Nurse Anesthesia: Peer-Reviewed Journal Articles
Permanent URI for this collectionhttp://hdl.handle.net/20.500.12521/83
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Item Metadata only Perioperative Dexamethasone for Patients With Diabetes and Its Effect on Blood Glucose After Surgery(Journal of PeriAnesthesia Nursing, 2022) Mason, JillPurpose P Perioperative administration of single-dose dexamethasone helps reduce postoperative nausea and vomiting, inflammation, and pain. However, it is unclear which dose achieves these effects while minimizing the hyperglycemic impact in patients with diabetes. The purpose of this review was to elucidate the most appropriate perioperative dose of dexamethasone for diabetic patients, and whether it is necessary to withhold it in patients with poor glycemic control. Design A systematic review. Methods A literature search using PubMed and Cochrane Database of Systematic Reviews revealed 17 potential evidence sources. Eight sources met the inclusion criteria. Sources included one systematic review with meta-analysis, one randomized control trial, and six observational studies. Findings Evidence suggests diabetic patients who receive dexamethasone perioperatively are more likely to develop postoperative hyperglycemia, with a maximum blood glucose increase of 30 to 45 mg/dL in the first 24 hours following a single dose. One study described increased blood glucose levels with escalating doses, but no other sources have supported that finding. The available studies were markedly heterogeneous in both design and proportion of diabetic subjects included, and most were of low quality. Conclusions There is not enough evidence to quantify the hyperglycemic effect of commonly used dexamethasone doses, and rigorous studies are needed to inform practice.Item Metadata only Perceived Knowledge and Attitudes of Certified Registered Nurse Anesthetists and Student Registered Nurse Anesthetists on Fire Risk Assessment During Time-out in the Operating Room(AANA Journal, 2018-04) Gomez, KarenFire risk assessment remains separate from the universal protocol for surgical time-outs. A descriptive cross-sectional design was used to examine the perceived knowledge and attitudes of Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs) on fire risk assessment during surgical time-outs. Modified knowledge and attitudes questionnaires were sent to approximately 1,600 active members of the Illinois Association of Nurse Anesthetists through an online survey. Data were analyzed using descriptive, t-test, analysis of variance, and point biserial correlation statistics. Most of the 140 study participants overwhelmingly reported positive attitudes toward fire risk assessment, but they had self-reported information needs in 11 areas of the operating room fire risk assessment questionnaire. Age, gender, years in practice, and highest education had no statistically significant correlation with knowledge and attitudes regarding fire risk assessment. The perceived knowledge deficits on fire risk assessment may hinder the CRNAs and SRNAs from adopting a tool such as a fire risk assessment checklist that is ready for implementation at their current place of employment. Additional studies are needed to identify the factors that facilitate integration of fire risk assessment using a checklist during surgical time-outs.Item Metadata only Sugammadex Use Among CRNAs in Illinois: A Qualitative Analysis(Journal of the IANA, 2020) Gomez, KarenThe availability of sugammadex has increased options for Certified Registered Nurse Anesthetists’ (CRNAs) and their choice of neuromuscular reversal agents, however administration is impacted by a variety of provider and institutional factors. The purpose of qualitative this study was to examine and describe the personal and institutional factors impacting the use of sugammadex by CRNAs in Illinois. Methods: This study utilized a qualitative, descriptive study design using an online survey with open ended questions to identify themes and subthemes surrounding Illionis CRNAs’ use of sugammadex. Demographic questions were categorical in nature and analyzed using SPSS software. Qualitative data were analyzed using Nvivo. Results: 209 responses yielded three main themes: 1) Why CRNAs choose to use or avoid sugammadex 2) How CRNAs dose sugammadex and 3) Practice variations existing within the clinical setting. The most commonly reported subthemes included depth of blockade/dosing of paralytic, underlying disease pathology, size of the patient, and cost considerations or availability at their institution. Conclusion: Based upon these main themes and subthemes, it is recommended that institution wide policies be created to reduce variability in provider administration practices if sugammadex is not widely accepted as standard reversal.Item Metadata only A Systematic Review Examining the Pulmanry