Family caregiving tips: Am I a caregiver?

The Oklahoma Cooperative Extension Service periodically issues revisions to its publications. The most current edition is made available. For access to an earlier edition, if available for this title, please contact the Oklahoma State University Library Archives by email at [email protected] or by phone at 405-744-6311

The Perioperative Effect of Increased Body Mass Index on Peripheral Nerve Blockade: an Analysis of 528 Ultrasound Guided Interscalene Blocks

SummaryBackground and objectivesObese patients can pose a unique perioperative anesthetic challenge, making regional anesthetic techniques an intriguing means of providing analgesia for this population. Ultrasound guidance has been touted recently as being beneficial for this population in which surface landmarks can become obscured. In this study, the effect of increased Body Mass Index (BMI) on ultrasound guided interscalene peripheral nerve blockade is investigated.Material and methodsThis study is a retrospective review of 528 consecutive patients who received preoperative ultrasound-guided interscalene nerve blocks at the University of Wisconsin Hospital and Clinics. We examined the association between BMI and the following parameters: time required for block placement; presence of Postoperative Nausea and Vomiting (PONV); postoperative Post Anesthesia Care Unit (PACU) pain scores; volume of local anesthetic injected; acute complications; and opioid administration preoperatively, intraoperatively, and postoperatively. Univariate and multivariate least squares and logistic regression models were used.ResultsAn elevated BMI was associated with an increased: time required for block placement (p-value=0.025), intraoperative fentanyl administration (p-value<0.001), peak PACU pain scores (p-value<0.001), PACU opioid administration (p-value<0.001), PACU oral opioid administration (p-value<0.001), total PACU opioid administration (p-value<0.001) and incidence of PACU nausea (p-value=0.025)ConclusionsUltrasound guided interscalene nerve blocks for perioperative analgesia can be safely and effectively performed in the obese patient but they may be more difficult to perform and analgesia may not be as complete

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

An easily made, low-cost phantom for ultrasound airway exam training and assessment

Background: Recent manuscripts have described the use of ultrasound imaging to evaluate airway structures. Ultrasound training tools are necessary for practitioners to become proficient at obtaining and interpreting images. Few training tools exist and those that do can often times be expensive and rendered useless with repeated needle passes. Methods: We utilised inexpensive and easy to obtain materials to create a gel phantom model for ultrasound-guided airway examination training. Results: Following creation of the gel phantom model, images were successfully obtained of the thyroid and cricoid cartilages, cricothyroid membrane and tracheal rings in both the sagittal transverse planes. Conclusion: The gel phantom model mimics human airway anatomy and may be used for ultrasound-guided airway assessment and intervention training. This may have important safety implications as ultrasound imaging is increasingly used for airway assessment

Validation of the unassisted, gum-elastic bougie-guided, laryngeal mask airway-ProSeal™ placement technique in anaesthetized patients

Aims: The laryngeal mask airway-ProSeal™ can be inserted digitally, by introducer tool, or by railroading it over a bougie placed first in the patient′s oesophagus, which is highly successful, but as originally described, requires an assistant. An unassisted bougie-guided placement technique has also been described, but no data on its effectiveness have been reported. Methods: We reviewed data collected during a randomized, controlled trial comparing the air-Q® Intubating Laryngeal Airway and LMA-Proseal™, in which all LMA-Proseal™ devices were inserted using the unassisted (one-operator), bougie-guided placement technique. Results: Forty-eight devices were placed. All devices were placed successfully. Successful placement was achieved in 47 (98%) patients on first attempt and in one (2%) patient on the third attempt. Mean (SD) time required for insertion establishing ventilation was 28 (11) s. Mean (SD) airway seal pressure was 30 (6) cmH 2 O. Gross blood was found on four (8%) devices upon removal, but no oropharyngeal injuries were noted on oral exam in the recovery unit prior to discharge. The most common complaints in recovery and 24 h post-operatively were sore throat [discharge: mild = 18/48 (38%); 24 h: mild = 9/38 (19%), moderate = 1/38 (3%)] and pain on swallowing [discharge: mild = 7/48 (15%); 24 h: mild = 2/38 (6%)]. Conclusions: Our data confirm that in experienced hands, bougie-guided placement of the LMA-Proseal™ without the aid of an assistant can be accomplished quickly and successfully without affecting the expected clinical performance of the device

