Intraoperative Cuff Pressure Monitoring of Airway Devices: An Evidence-Based Educational Intervention

Background and Review of Literature: Subjective methods for assessing airway device cuff pressures (CP) remain in use to determine correct inflation, despite evidence indicating inadequate sensitivity for identifying under and overinflation. Inadequate CP can cause tissue ischemia, mucosal ulcers, stenosis, and aspiration. Recommendations for endotracheal tubes (ETT) CP are 20 to 30 cm H2O and ≤ 60 cmH2O for supraglottic airway (SGA) devices. Currently, there are no guidelines for intraoperative monitoring of airway devices. Manometers are the most accurate and accepted method for assessing CP; however, they are underutilized intraoperatively. Purpose: The project goal was to promote CP assessment intraoperatively with manometry and create a practice guideline for measuring and monitoring CP. Methods: A literature review was performed to evaluate recent evidence on CP assessment for airway devices to develop practice guidelines for intraoperative monitoring of CP. A group of 23 licensed anesthesia providers participated in the project. Pre-and post-surveys were utilized. Evaluation of current knowledge, methodology, rating of importance, and willingness to adopt manometry for CP intraoperative monitoring was obtained. Education on CP monitoring was discussed with participants, followed by post-survey. Pre-survey was used to evaluate participants’ current methods for ETT and SGA CP assessment. During routine intubation, participants were asked to inflate an airway device using their preferred technique to determine adequate CP. Readings for CP were measured using a manometer device approved by the Food and Drug Administration (FDA). Data for their corresponding CP reading was shared with participants, and educational information reflecting current evidence for CP monitoring. Post-survey was then performed to evaluate the participants’ willingness to adapt CP assessment with manometry into their practice. Conclusion: Intraoperative CP was predominantly performed with subjective techniques. Anesthesia providers expressed a willingness to assess CP with manometry, posing education as a possible foundational step for future implemention of CP monitoring in the operating room (OR). Lack of guidelines for CP monitoring intraoperatively and variability in monitoring CP due to subjective assessment methods emphasized the need for standardization and the increased availability of manometry devices for intraoperative use

Supplemental Intraoperative Intravenous Fluid Administration among Patients Undergoing Surgical Procedures and General Anesthesia for the Prevention of Postoperative Nausea and Vomiting: A Retrospective Chart Review

Background and Review of Literature: Postoperative nausea and vomiting (PONV) is one of the most common patient complications following general anesthesia. Recent literature supports the practice of supplemental intravenous fluid administration to patients receiving general anesthesia with no risk of fluid volume overload. Purpose: The purpose of this DNP project was to assess the overall occurrence of PONV and to determine if patients who experienced PONV after receiving general anesthesia, were administered supplemental intravenous fluids during the intraoperative period. Methods: The project consisted of a retrospective chart review. A total of 342 electronic health records (EHRs) were reviewed and 57 patients were included in the DNP project. Implementation Plan: A project site was identified; a retrospective chart review was conducted, examining one month of patient EHRs who underwent general anesthesia. Data was collected and analyzed via Microsoft Excel, which included the amount of intravenous fluids received during the intraoperative period, weight, gender, surgical procedure, and ASA physical status. Implications/Conclusions: At the completion of the retrospective chart review, it was discovered that 57 (17%) out of 342 patients who underwent general anesthesia were treated for PONV. Of the 57 patients, 50 (88%) did not receive intraoperative supplemental intravenous fluids. Only 7 (12%) patients received greater than 15mL/kg of intravenous fluid during the intraoperative period

Comparing postoperative pain scores and opioid consumption in patients receiving Lumbar Plexus block versus Fascia Iliaca block after undergoing hip arthroplasty

Background and Review of Literature: Lumbar plexus block and fascia iliaca block are two commonly used anesthesia modalities for patients underdoing hip arthroplasty at Union Hospital in Terre Haute, Indiana. Currently, there are not any studies that demonstrate which block is more effective at reducing postoperative pain and opioid consumption after hip arthroplasty. Review of literature demonstrates that both blocks have their advantages and disadvantages for providing postoperative pain relief. Purpose: To determine which block is more effective at reducing postoperative pain, opioid consumption, and length of stay in hospital after hip arthroplasty procedures. These findings will then be presented to anesthesia staff at Union Hospital. Methods: A retrospective chart review will be conducted on 25 patients that received a lumbar plexus block and 25 that received facia iliaca block. Pain scores and opioids consumed will be calculated for each patient in each group to determine which block provides superior pain relief. Overall length of stay will be calculated for each block group as well. Microsoft Excel and SigmaXL were utilized to analyze the data. ClinCalc opioid equivalent calculator was utilized to convert all opioids administered into intravenous morphine milliequivalents Conclusion: This project demonstrated that the fascia iliaca block was superior at reducing postoperative pain (P = 0.045) in PACU as well as reducing overall opioid consumption (P = 0.0056) when compared to the lumbar plexus block. However, length of stay in hospital and pain score at 24 hours were similar. Difficulty of block and anesthesia provider experience must also be considered

Preoperative Administration of Acetaminophen for Women Undergoing Hysterectomy Reducing Opioid Consumption in the Postoperative Setting

There has been increased attention to pain control as well as patient satisfaction following surgical procedures. The interest in pain control coupled with the growing opioid epidemic has prompted anesthesia providers to utilize protocols that consist of multimodal techniques during the perioperative period to reduce post-surgical pain and improve patient outcomes. The postoperative consumption of opioids among adult patients that received preemptive acetaminophen (Ofirmev) were compared to those that did not to determine the impact of preoperative analgesics. This pain management implementation was measured among female patients that underwent hysterectomies. The sample included 39 female patients that received a hysterectomy (laparoscopic or open). Among the patients studied, there was no clear reduction in postoperative pain medications for those that received preoperative acetaminophen (Ofirmev) as the sole adjunct compared to those that did not receive Ofirmev preoperatively. There was also no definitive decrease in the pain scores or time to first dose of medication in the postoperative period for patients that received Ofirmev compared to those that did not. Data trends prove there is a need for postoperative opioid dosing education among PACU nurses that are administering opioids. There needs to be additional studies with more participants and defined controls to determine the true impact of this new multimodal approach

