity is crucial in the analysis of ICU mortality. Although a variety of severity of illness scoring systems have been developed for this assessment and validated across Europe and the USA, few studies exist to show support of their utilization in African countries. There is conflicting evidence regarding the most reliable severity of illness scoring system suitable for resource limited countries as their mortality predictive values differ with different populations. SOFA is already in use at the AKUHN ICU and has …

Laryngeal Mask Airway: A Postoperative Sore Throat Clinical Practice Guideline, Logan Williams

Doctoral Projects

One of the most common and preventable complications experienced by patients undergoing general anesthesia is a postoperative sore throat (POST). Up to 70% of patients who receive a laryngeal mask airway (LMA) during anesthesia suffer from POST. Despite its regular occurrence and designation as a minor complication, POST has proven to be a distressing complication for patients afflicted. Consequently, a perceived minor complication can, in fact, play a major role in a patient’s perception of their care, the skill of their anesthesia provider, and their overall satisfaction with their experience.

Evidence shows that inflation of LMA cuffs beyond the recommended …

Designing The Ideal Perioperative Pain Management Plan Starts With Multimodal Analgesia., Eric S. Schwenk, Edward R. Mariano

Department of Anesthesiology Faculty Papers

Multimodal analgesia is defined as the use of more than one pharmacological class of analgesic medication targeting different receptors along the pain pathway with the goal of improving analgesia while reducing individual class-related side effects. Evidence today supports the routine use of multimodal analgesia in the perioperative period to eliminate the over-reliance on opioids for pain control and to reduce opioid-related adverse events. A multimodal analgesic protocol should be surgery-specific, functioning more like a checklist than a recipe, with options to tailor to the individual patient. Elements of this protocol may include opioids, non-opioid systemic analgesics like acetaminophen, non-steroidal anti-inflammatory …

Intra-Tracheal Extension Of Hilar Mass Mimicking Severe Asthma: Anesthesiologist Perspective, Khalid M Siddiqui, Muhammad Faisal Khan, Muhammad A. Asghar, Syed S. Uddin

Department of Anaesthesia

No abstract provided.

Integration Of Reflective Practice In Postgraduate Medical Education, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Postoperative Pain Management Practices And Their Effectiveness After Major Gynecological Surgery: An Observational Study In A Tertiary Care Hospital, Samina Ismail, Sarfraz Siddiqui, Azhar Rehman

Department of Anaesthesia

Background and Aims: Despite advances in postoperative pain management, patients continue to experience moderate to severe pain. This study was designed to assess the strategy, effectiveness, and safety of postoperative pain management in patients undergoing major gynecological surgery.
Material and Methods: This observational study included postoperative patients having major gynecological surgery from February 2016 to July 2016. Data collected on a predesigned data collection sheet included patient's demographics, postoperative analgesia modality, patient satisfaction, acute pain service assessment of numeric rating scale (NRS), number of breakthrough pains, number of rescue boluses, time required for the pain relief after rescue analgesia, and …

Referral Policy For Moderate To High-Risk Obstructive Sleep Apnea Patients Identified By The Stop-Bang Questionnaire: A Quality Improvement Project, Martha Kate Goforth, Price Roberts

Doctoral Projects

BACKGROUND: An increase in the prevalence of Obstructive Sleep Apnea is as high as 70% in the surgical population. OSA is associated with a higher incidence of complications in the perioperative setting showing the increased need for proper identification of moderate to high-riskpatients for referral to local sleep clinics. Identifying and treating OSA is an important step to improve managementof chronic diseases, decrease complications both inside and outside the perioperative setting, and reduce healthcare spending.

METHODS: The purpose of this project was to create an OSA referral program for patients undergoing general anesthesia at a hospital in Mississippi. The recommended …

Implementation Of A Sustainable Peer Mentor Program In Student Registered Nurse Anesthetists (Srnas)”, Kristin Cox

Doctoral Projects

Evidence has shown that Student Registered Nurse Anesthetist’s (SRNAs) stress is perceived as above average and is correlated with substandard patient care during clinical courses (Chipas et al., 2012). Some studies have indicated SRNAs experience low self-efficacy during clinical, which could lead to difficulty in thinking clearly or responding to clinical situations (Imus, Burns, & Weglarz, 2017). Peer mentoring has shown to result in stress reduction and improvement in self-efficacy in students (Barker et al., 2012; Giordana & Wedin, 2010). Despite the current evidence, a nurse anesthesia program in the southeastern United States did not have an organized peer mentor …

Continuous Epidural Analgesia For Postoperative Pain Management: A Policy Analysis, Madison Nowell

Doctoral Projects

Postoperative pain management is a necessary component of the care of every surgical patient. Epidural analgesia is a widely used method to provide excellent postoperative pain relief and enhance postoperative recovery (Sawhney, 2012). Epidural analgesia is associated with fewer side effects than alternative pain management techniques; however, when epidural catheters are managed improperly, or pain is inadequately assessed, epidural analgesia fails to provide adequate pain relief (Deni et al., 2016). More than 80% of surgical patients experience moderate to severe postoperative pain, and 28 to 50% of these patients have a pain score greater than 6 out of 10 at …

Use Of Guedel Airway As A Guide To Insert Nasogastric Tube Under General Anaesthesia: A Simple And Logical Way, Faraz Shafiq, Faruq Hameed, Khalid M Siddiqui

Department of Anaesthesia

No abstract provided.

