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Evidence-Based Clinical Practice Guidelines for Postspinal Hypotension in Pregnant Women
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Postspinal hypotension (PSH) in pregnant women undergoing a cesarean delivery is a common yet significant problem for the safety of the mother and fetus. The physiological effects of a spinal injection may compromise uteroplacental flow, predisposing the fetus to hypoxia and acidosis. Maternal consequences of prolonged hypotension include unstable hemodynamics, loss of consciousness, and nausea. Historically, healthcare providers have used crystalloid preloads and reactive phenylephrine boluses to correct hypotension. However, recent evidence suggests that these interventions have limited effectiveness. Thorough research led to the development of clinical guidelines that propose providing a 500 mL 6% hydroxyethyl starch preload or a 1000 mL Lactated Ringers coload in conjunction with a prophylactic variable-rate norepinephrine infusion immediately following the injection of the spinal anesthesia to avoid hypotension. For the project’s hypothetical implementation a hospital with a large obstetric unit will undergo pre- implementation measurements of several outcomes, including: incidence of hypotension, total vasopressor requirements, frequency of maternal bradycardia, and nausea. During a two-month trial implementation period, the proposed clinical guidelines will be implemented for all elective cesarean deliveries that meet the inclusion criteria. After two months, the Quality Improvement team and anesthesia leadership members will compare the new measurements to the baseline data. With the new guidelines in place, an anticipated decrease in the occurrence of postspinal hypotension, as well as the need for vasopressors, incidence of bradycardia, and nausea will occur in pregnant women undergoing cesarean deliveries
Evidence-Based Guidelines for Intraoperative Quantitative Neuromuscular Monitoring
Full text linkNondepolarizing neuromuscular blocking agents are routinely used medications vital to anesthetic care. When administering neuromuscular blocking agents, monitoring neuromuscular blockade depth and degree of recovery is a standard of nurse anesthesia practice to facilitate adequate recovery. If not adequately reversed, postoperative residual neuromuscular blockade can cause severe complications. Traditional qualitative neuromuscular monitoring practices largely contribute to the continuing high incidence of postoperative residual neuromuscular blockade, as supported by research that qualitative monitoring methods are insensitive to the depth of blockade and clinical situations, providing unreliable physiologic information. As recommended in practice guidelines by the American Society of Anesthesiologists, quantitative neuromuscular monitoring offers objective neuromuscular function measurements that are shown to reduce the incidence of postoperative residual neuromuscular blockade, hypoxemia, and muscle weakness. This proposed scholarly project focuses on implementing guidelines for reversing nondepolarizing neuromuscular blocking agents using intraoperative quantitative neuromuscular monitoring. During implementation, data will be collected on the incidence of postoperative residual neuromuscular blockade, hypoxemia, and muscle weakness. The quantitative data will be analyzed and compared to traditional qualitative monitoring data. The project team predicts a statistical decrease in the incidence of postoperative residual neuromuscular blockade, hypoxemia, and muscle weakness in patients monitored using quantitative monitoring. Therefore, standardization of quantitatively monitoring neuromuscular blockade into guidelines for routine practice is essential
The Use of Video Laryngoscopy In Pregnant Women Undergoing Non-Obstetric Surgery
Full text linkThis quality improvement project looks at the proposed implementation of endotracheal intubation guidelines regarding pregnant patients undergoing non-obstetric surgery and how the use of video laryngoscopy versus the traditional practice will affect the first pass rate of the endotracheal tube intraoperatively. Statistics show that 2% of women undergo non-obstetric related surgery during pregnancy. Physiological changes during pregnancy, including increased laryngeal mucosa swelling and higher metabolic oxygen consumption, result in a heightened risk of apnea and hypoxemia during intubation. Pregnant women experience an eightfold higher incidence of failed intubation compared to non-pregnant populations. The number of patients classified as Mallampati 4 increased by 34% from 12 to 38 weeks of gestation. In traditional practice, direct laryngoscopy with either a Macintosh blade or a Miller blade is a popular first-line intubation method. Video laryngoscope devices like the McGrath and Glidescope offer real-time airway visualization, improving intubation success rates by providing superior glottic views without requiring alignment of the oral, laryngeal, and pharyngeal axes. Despite video laryngoscopy showing higher first-pass success rates, its usage remains limited among anesthesia providers in obstetrics. Implementing video laryngoscopy as a standard for patients at 20 weeks of gestation could reduce maternal mortality. The proposed implementation will occur over one year at an urban level-one trauma facility. This quality improvement initiative aims to improve patient safety and minimize anesthesia-related mortality by promoting video laryngoscopy usage in at least 75 cases, ensuring sustainable integration into clinical practic
