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The Otterbein Review May 28, 1917
Full text linkVolume 8, Number 32https://digitalcommons.otterbein.edu/otreview/1017/thumbnail.jp
Evidenced-Based Practice Guideline Development: The Addition of Adjunctive Dexmedetomidine in Brachial Plexus Blocks for Upper Arthroscopic Surgery
Full text linkDexmedetomidine (DEX) is an alpha-2 adrenergic agonist increasingly studied as an adjunct in brachial plexus blocks (BPBs) to enhance postoperative pain management. This project examines the efficacy of DEX as an adjunct in BPBs for upper extremity arthroscopic surgeries, focusing on its ability to extend analgesia duration, reduce opioid use, and enhance patient satisfaction. With analgesic and sedative properties, DEX can improve postoperative pain management with minimal side effects, providing shortened hospital stays, decreased costs, and better patient outcomes. Using the Iowa Model for evidence-based practice, baseline data on postoperative pain, analgesia duration, and opioid use will be collected from patients receiving standard BPBs, establishing control metrics. During the trial, 50 patients will be randomized to receive DEX-adjunct BPBs or standard BPBs with lidocaine. Key outcomes, including analgesia duration and opioid consumption, will be analyzed with two-sample t-tests, and logistic regression will be used to assess binary outcomes of opioid use. Patient satisfaction, measured via Likert scale surveys, will be evaluated using descriptive statistics and t-tests. Preliminary evidence suggests that DEX can significantly reduce pain and opioid consumption postoperatively. This study aims to confirm these benefits with a Quality Improvement (QI) review to ensure protocol adherence and data quality through chart audits and electronic medical record (EMR) reviews. Findings will be shared with stakeholders and published in medical journals to promote DEX’s use in BPBs. If successful, the project could lead to broader adoption of DEX in BPBs
Implementation of Evidenced Based Practice Guidelines for Reducing Emergence Delirium in Elderly Patients Undergoing a Total Hip Replacement
Full text linkA total hip replacement is a common surgery for the elderly population, as it is a successful treatment option for hip fractures and end-stage osteoarthritis, a common condition associated with aging. Recovery from surgery is critical, and any postoperative complication can delay recovery, increase cost, lengthen hospital stay, and lead to a poorer long-term surgical outcome. One of the most common and severe postoperative complications for elderly patients following general anesthesia is emergence delirium. Traditional practice focuses on treating the symptoms of emergence delirium reactively instead of proactively and lacks standardized guidelines. Recent literature found a promising decrease in the incidence of emergence delirium for elderly patients undergoing a total hip replacement with general anesthesia using evidence-based practice interventions. In this proposed project, after receiving approval from hospital administrators, the project team will educate recovery nurses on appropriate assessment tools to collect baseline data for the current rates of emergence delirium for three months or roughly 50 patients. The project team will then educate staff on changes to practice for the proposed evidence-based practice guidelines and gather data for another three months or approximately 50 patients. After completion of data collection, a data analysis will be used to assess the impact of the proposed guidelines on emergence delirium. The final scholarly project team anticipates a statistically significant reduction in the incidence of emergence delirium using the proposed guidelines. If the desired outcomes are unmet, additional investigation will be necessary to determine causative factors and adjust the guidelines as required
Dexmedetomidine and the Prevention of Emergence Agitation in Military Veterans with Post-Traumatic Stress Disorder
Full text linkEmergence agitation (EA) is a post-anesthetic complication that occurs when the patient is in a self-limited, nonfluctuating state of excitement while transitioning into a state of consciousness. EA can lead to negative adverse outcomes including, accidental invasive line removal, bleeding, respiratory depression, unintentional extubation, and injury to the staff and the patient. EA is often observed in military veterans who have a medical history of post-traumatic stress disorder (PTSD). For patients with a history of military exposure undergoing elective general anesthesia who also have PTSD, anxiety, and or depression, the incidence of EA was estimated to be around 27%. The pathophysiology of EA is unknown; however, a collection of risk factors has been associated with a higher incidence of EA. These risk factors include pre-operative anxiety, history of pre-existing mental disorders like PTSD, use of volatile agents with low solubility, age, sex, invasive lines and tubes, and the use of premedications like benzodiazepines and anticholinergics.There are currently no evidence-based guidelines or policies in place to properly manage and prevent the incidence of EA in military veterans with a history of PTSD scheduled for general anesthesia. Dexmedetomidine is an alpha-2 adrenoceptor agonist that produces sedation that resembles a patient\u27s natural sleep without causing respiratory depression and allowing for patient arousal. The combination of high-risk identifying assessment tools including the DSM-5, the Richmond Agitation Sedation Scale (RASS), and the utilization of Dexmedetomidine in the peri-operative setting has been proven to decrease the incidence of EA in patients with a history of PTSD
