Anesthesiology Commons^™

A Systematic Analysis On Opioid-Free General Anesthesia Versus Opioid-Based General Anesthesia For Bariatric Surgery, Ina Basha

Nurse Anesthesia Student Capstones

One-third of the American adult population is considered overweight, a figure that is still on the rise. Obesity negatively impacts every organ system in the human body. When minimally invasive strategies such as life style changes fail, bariatric surgery procedures have become the other option. The purpose of this systemic analysis is to look at the outcomes of post-operative pain, post-operative nausea and vomiting (PONV), and the length of stay required in the postanesthesia care unit (PACU) in obese adults undergoing bariatric surgery using opioid-free general anesthesia compared to opioid-based general anesthesia. The studies included in this systematic analysis conclude …

Prophylactic Phenylephrine Infusion Versus Bolus Regimens During Spinal Anesthesia For Cesarean Section, Safira Iddriss

Nurse Anesthesia Student Capstones

Hypotension is a well-recognized phenomenon associated with any spinal anesthesia. It is most particularly evident in the parturients as a higher block is required for cesarean section (C-section) (Nagelhout, 2014). These populations are also more prone to the effect of sympathectomy because of decreased sensitivity to endogenous vasoconstrictors in addition to increased synthesis of endothelium vasodilators (Miller, 2009). Sympathectomy results in hypotension and other adverse effects such as nausea and vomiting. Many studies over the decades have examined the best management option for the hypotension. This review seeks to determine the best management regimen for the use of the vasopressor …

The Effects Of Pain On Informed Consent, Bryan Aja

Nurse Anesthesia Student Capstones

It is common for providers to withhold pain medication as opposed to treating pain prior to obtaining informed consent due to the concern of invalid informed consent. Pain’s influence on cognition can significantly impact the cognitive domains required to obtain valid informed consent. Determining if a patient has the capacity or competence to participate in the informed consent process has medical, ethical, and legal implications. The medical use of competence and capacity is not equivalent to the legal use of the same terminology. Legal implications concerning consent include signing consent while in duress or pain, signing under the influence of …

Utilizing Tranexamic Acid To Reduce Blood Transfusion In Hip Fractures, Katherine Balzano-Cowan, Morgan Guerrette

Nurse Anesthesia Student Capstones

Minimizing perioperative blood loss during orthopedic surgery has proven challenging for providers. Perioperative utilization of antifibrinolytic pharmacologic interventions, such as tranexamic acid (TXA), has been demonstrated as a safe and effective technique for decreasing blood loss and allogenic blood transfusion rates. Currently, the Food and Drug Administration (FDA) approved on-label indications of TXA are for use in short-term treatment of hemophilia patients undergoing dental extractions and in management of patients experiencing menorrhagia (Mayeux, Alwon, Collins, & Hewer, 2016). Despite the current limited scope of FDA approval for TXA, use in elective surgery with otherwise clotting-uncompromised patients is not a new …

Clinical Performance And The Student Registered Nurse Anesthetist, Alyson Cronan

Nurse Anesthesia Student Capstones

The clinical component of graduate nurse anesthesia programs continues to be the key factor in evaluating and ensuring student success. Clinical experience has a direct correlation on student development in areas of self-awareness, psychomotor proficiency, critical thinking and professionalism. To effectively create a positive and motivating learning environment for the student registered nurse anesthetist (SRNA), the literature recommends instructors theoretically adapt to the individual learning style of the student, and incorporate various teaching techniques and modalities clinically. The overall goal of the clinical rotation is to establish an atmosphere where an individual can modify learning and skills. Positive, respectful and …

Decreasing Cost In The Gi Endoscopy Suite By Utilizing Best Sedation Practices, Casey Brianne Mancini

Doctoral Projects

Colorectal cancer is a leading cause of cancer death in the United States (Mandel, Tanner, Lichtenstein, Metz, Katzka, Ginsberg, & Kochman, 2008; Siegel, DeSantis, & Jemal, 2014). Because this lethal disease claims lives of many people every year, more patients are undergoing screening colonoscopies, which have greatly aided in decreasing the number of colorectal cancer deaths (Siegel et al., 2014). The most common form of sedation for colonoscopies is moderate sedation with a benzodiazepine and an opioid (Cohen, Hightower, Wood, Miller, & Aisenberg, 2004; Lera dos Santos, et. al., 2013). However, sedation by anesthesia providers using propofol is becoming more …

The Acttion-Aps-Aapm Pain Taxonomy (Aaapt) Multidimensional Approach To Classifying Acute Pain Conditions., Michael L Kent, Patrick J Tighe, Inna Belfer, Timothy J Brennan, Stephen Bruehl, Chad M Brummett, Chester C Buckenmaier, Asokumar Buvanendran, Robert I Cohen, Paul Desjardins, David Edwards, Roger Fillingim, Jennifer Gewandter, Debra B Gordon, Robert W Hurley, Henrik Kehlet, John D Loeser, Sean Mackey, Samuel A Mclean, Rosemary Polomano, Siamak Rahman, Srinivasa Raja, Michael Rowbotham, Santhanam Suresh, Bernard Schachtel, Kristin Schreiber, Mark Schumacher, Brett Stacey, Steven P Stanos, Knox Todd, Dennis C Turk, Steven J Weisman, Christopher Wu, Daniel B Carr, Robert H Dworkin, Gregory Terman

