Intratracheal Lidocaine and Postoperative Sore Throat at Providence Sacred Heart Medical Center and Providence Holy Family Hospital

Background Postoperative sore throat (POST) is a common side effect from general anesthesia (GA) and has a prevalence of 14.4-50%.1 The experience of POST contributes to patient discomfort during recovery from surgery. The etiology of this is thought to be from tracheal mucosal erosion from the cuff of the endotracheal tube (ETT), trauma from intubation, coughing and bucking, and friction between the ETT and the tracheal mucosa during general anesthesia.2 Risk factors shown to contribute to the development of POST include, but are not limited to, elderly age, smoking history, patient positioning, ETT cuff pressure, and movement of ETT during procedure.2,3 The presence of POST after surgery can affect patient comfort during the post-operative recovery period and ultimately, impact patient satisfaction. Methods • A retrospective, observational, EPB project was conducted at Providence Sacred Heart Medical Center and Providence Holy Family Hospitals. • CIRC approval and IRB exemption was obtained. • A HIPPAA compliant REDCap database was used to securely store deidentified extracted data. No PHI was collected. • The outcome of post-operative sore throat was assessed. • Exposure to various modalities of intra-tracheal lidocaine was assessed. • Surgical patients undergoing elective general anesthesia with endotracheal tube from January 1 to December 31 of 2019 were included. • Exclusion criteria: Non-ETT general anesthesia with age• An a-priori power analysis revealed 785 records would power results (1- β=0.80, α=0.05, Df=1, W=0.1). • Univariate analysis was done on categorical and continuous data. • Bivariate analysis for POST and lidocaine was conducted and RR, CI, and chi-Square p-values were reported. • Binary logistic regression analysis was performed. Discussion This retrospective observational EBP study shows that rates of POST among patients receiving GA with an ETT are 21% (n=318). Of the POST group, 81% did not receive any form of intratracheal lidocaine (n=282). The most common form of intratracheal lidocaine used was via laryngotracheal topical anesthesia (LTA). Limitations of this study include small sample size, limited and subjective reporting of POST, and inconsistent documentation of intratracheal lidocaine. Multiple studies support the use of intratracheal lidocaine to prevent the development of POST after general anesthesia with an ETT.1 This EBP project shows that there was a statistically insignificant reduction of POST with the use of 4% LTA. However, this study may generate hypothesis about LTA use, given limited research published on the use of LTA’s for POST. Lidocaine gel 2% showed statistically significant reduction in POST. Only one occurrence of intra-cuff lidocaine was documented, showing no reduction in POST, however there is strong research evidence showing the effectiveness of intra-cuff lidocaine on the reduction of POST. 4 This study may inform further hypothesis about group characteristics of patients receiving intratracheal lidocaine.https://digitalcommons.psjhealth.org/other_pubs/1089/thumbnail.jp

Sequelae due to bacterial meningitis among African children: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>African children have some of the highest rates of bacterial meningitis in the world. Bacterial meningitis in Africa is associated with high case fatality and frequent neuropsychological sequelae. The objective of this study is to present a comprehensive review of data on bacterial meningitis sequelae in children from the African continent.</p> <p>Methods</p> <p>We conducted a systematic literature search to identify studies from Africa focusing on children aged between 1 month to 15 years with laboratory-confirmed bacterial meningitis. We extracted data on neuropsychological sequelae (hearing loss, vision loss, cognitive delay, speech/language disorder, behavioural problems, motor delay/impairment, and seizures) and mortality, by pathogen.</p> <p>Results</p> <p>A total of 37 articles were included in the final analysis representing 21 African countries and 6,029 children with confirmed meningitis. In these studies, nearly one fifth of bacterial meningitis survivors experienced in-hospital sequelae (median = 18%, interquartile range (IQR) = 13% to 27%). About a quarter of children surviving pneumococcal meningitis and <it>Haemophilus influenzae </it>type b (Hib) meningitis had neuropsychological sequelae by the time of hospital discharge, a risk higher than in meningococcal meningitis cases (median = 7%). The highest in-hospital case fatality ratios observed were for pneumococcal meningitis (median = 35%) and Hib meningitis (median = 25%) compared to meningococcal meningitis (median = 4%). The 10 post-discharge studies of children surviving bacterial meningitis were of varying quality. In these studies, 10% of children followed-up post discharge died (range = 0% to 18%) and a quarter of survivors had neuropsychological sequelae (range = 3% to 47%) during an average follow-up period of 3 to 60 months.</p> <p>Conclusion</p> <p>Bacterial meningitis in Africa is associated with high mortality and risk of neuropsychological sequelae. Pneumococcal and Hib meningitis kill approximately one third of affected children and cause clinically evident sequelae in a quarter of survivors prior to hospital discharge. The three leading causes of bacterial meningitis are vaccine preventable, and routine use of conjugate vaccines could provide substantial health and economic benefits through the prevention of childhood meningitis cases, deaths and disability.</p

ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats

An update to the 2007 American College of Veterinary Internal Medicine (ACVIM) consensus statement on the identification, evaluation, and management of systemic hypertension in dogs and cats was presented at the 2017 ACVIM Forum in National Harbor, MD. The updated consensus statement is presented here. The consensus statement aims to provide guidance on appropriate diagnosis and treatment of hypertension in dogs and cats

How Do Employers Use Compensation History?: Evidence from a Field Experiment

We report the results of a field experiment in which treated employers could not observe the compensation history of their job applicants. Treated employers responded by evaluating more applicants, and evaluating those applicants more intensively. They also responded by changing what kind of workers they evaluated: treated employers evaluated workers with 7% lower past average wages and hired workers with 16% lower past average wages. Conditional upon bargaining, workers hired by treated employers struck better wage bargains for themselves. Using a structural model of bidding and hiring, we find that the selection effects we observe would also occur in equilibrium

Talk opportunities around text and the responses they elicit from middle level English language learners

The purpose of this qualitative study was to examine the role that talk about text assumes for English language learners in their middle level reading classrooms. In particular, this study looked at the opportunities that English language learners have to talk about text in middle level reading classrooms and their responses to these opportunities. In addition, it looked at how English language learners explain and regard the talk opportunities they receive and their participation in them. Scholars propose that talk in general, and talk about text specifically, fosters comprehension, higher level thinking, and academic language proficiency. A relatively large body of scholarship has examined the role that talk about text assumes for English language learners at the elementary level. However, very few studies have done this at the middle level. This study seeks to augment that sparse body of research. It contributes to middle level research, research around English language learners, and research regarding the role of talk in reading classrooms. [The dissertation citations contained here are published with the permission of ProQuest llc. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]