Effects of Electronic Vapor Delivery Systems(Journal of Clinical Anesthesia, 2022-11) Gomez, KarenStudy objective Despite the popularity of vaping and electronic vapor delivery systems (EVDS), the healthcare community remains largely unfamiliar with their potential to induce harm. The purpose of this systematic review is to identify how EVDS use affects the pulmonary system in order to support future anesthetic guidelines for patients who vape. Design Systematic Review. An electronic search of databases CINAHL and PubMed was performed in October 2020. Study eligibility criteria Studies were included if they were deemed original research published in English, if they were performed exclusively in humans or on human tissue, if they examined the effects of EVDS on pulmonary function or tissue, and/or if they produced quantitative data. Studies were excluded if they utilized animal samples, studied subjects under the age of 18, presented expert opinions or reviews, offered qualitative data, reported case studies, or only evaluated EVDS' efficacy as a smoking cessation tool. Main results This review identified six EVDS-induced pulmonary implications warranting anesthetic consideration: alterations in pulmonary function tests, disrupted ventilation, impaired mucociliary clearance, tissue destruction, a disrupted immune response, and oxidative stress with DNA fragmentation. Conclusion A total of 38 studies described the effects of EVDS on pulmonary function, airway epithelial tissue, and inflammatory mechanisms that may lead to chronic pulmonary disease. Anesthesia providers are encouraged to assess patients for EVDS use during the preoperative period and use the information generated by this systematic review to drive subsequent care.Item Metadata only Opioid-sparing Effects of Transversus Abdominis Plane Block in Elective Hysterectomy: A Systematic Review and Meta-analysis(2018) Mason, JillPosthysterectomy pain is caused by abdominal incision and traumatic manipulation of the intra-abdominal structures. Optimal pain management consists of a multimodal pain regimen combined with transversus abdominis plane (TAP) block. We searched PubMed, EMBASE, and Cochrane Database for randomized controlled trials evaluating the opioid-sparing effects of TAP block in patients undergoing hysterectomy. The primary outcome was morphine consumption in the perioperative phase extending to 48 hours alter surgery. The secondary outcomes were pain scores at rest and during coughing, time of first postoperative analgesia, and incidence of postoperative nausea and vomiting (PONV) and sedation. Twenty-three trials were selected consisting of 1,554 patients. Morphine consumption showed a reduction of 3.6 mg intraoperatively (mean difference [MD], -3.57; 95% CI, -6.88 to -0.25); 2.9 mg in the recovery room (MD, -2.86; 95% CI, -5.55 to -0.15); 3.4 mg at 24 hours (MD, -3.43; 95% CI, -6.77 to -0.09), and 29 mg at 48 hours (MD, -28.68; 95% CI, -44.35 to -13.01) after surgery in favor of TAP block. Pain scores were lower at rest, and the incidence of PONV and sedation were reduced. Although opioid-sparing effects of TAP block were significant perioperatively, its clinical application is debatable because of substantial heterogeneity across studies.Item Metadata only Laryngeal Mask Airway Use in Morbidly Obese Patients Undergoing General Anesthesia(2017) Mason, JillThe use of laryngeal mask airways with morbidly obese patients remains controversial. A recent legal case involving the use of a laryngeal mask airway with a morbidly obese patient who aspirated during the anesthetic found the anesthesia providers negligent. We sought evidence examining the use of laryngeal mask airways with obese patients undergoing surgery. One Cochrane systematic review and a randomized controlled trial met our inclusion criteria. Subjects received general anesthesia with a laryngeal mask airway. Outcomes included the ability to successfully place a laryngeal mask airway, ease and time of insertion, ability to ventilate, hypoxemia, presence of laryngospasm/ bronchospasm, and/or evidence of aspiration. The trials had some methodologic concerns including the inability to blind anesthesia providers, not including exclusively morbidly obese subjects, not powered to detect all complications such as aspiration, and overall small sample sizes. The investigators reported few problems when using these devices with obese subjects. However, because of the limited amount and quality of the evidence and the catastrophic nature of potential complications, future research must be done before a recommendation can be made regarding the use of these devices with morbidly obese patients.Item Metadata only Treating Chronic Nonmalignant Pain: Evidence and Faith-based Approaches(2019) Snell, Sarah; Hughes, Tia; Fore, Carolyn; Lukman, RoyA significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.