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Final Scholarly Project: Development of Evidenced-Based Practice Guidelines for Female Patients Undergoing Anesthesia for Breast Cancer Surgery
Get PDFIn the United States, the rate at which cancer is diagnosed is on the rise. In women, breast cancer is the second most common cancer diagnosis, following skin cancer, with approximately one in eight women developing breast cancer in their lifetime. When a patient receives a breast cancer diagnosis, the oncologic team will discuss the most suitable treatment plan for the patient, this often includes chemotherapy, radiation therapy, and surgery. Within the last few decades, research has shown that there may be a correlation between anesthetic medications and breast cancer metastasis. This project aims to create an evidence-based anesthesia guideline for patients undergoing breast cancer surgery. Interventions will include a paravertebral block, total intravenous anesthesia (TIVA), and non-opioid analgesics; evidence has shown that volatile agents and opioids can decrease natural killer cell activity and increase postoperative metastasis. The Johns Hopkins Evidence-Based Practice Guideline Model for Nurses and Healthcare Professionals will be used to guide this process
Development of a ROTEM-guided Transfusion Algorithm in Cardiothoracic Surgery Patients
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Cardiothoracic surgical patients are at an increased risk for bleeding complications for various reasons, including induction of hypothermia, initiation of the coagulation cascade, degradation of the coagulation factors, mechanical destruction of platelets, and a systemic inflammatory response due to cardiopulmonary bypass (CPB). The American Society of Anesthesiologists recommends rotational thromboelastometry (ROTEM)-guided transfusion algorithms for perioperative blood management; however, there remains a heavy reliance on conventional coagulation laboratory values. Utilization of the following PICOT question will guide this project: In cardiothoracic surgical patients, how does the use of ROTEM versus traditional coagulation laboratory tests (PT, INR, aPTT, ACT, platelet count, and fibrinogen) affect blood product utilization, patient mortality, and overall cost peri-operatively and post-operatively? The literature review encompasses the highest level of current evidence to determine if there is a statistically significant difference in the number of blood products administered, mortality, and cost associated with utilizing ROTEM technology. The proposed project site would be a large urban hospital with an anticipated sample of 240 cardiothoracic cases over six months. Outcome data will be examined to help the project team explore and compare the impacts of a ROTEM-guided transfusion algorithm versus traditional coagulation laboratory tests. Overall, this project aims to develop a blood product management algorithm utilizing ROTEM technology to enhance the identification of coagulopathies, thereby limiting inappropriate blood product administration, lowering mortality rates, and providing a cost-effective method for coagulation management.
Keywords: cardiothoracic, anesthesia, rotational thromboelastometry (ROTEM
09. Marianne\u27s Imaginary Garden with Real Flamingo
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A Midsummer Night\u27s Dream (2024)
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A Midsummer Night\u27s Dream (2024)
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A Midsummer Night\u27s Dream (2024)
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9 to 5 (2024)
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Beehive: The \u2760s Musical (2024)
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