Efeito perioperatório do índice de massa corporal elevado no bloqueio do nervo periférico: uma análise de 528 bloqueios interescalênicos guiados por ultrassom

JUSTIFICATIVA E OBJETIVOS: Os pacientes obesos podem representar um desafio anestésico perioperatório único, tornando as técnicas anestésicas regionais um meio desafiador de oferecer analgesia para esta população. A orientação por ultrassom foi recentemente elogiada como sendo benéfica para esta população na qual os limites anatômicos de superfície podem ser obscurecidos. Neste estudo, é investigado o efeito do Índice de Massa Corporal (IMC) elevado no bloqueio interescalênico do nervo periférico guiado por ultrassom. MATERIAL E MÉTODOS: Este estudo é uma análise retrospectiva de 528 pacientes consecutivos que receberam bloqueios nervosos interescalênicos pré-operatórios guiados por ultrassom no Hospital e Clínica da University of Wisconsin. Examinamos a associação entre IMC e os parâmetros: tempo exigido para localização do bloqueio; presença de náuseas e vômitos pós-operatórios (NVPO); pontuações de dor pós-operatória na sala de recuperação pós-anestésica (SRPA); volume de anestésico local injetado; complicações agudas; e administração de opioides antes, durante e depois da cirurgia. Foram utilizadas regressões univariada e multivariada com estimativa dos mínimos quadrados e logística. RESULTADOS: Um IMC elevado foi associado a maiores: tempo exigido para localização do bloqueio (p = 0,025), administração de fentanil durante a cirurgia (p < 0,001), pico de pontuações de dor em SRPA (p < 0,001), administração de opioide na SRPA (p < 0,001), administração oral de opioide na SRPA (p < 0,001), administração total de opioide na SRPA (p < 0,001) e incidência de náusea em SRPA (p = 0,025). CONCLUSÕES: Os bloqueios nervosos interescalênicos guiados por ultrassom para analgesia perioperatória podem ser executados de forma segura e efetiva em pacientes obesos, mas o procedimento pode ser mais difícil e a analgesia talvez não seja complet

Standards of Care for Research in Group Work

The Standards of Care for Research in Group Work were developed in partnership between the Association for Assessment in Research in Counseling (AARC) and the Association for Specialists in Group Work (ASGW). The purpose of these standards is to highlight empirically validated and literature-supported practices for conducting research in group work, as there are methodological and design considerations that are unique to group work research. These include, but are not limited to, small sample sizes that are often inherent in group work, the dependence of variables when measured in a group setting, historical lack of empirical rigor in group work research, and the need for theoretical and methodological congruence in qualitative research. During the development of this document, the committee used extant research standards to guide and center our efforts, and it was our intent for these standards to be used in conjunction with other established research standards. We also recognized the need to emphasize quantitative and qualitative research guidelines to encompass the importance of both types of research in the counseling field; and to highlight the importance of recognition and attention to concerns related to conducting group work research with participants from diverse and underrepresented backgrounds

Standards of Care for Research in Group Work

The Standards of Care for Research in Group Work were developed in partnership between the Association for Assessment in Research in Counseling (AARC) and the Association for Specialists in Group Work (ASGW). The purpose of these standards is to highlight empirically validated and literature-supported practices for conducting research in group work, as there are methodological and design considerations that are unique to group work research. These include, but are not limited to, small sample sizes that are often inherent in group work, the dependence of variables when measured in a group setting, historical lack of empirical rigor in group work research, and the need for theoretical and methodological congruence in qualitative research. During the development of this document, the committee used extant research standards to guide and center our efforts, and it was our intent for these standards to be used in conjunction with other established research standards. We also recognized the need to emphasize quantitative and qualitative research guidelines to encompass the importance of both types of research in the counseling field; and to highlight the importance of recognition and attention to concerns related to conducting group work research with participants from diverse and underrepresented backgrounds