Evidence-Based Practice Guidelines for Lung Protective Ventilation in Adult Patients Undergoing Abdominal Laparoscopic Surgery
Full text linkThe rise in abdominal laparoscopic surgeries has underscored the need for improved ventilation strategies to reduce postoperative pulmonary complications, such as atelectasis, ventilator-induced lung injury, and pneumonia. These complications can increase hospital stays, healthcare costs, and mortality. This final scholarly project investigates the impact of lung protective ventilation in adult patients undergoing abdominal laparoscopic procedures and proposes guidelines for implementation. Lung protective ventilation strategies, including low tidal volume ventilation, individualized positive end-expiratory pressure, and recruitment maneuvers. Current research shows potential in mitigating postoperative pulmonary complications by improving intraoperative oxygenation and lung compliance. Using the Johns Hopkins Evidence-Based Practice model, this project critically reviews current literature, identifies gaps in practice, and formulates an evidence-based framework tailored for the perioperative setting. The primary aim was to develop and standardize lung protective ventilation guidelines to enhance patient outcomes and minimize postoperative pulmonary complications’ clinical and economic impacts. The secondary aim was to increase adherence to lung protective ventilation practices among Certified Registered Nurse Anesthetists and anesthesia teams through education and structured implementation protocols. Findings from this project are intended to support the broader adoption of lung protective ventilation in clinical practice, setting a new standard for safer, more effective ventilation management during laparoscopic surgery
Proposed Evidence-based Practice Guidelines for Using Esmolol to Blunt the Sympathetic Stress Response to Laryngoscopy and Intubation
Full text linkDirect laryngoscopy (DL) and endotracheal intubation (ETI) are standard procedures performed during general anesthetic induction, which provoke a sympathetic stress response that can result in intraoperative hemodynamic instability. Traditional agents like lidocaine and fentanyl, commonly used to mitigate the stress response, have limitations and can lead to adverse effects. Recent literature suggests that esmolol, an ultra-short-acting, cardio-selective beta-1 adrenergic receptor antagonist, may be an effective alternative due to its rapid onset, short duration, and minimal side effects. This final scholarly project (FSP) aims to develop evidence-based practice guidelines for using esmolol as an adjunctive induction agent. A systematic literature review identified the efficacy and safety of administering a 1.5 mg/kg esmolol bolus three minutes before DL. The FSP will engage an interdisciplinary team to implement and evaluate the developed guidelines in a central Ohio hospital system. Baseline and intervention data on blood pressure, heart rate, and rate pressure product will be collected on 150 patients to assess the impact of an esmolol bolus on stress response attenuation during induction relative to traditional agents. Achieving a statistically significant improvement in hemodynamic stability will support esmolol’s adoption as a preferred induction agent. The FSP will provide clinical insights into optimizing anesthesia practices to enhance intraoperative patient safety and reduce opioid reliance. Should the desired outcomes be unmet, further research will be initiated to identify influencing factors and refine the esmolol induction guidelines accordingly
Proposed Evidence-Based Practice Consideration: The Use of Remimazolam Tosilate Instead of Propofol for Endoscopic Procedures Under Monitored Anesthesia Care in the Elderly Population
Full text linkEndoscopic procedures are essential for diagnosing and managing gastrointestinal conditions, particularly in a growing elderly population. The selection of sedative agents significantly influences patient safety and procedural outcomes. Propofol, the traditional choice, is successful but associated with risks such as hypotension, bradycardia, and respiratory depression, particularly in elderly patients. This hypothetical Doctor of Nursing Practice (DNP) project explores the use of remimazolam tosilate (RT), a novel ultra-short-acting benzodiazepine, as an alternative to propofol during monitored anesthesia care (MAC) for elderly patients undergoing endoscopic procedures. The project utilizes a randomized controlled trial (RCT) design to compare RT and propofol regarding hemodynamic stability, respiratory outcomes, recovery times, and patient satisfaction. The project team collects quantitative data via validated tools, including the Modified Observer’s Assessment of Alertness/Sedation Scale and Aldrete Scoring System, and gathers qualitative feedback through Likert-scale surveys. Findings highlight that RT maintains superior hemodynamic stability, reduces respiratory complications, and achieves comparable sedation success with shorter recovery times than propofol. These results suggest that RT is safer and more optimal for elderly patients, aligning with evidence-based practice goals to enhance patient outcomes and procedural efficiency. By addressing the limitations of traditional sedatives, this project underscores the potential of RT to improve clinical practices in geriatric anesthesia care. Future implementation of RT protocols could enhance patient safety, reduce healthcare costs, and optimize resource utilization