A Six-Month Retrospective Study Of Resources Burden By Trauma Victims In The Surgical Intensive Care Unit Of A University Hospital In Pakistan, Muhammad Rizwan, Madiha Hashmi, Hasnain Zafar

Department of Anaesthesia

Introduction: Trauma is the fourth leading cause of death globally and constitutes a huge burden on limited critical care resources. Aim This study aimed to identify the trauma patient burden in terms of resources used in the surgical intensive care unit (SICU) of Aga Khan University Hospital in Pakistan which also included characteristics and outcomes of trauma and non-trauma patients.
Methods: We retrospectively reviewed all patient data for adult patients (>16 years old) admitted to the SICU from July through December 2014.
Results: Of 141 SICU cases included in our study period, 32 (22.7%) trauma patients were identified. On …

Corticosteroid Therapy For Sepsis: A Clinical Practice Guideline, Francois Lamontagne, Bram Rochwerg, Lyubov Lytvyn, Gordon H. Guyatt, Morten Hylander Møller, Djillali Annane, Michelle E. Kho, Neill K J Adhikari, Flavia Machado, Madiha Hashmi

Department of Anaesthesia

No abstract provided.

Effect Of Two Techniques Of Parental Interaction On Children's Anxiety At Induction Of General Anaesthesia - A Randomized Trial, Alia Hussain, Fauzia Khan

Department of Anaesthesia

Objective: Several non-pharmacological techniques, such as parental presence and behavioral preparation, are used to decrease children's anxiety at anaesthesia induction. We compared the mean anxiety score in children at the time of anaesthesia induction with two different physical techniques of parental interaction and a control group with no parent present. The secondary objective was to determine the face mask acceptance during induction.
Methods: This study recruited 123 ASA I & II children, aged 1 to 8 years, undergoing day care surgery, who were randomly allocated to three groups. Children either went to the operating room (OR) alone (Gp C), or …

Challenges Of Pain Management In Neurologically Injured Patients: Systematic Review Protocol Of Analgesia And Sedation Strategies For Early Recovery From Neurointensive Care., David Wyler, Michael Esterlis, Brittany Burns Dennis, Andrew Ng, Abhijit Lele

Department of Anesthesiology Faculty Papers

BACKGROUND: A recent paradigm shift within the intensive care discipline has led to implementation of protocols to drive early recovery from the intensive care unit (ICU). These protocols belong to a large knowledge, translation and quality improvement initiative lead by the Society of Critical Care Medicine, aiming to "liberate" patients from the ICU. They "bundle" evidence-based elements shown to lower ICU stay and mortality and optimize pain management. The bundled elements focus on Assessing, preventing and managing pain; Both spontaneous awakening trials and spontaneous breathing trials; Choice of analgesia and sedation; assessment, prevention, and management of Delirium; Early mobility and …

Noninvasive Hemodynamic Monitoring In Emergency Trauma Patients, Ryan Boyd

Nurse Anesthesia MSNA Student Capstones

Noninvasive hemodynamic monitoring has evolved steadily over the past few decades in response to healthcare providers' preference for less invasive monitoring methods for their patients. Invasive monitoring has its place in the critically ill patient population as witnessed in intensive care units throughout the country. Even in this environment, providers are opting less for the pulmonary artery catheter which has been the gold standard for invasive cardiac output monitoring in the past. Providers are now utilizing less invasive monitoring techniques which offer fewer potential complications to the patient while providing rapid access to critically important hemodynamic data. Examination of different …

The Utilization Of Laryngeal Mask Airways Vs. Endotracheal Tubes In Pediatrics With Upper Respiratory Tract Infection In Reducing Airway Complications, Ruby Foster

Nurse Anesthesia MSNA Student Capstones

According to Tait & Malviya, (2005) children typically experience six to eight upper respiratory infections (URIs) per year with ninety-five percent being viral in etiology (Tait & Malvia, 2005). URIs commonly occur in the pediatric population (Bernando-Ocampo, 2012). An issue surrounding the debate on whether a child with upper respiratory infection (URI) should proceed with surgery or cancel surgery is a debate that has been ongoing for several years (Tait el al. 2005). This review examines whether children who have an URI scheduled for surgery are at an increased risk for adverse respiratory complications when the laryngeal mask airway (LMA) …