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Spring 2009 Student Journal
Volume 8 Number 1 Spring 2009 The International Student Journal of Nurse Anesthesia TOPICS IN THIS ISSUE MS & ECT Cardioprotection of Volatile Agents Hyperthermic Chemotherapy Intubating LMA Pierre Robin Syndrome Alpha Thalassemia Latex Allergy & Spina Bifida Distorted Upper Airway Volunteerism – Honduras INTERNATIONAL STUDENT JOURNAL OF NURSE ANESTHESIA Vol. 8 No. 1 Spring 2009 Editor - in - Chief Ronald L. Van Nest, CRNA, JD Associate Editors Vicki C. Coopmans, CRNA, PhD Julie A. Pearson, CRNA, PhD EDITORIAL BOARD & SECTION EDITORS Pediatrics Janet A. Dewan, CRNA, MS Northeastern University Obstetrics Greg Nezat, CRNA, PhD Navy Nurse Corps Anesthesia Program Research & Capstone Joseph E. Pellegrini, CRNA, University of Maryland PhD Regional / Pain Christopher Oudekerk, CRNA, Uniformed Services Universi- DNP ty of the Health Sciences Cardiovascular Michele Gold, CRNA, PhD University of Southern Cali- fornia Thoracic/ Fluid Balance Lori Ann Winner, CRNA, MSN University of Pennsylvania Unique Patient Syndromes Kathleen R. Wren, CRNA, PhD Florida Hospital College of Health Sciences Equipment Carrie C. Bowman Dalley, Georgetown University CRNA, MS Pharmacology Maria Magro, CRNA, MS, University of Pennsylvania MSN Pathophysiology JoAnn Platko, CRNA, MSN University of Scranton Special Surgical Techniques Russell Lynn, CRNA, MSN University of Pennsylvania 1 Airway & Respiration Michael Rieker, CRNA, DNP Wake Forest University Baptist Medical Center ,Nurse Anesthesia Program, Univer- sity of North Carolina at Greensboro Neurology & Neurosurgery -
Authors Conducted an E-Mail Survey of Anesthesiologists in the US in 2010
Appendix 2: Reference 1 Methods: Authors conducted an e-mail survey of Anesthesiologists in the US in 2010. Results: “Five thousand anesthesiologists were solicited; 615 (12.3%) responses were received. Twenty-four percent of respondents had installed an AIMS, while 13% were either installing a system now or had selected one, and an additional 13% were actively searching. Larger anesthesiology groups with large case loads, urban settings, and government affiliated or academic institutions were more likely to have adopted AIMS. Initial cost was the most frequently cited AIMS barrier. The most commonly cited benefit was more accurate clinical documentation (79%), while unanticipated need for ongoing information technology support (49%) and difficult integration of AIMS with an existing EMR (61%) were the most commonly cited problems.” [Trentman TL, Mueller JT, Ruskin KJ, Noble BN, Doyle CA. Adoption of anesthesia information management systems by US anesthesiologists. J Clin Monit Comput 2011;25:129–35.] Reference 2 Joint Commission Report. 60 [Kohn L, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System. Report from the Committee on Quality of Health Care in America. Washington DC: The Joint Commission journal on quality improvement, 1999:227–34.] Reference 3 Excerpt: “The Department of Health and Human Services (DHHS) released two proposed regulations affecting HIT (www.healthit.hhs.gov). The first, a notice of proposed rule- making (NPRM), describes how hospitals, physicians, and other health care professionals can qualify for billions of dollars of extra Medicare and Medicaid payments through the meaningful use of electronic health records (EHRs). The second, an interim final regulation, describes the standards and certification criteria that those EHRs must meet for their users to collect the payments. -
Northwest Arkansas Regional Ems Protocols