Winter 2026 Otterbein Connections
No full textIn this issue: Welcome Letter by Floyd Akins Students Helping to Strengthen Bonds by Jordan Helphrey Volunteer Spotlight Division Name Update Year-End Giving by Jordan Helphrey Summer Fun at the \u27Bein by Dana Viglietta \u2796 Understanding Donor Advised Funds by Kathleen Bonte Class of 1975 Celebrates 50th Golden Reunion by Stephanie Clark Alumni Spotlight by Michael Hickin \u2725 Reminders Words of Encouragement by Valerie Gruber \u2784https://digitalcommons.otterbein.edu/connections/1007/thumbnail.jp
Practice Considerations for Perioperative Ondansetron Use in Parturients Undergoing Cesarean Sections with Spinal Anesthesia
Full text linkElective cesarean sections are often performed with spinal anesthesia, a form of neuraxial anesthesia that offers superior pain relief and reduces the risks associated with general anesthesia. However, over 50% of parturients experience side effects from spinal anesthesia, including shivering, hypotension, nausea, and vomiting, which can cause both physiological and psychological issues for the laboring mother and be detrimental to the fetus. Preventing these side effects is vital for improving safety, patient satisfaction, and minimizing complications. While various interventions and medications have been explored to manage these effects, no standardized guidelines exist for their prevention. A review of existing literature highlights the effectiveness of ondansetron in reducing post-spinal anesthesia complications, particularly for women undergoing non-emergent cesarean sections. This proposed final scholarly project addresses the lack of standardized, evidence-based practice (EBP) guidelines by proposing perioperative dosing recommendations for ondansetron. The Johns Hopkins EBP Model will be used as the framework for this project, which employs a quantitative approach to assess the impact of the practice in an academic center with a comprehensive obstetrics unit in central Ohio. While the project aims to develop an evidence-based framework for practice, it is currently not being implemented. The implementation plan spans approximately nine months, including a literature review, data collection, and evaluation. The expected outcomes include a reduction in post-spinal anesthesia side effects such as shivering, hypotension, nausea, and vomiting. This intervention is anticipated to reduce complications, improve maternal and fetal health, lower healthcare costs, and shorten hospital stays
Integrating the Transversus Abdominis Plane Block into an ERAS Protocol for Bariatric Surgery Patients
Full text linkThis Doctor of Nursing Practice (DNP) project investigates the integration of the Transversus Abdominis Plane (TAP) block into Enhanced Recovery After Surgery (ERAS) guidelines for bariatric surgery patients, aiming to improve postoperative outcomes by reducing opioid consumption, time to ambulation, and hospital length of stay (LOS). Bariatric patients who undergo sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) frequently encounter challenges with postoperative pain, increasing opioid use, delaying postoperative time to ambulation, and increasing postoperative hospital LOS. Prolonged postoperative hospitalization increases the financial impact on the healthcare system, and bariatric patients who have a longer postoperative LOS have a higher rate of readmission. While the TAP block has shown promise in enhancing postoperative analgesia and reducing reliance on opioids, it remains underutilized in clinical settings. This DNP project utilizes the Iowa Model of Evidence-Based Practice to guide the development, pilot implementation, and hospital-wide adoption of the TAP block within an ERAS guideline for bariatric patients. A multidisciplinary team has designed and implemented an intervention that could be evaluated by incorporating a small-scale pilot study to evaluate its impact on patient outcomes. The anticipated outcomes include a 20% reduction in opioid use, earlier ambulation, and shorter LOS, contributing to improved patient satisfaction and decreased healthcare costs. This proposed project can potentially standardize the TAP block as an integral part of and ERAS guideline, enhancing recovery for bariatric surgery patients in rural community hospitals
Voices of the Silenced
No full textVoices of the Silenced is a collection of creative work produced by the students of English 1192 at Otterbein University (Fall 2025). This booklet brings together prose, poetry, visual art, and multimedia expression centered on themes of activism, self-advocacy, identity, resilience, and social change.
Table of Contents: Preface by Dr. Frank Dobson Are You Becoming Who You Want to Be? by Madison Borowicz Agree to Disagree by Cedar Carden A Seriously Unserious Nation by Nick Clark Closeted Courage by Kenneth Fischer The Philosophy of an Activist by Selah Gitonga The Price We Pay by Ray Harvey & TaNasia Cunningham The Shape of a Voice by Max Lewis He\u27s Perfect by Gretchen Schneider We Dream for Equality by Raymond Shellow & Destiny Sexton The Anomaly of His Era by Isaiah Siaway On the Line by Awo Warsame Quiet Flames by Aashvi Sonihttps://digitalcommons.otterbein.edu/stu_pub_misc/1000/thumbnail.jp
Footloose: The Musical
No full texthttps://digitalcommons.otterbein.edu/theatre_dance_gallery/5855/thumbnail.jp
Footloose: The Musical
No full texthttps://digitalcommons.otterbein.edu/theatre_dance_gallery/5851/thumbnail.jp
Always... Patsy Cline
No full texthttps://digitalcommons.otterbein.edu/theatre_dance_gallery/5869/thumbnail.jp