Articles, Abstracts, and Reports

Objective: With the increasing societal awareness of the prevalence and impact of acute pain, there is a need to develop an acute pain classification system that both reflects contemporary mechanistic insights and helps guide future research and treatment. Existing classifications of acute pain conditions are limiting, with a predominant focus on the sensory experience (e.g., pain intensity) and pharmacologic consumption. Consequently, there is a need to more broadly characterize and classify the multidimensional experience of acute pain.

Setting: Consensus report following expert panel involving the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION), American Pain Society …

Manual Trans-Tracheal High Frequency Positive Pressure Ventilation For Left Main Bronchus And Carinal Mass Surgical Resection In A Child, Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid

Department of Anaesthesia

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was …

Pharmacology, Pharmacokinetics, And Metabolism Of The Dna-Decoy Ayx1 For The Prevention Of Acute And Chronic Post-Surgical Pain, Julien Mamet, Scott Harris, Michael Klukinov, David C. Yeomans, Renee R. Donahue, Bradley K. Taylor, Kelly Eddinger, Tony Yaksh, Donald C. Manning

Physiology Faculty Publications

Background: AYX1 is an unmodified DNA-decoy designed to reduce acute post-surgical pain and its chronification with a single intrathecal dose at the time of surgery. AYX1 inhibits the transcription factor early growth response protein 1, which is transiently induced at the time of injury and triggers gene regulation in the dorsal root ganglia and spinal cord that leads to long-term sensitization and pain. This work characterizes the AYX1 dose-response profile in rats and the link to AYX1 pharmacokinetics and metabolism in the cerebrospinal fluid, dorsal root ganglia, and spinal cord.

Results: The effects of ascending dose-levels of AYX1 on mechanical …

Subanesthetic Ketamine For Pain Management In Hospitalized Children, Adolescents, And Young Adults: A Single-Center Cohort Study, K A. Sheehy, C Lippoid, A L. Rice, R Nobrega, Julia C. Finkel, Zenaide Quezado

Anesthesiology and Critical Care Medicine Faculty Publications

¹Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s Research Institute, Children’s National Health System, George Washington University School of Medicine and Health Sciences, ²Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, USA *These authors contributed equally to this work Background: Subanesthetic doses of ketamine, an N-methyl-D-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is …

Robert Reynolds Macintosh, M.D. (1897-1989): Forefather Of Anesthesiology, Advocate For Patient Safety., Haig Minassian, Scott W. Cowan, Charles J. Yeo

Department of Surgery Gibbon Society Historical Profiles

No abstract provided.

Ultrasound-Guided Vascular Access: An Evolving Standard Of Care Clinical Practice, Which Is Extremely Under-Utilized In Pakistan, Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai

Department of Anaesthesia

No abstract provided.

Endothelin Signaling In Bone, Jasmin Kristianto, Michael Johnson, Rafia Afzal, Robert D. Blank

Department of Anaesthesia

The endothelin (ET) system includes 3 small peptide hormones and a pair of G-protein-coupled receptors. This review first outlines the ET signaling pathway and ET metabolism. Next, it summarizes the role of ET1 signaling in craniofacial development. Then, it discusses observations relating ET signaling to osteoblastic and other osteosclerotic processes in cancer. Finally, it describes recent work in our laboratory that points to endothelin signaling as an upstream mediator of WNT signaling, promoting bone matrix synthesis and mineralization. It concludes with a statement of some remaining gaps in knowledge and proposals for future research.

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety At A Tertiary Hospital In Kenya: A Cohort Study, Anthony Kamau, Vitalis Mung’Ayi, Gerald Yonga

Anaesthesiology, East Africa

Background: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction.

Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward.

Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and …

Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai

Department of Anaesthesia

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and …

Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar

Department of Anaesthesia

No abstract provided.

Emerging Protagonists In Cancer Metastasis: An Oath Of Allegiance By Platelets, Akbar Shoukat Ali, Arzoo Ajaz, Heeba Hamid

Department of Anaesthesia

No abstract provided.

Physical Manipulation Of Larynx As A Technique For Insertion Of Nasogastric Tube, Sheema Siraj, Mehmood Mian, Fauzia Anis Khan

Department of Anaesthesia

No abstract provided.

Telemedicine Coverage For Post-Operative Icu Patients., Tara Ann Collins, Matthew P. Robertson, Corinna P. Sicoutris, Michael A. Pisa, Daniel N. Holena, Patrick M. Reilly, Benjamin A. Kohl

Department of Anesthesiology Faculty Papers

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical …

Perioperative Medicine And The Future Of Anesthesia, Alvin Kennedy

Loma Linda University Student Journal

No abstract provided.