Evidence-Based Practice Guidelines for the Risk Stratification and Anesthetic Management of Geriatric Surgery Patients at High Risk for Postoperative Cognitive Dysfunction Undergoing Non-Cardiac Surgery
Full text linkAs the global geriatric surgical population rapidly expands, managing complications like postoperative cognitive dysfunction is increasingly essential, given its adverse impacts on recovery, quality of life, and healthcare costs. Postoperative cognitive dysfunction can lead to extended hospital stays, delayed recovery, and significant cognitive decline, particularly among elderly patients exposed to general anesthesia. This quality improvement final scholarly project develops and hypothetically implements evidence-based practice guidelines for anesthetic management in geriatric patients at high risk for postoperative cognitive dysfunction undergoing non-cardiac surgery. This Doctor of Nursing Practice (DNP) project uses preoperative cognitive assessments, such as the Mini-Cog tool, to identify patients at elevated risk for postoperative cognitive dysfunction and inform anesthetic strategies tailored to reduce cognitive decline. Using the Iowa Model of Evidence-Based Practice, a multidisciplinary team, including anesthesia providers, nursing staff, and quality improvement personnel, will pilot, implement, and continuously evaluate these evidence-based practice guidelines to monitor their effectiveness in reducing postoperative cognitive dysfunction incidence. The project emphasizes quality improvement and data-driven adjustments to the guidelines, ensuring alignment with patient safety and optimal outcomes. Findings will contribute valuable insights for clinical settings, supporting safer, evidence-based anesthetic practices for the aging surgical population and improving geriatric care through targeted risk assessment, adjusted anesthetic techniques, and structured postoperative interventions
Hypothermia Prevention in Major Trauma Patients
Full text linkTraumatic injuries present a significant health challenge for providers, often resulting in hypothermia, coagulopathy, and acidosis, referred to as the trauma triad of death. Hypothermia significantly impacts trauma patients\u27 outcomes and exacerbates morbidity and mortality rates, particularly in trauma cases with high injury severity scores who require immediate surgical intervention. Despite the detrimental effects of hypothermia, evidence-based approaches to treating hypothermia in this population are lacking. Traditional warming methods heavily rely on provider preference and can lead to inconsistent care. Rapid, reliable, and effective resuscitation interventions are essential in the immediate care of major trauma patients. The proposed project will create evidence-based guidelines for the prevention of hypothermia in trauma patients arriving to the emergency room and operating room. After receiving approval from hospital administration, the project team will gather data from previous major trauma patients and educate nursing and anesthesia staff on the new hypothermia guidelines. The trial period will last eight months. After completion of the trial period, data gathered will evaluate the effectiveness of the guidelines in preventing the incidence of hypothermia. The project team expects the implementation of practice guidelines will decrease the incidence of hypothermia in major trauma patients who require immediate surgery. Effective prevention of hypothermia in trauma patients necessitates a multifaceted approach. By integrating innovative temperature control solutions into trauma resuscitation protocols, healthcare providers can mitigate the detrimental effects of hypothermia, ultimately saving lives and improving patient care
Enhancing the Diversity and Number of Certified Registered Nurse Anesthetists: A Proposed Pipeline Program for Underrepresented Students
Full text linkThe underrepresentation of minority groups in the Certified Registered Nurse Anesthetist (CRNA) profession impacts healthcare providers’ diversity and cultural competence. This Final Scholarly Project (FSP) proposes a pipeline program to increase diversity within the CRNA field by providing academic support, mentorship, and clinical exposure to students from underrepresented backgrounds. Given the shortage of anesthesia providers, especially in underserved areas, improving access to the CRNA profession for minority students is critical for enhancing patient outcomes. This FSP suggests establishing mentorship and skill development concepts through a 12-month structured program that targets minorities, first-generation college students, or those from rural backgrounds. The program utilizes a mixed-methods approach, collecting quantitative and qualitative data to assess recruitment, retention, academic progress, and mentorship effectiveness. Quantitative data analysis includes descriptive statistics, paired t-tests, and ANOVA, while qualitative feedback is assessed through thematic analysis. Success is measured by a 15% average increase in academic assessment scores, 75% enrollment from target demographics, and a 25% CRNA program application rate among participants. Findings are expected to demonstrate that the program effectively supports minority students pursuing CRNA careers, addressing workforce shortages and the need for diversity. This FSP has broader implications for reducing healthcare disparities and advancing diversity in other medical professions by creating a replicable model for academic and professional support