Assessing Anesthesia Provider Recognition and Compliance of the World Health Organization Five Moments of Hand Hygiene in the Operating Room

BACKGROUND AND LITERATURE REVIEW: Hand hygiene (HH) is the number one way to reduce healthcare associated infections (HAI). These infections account for increased morbidity and mortality and are linked with poor HH among anesthesia personnel. Anesthesia provider HH compliance is low, and with solid HH guidelines available, increasing their compliance is paramount in reducing HAIs. PURPOSE: This study aims to assess anesthesia provider HH recognition and compliance among student registered nurse anesthetists (SRNA) at Marian University and certified registered nurse anesthetists (CRNA) at a large urban academic hospital in St. Louis, Missouri. METHODS: A one-time eleven question survey will be administered online through Qualtrics assessing knowledge and compliance of the WHO five moments of HH in the operating room (OR). The survey is based on a validated survey instrument and consists of five questions regarding moments to perform HH and six questions regarding demographics. IMPLEMENTATION PLAN/PROCEDURE: Over four weeks, the survey will be administered to 170 anesthesia providers to include 101 CRNAs, 68 SRNAs, and 1 MDA. Qualtrics will be utilized to deliver the survey link to respondent emails and collect responses electronically. This project is supported by Marian University, Leighton School of Nursing, Department of Nurse anesthesia faculty. IMPLICATIONS/CONCLUSIONS: Increasing HH among anesthesia providers will reduce HAIs and increase patient outcomes. Multimodal strategies work best, including increased access to HH products and those that include an education element. Long term success of these interventions is related to sustainment efforts of the institution and will likely decrease over time without them. Understanding current HH recognition and compliance is the first step to increasing HH performance rates and is the focus of this study

Investigating the Role of Ca2+ and the Acto-myosin Mechanism on the Human MCF-7 Breast Cancer Cell Line

Cancer cells have shown to exhibit enhanced potential to metastasize via increased actin-myosin crossbridge formation, which requires increased Ca2+ influx via the voltage-gated calcium channels. This then leads to the activation of myosin light chain kinase (MLCK). MLCK then phosphorylates myosin light chain and forms the actin-myosin cross bridges Additionally, the PI3-Kinase/Akt pathway is critical for cell survival and division, which works from the activation of Akt through phosphorylation of PI,4,5BP by PI-3 kinase. These two critical cell survival pathways have been extensively studied in the field of breast cancer cell research and my research is primarily focused on investigating the role of VGCC, MLCK and PI-3 kinase on MCF-7 cell viability by using pharmacological inhibitors to assess significant changes in morphology and cell survival via microscopy and MTT assays

The St. John’s Bible: Holding a Mirror Up to Life

Donald Jackson, calligrapher to the Queen of England, envisioned of The St. John’s Bible in 1995; he found a patron in the monks at St. John’s University, Collegeville, Minnesota. While this manuscript is a product of the twenty-first century, the twelfth-century Winchester Bible served as a model. In The St. John’s Bible: Holding a Mirror Up to Life, I examine how The St. John’s Bible collapses time—the past into the present—opening the viewer to the multilayered complexity of Medieval manuscript production in our modern world. I argue that The St. John’s Bible, the first fully illuminated and hand-written Bible produced since the Middle Ages, creates art that mirrors life. By way of fossils, satellite images, modern disaster and disease, the images of The St. John’s Bible re-frame social, political, and theological issues as significant expressions of mimetic art while exploring the power handwritten script and artfully-produced images still have over the viewer. With its illuminations that mirror life, The St. John’s Bible asks viewers to consider what we are doing to Creation and where that will lead. Will we be able to look ourselves in the mirror

Learning in the Moment: Case in Point Teaching Method

We will provide a mini experience of the Case in Point teaching method used in the core Adaptive Leadership and Transformational Leadership courses in the Masters of Educational Leadership and the EdD in Organizational Leadership programs. For folks who might be interested, we will explore Leadership and Authority

Navigating the Third Frontier of Antimicrobial Therapy to Support Women’s Health

This paper explores one of the underappreciated reasons for lack of efficacy in certain cases of antimicrobial therapy, namely the occurrence of a non-genetic resistance to antimicrobial drugs due to a metabolic quiescence of microorganisms. This review has centered on those microorganisms of particular importance in obstetrics and gynecology and accordingly has reviewed the nature and extent of the persister phenotype in relation to infectious agents affecting women’s health. We show how the quiescent persister microbial phenotype represents the next significant issue that could compromise successful antibiotic therapy. A brief history of antimicrobial therapy is provided as context for the problem posed by the persister phenotype. This review has been focused on the current literature having relevance for physicians concerned with women’s health. The study of this phenotype has led to increasing understanding of the molecular mechanisms for this state which also provides ideas for rational development of drug candidates to interdict these organisms in human disease and explores the possibility of developing specifically targeted molecules to address persisters, research on screening botanicals, existing drugs and chemicals to discover novel approaches to the clinical consequence of microbial persisters. Of interest in this review, is the return to naturally occurring botanical substances, first to be used as anti-infectives, now being considered as possible agents to address persister microorganisms. Overall this paper aims to provide information tailored especially to the obstetrics and gynecology specialists