Regional Protocol PROTOCOL SECTION NORTHWEST ARKANSAS REGIONAL EMS PROTOCOLS 2019 REVISION 2019 a Regional Protocol PROTOCOL SECTION TABLE OF CONTENTS……………………………………………………………………………….b - e INTRODUCTORY STATEMENT………………......……………………………………………….........f PARTICIPATING AGENCIES………………………………………………………………………….…………..g 2019 DEPARTMENT MEDICAL DIRECTORS & SIGNATURE………………..…………………………........h SECTION ONE - PROTOCOLS GENERAL PROTOCOLS UNIVERSAL PATIENT CARE ................................................................................................................... 1 CHEMICAL EXPOSURE (HAZMAT) ......................................................................................................... 2 CHEMICAL SEDATION FOR VIOLENT PATIENT .................................................................................... 3 PAIN MANAGEMENT ............................................................................................................................... 4 SPINAL RESTRICTION ............................................................................................................................ 5 VASCULAR ACCESS ............................................................................................................................... 6 RESPIRATORY OXYGEN ADMINISTRATION……….…………………………………………………………..…………………..7 GENERAL AIRWAY MANAGEMENT………………….……………………………………..…………………….8 ADVANCED AIRWAY MANAGEMENT….……………………………………………………..…………………..9 PHARMACOLOGICAL ASSISTED INTUBATION (PAI)………………….……………………………………..10 ALLERGIC REACTION—ANAPHYLAXIS….……………………………………………………………………..11 -
The Use of Remifentanil As the Primary Agent for Analgesia in Parturients
The Use Of Remifentanil As The Primary Agent For Analgesia In Parturients Author: Bryan Clifford Anderson, DNAP, CRNA Learning Objectives for this Self Study: The Importance of Exploring Remifentanil as an Upon completion of this study, the CRNA will be able to: Option for Treating Labor Pain The use of remifentanil in the parturient as the primary analgesic is 1. Discuss the significance of remifentanil use as a primary analgesic significant for several reasons; the most salient of which is the basic human agent in parturients for whom neuraxial anesthesia is not an option. right to the management of pain. Pain, as defined by the International Association for the Study of Pain (IASP), is “an unpleasant sensory and 2. Identify clients in which neuraxial anesthesia might be contraindicated. emotional experience associated with actual or potential tissue damage.” 2 Labor is a cause of severe pain for many women and is a problem that should 3. Compare the efficacy of select medications in the control of pain be addressed and managed in accordance with the needs and wishes of the in paturients. individual patient. Interventions that alleviate or eliminate pain are not merely a matter of beneficence, but also form part of the duty to prevent harm.3 4. Appraise findings in current evidence to determine to what extent The variations in pain perception among women in labor creates an essential remifentamil is a viable option for pain management in parturient patients. component in the administration of anesthesia in the provision of patient- centered anesthesia care. One recent study identifies that the perception of 5. -
A Comparison of Wilson Risk Sum Score and Combination of Modified Mallampati Classification, Hyomental Distance Ratio, Ratio Of
Jebmh.com Original Research Article A Comparison of Wilson Risk Sum Score and Combination of Modified Mallampati Classification, Hyomental Distance Ratio, Ratio of Height to Sternomental and Thyromental Distances for Predicting Difficult Laryngoscopy in Indian Population Deepak Kumar1, Saurabh Bhargava2, Ravindra Singh Sisodiya3, Deepak Tiwari4 1Department of Anaesthesia, National Institute of Medical Sciences and Research Centre, Jaipur, Rajasthan, India. 2, 4 Department of Emergency Medicine, National Institute of Medical Sciences and Research Centre, Jaipur, Rajasthan, India. 3Department of Anaesthesia, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India. ABSTRACT BACKGROUND A few patients of apparently normal appearance unexpectedly present with great Corresponding Author: difficulties during intubation which may lead to potentially serious consequences. Dr. Deepak Tiwari, Thus, we worked on this area with the aim to determine the ability to predict 109 Avar Faculty Block, Nims University, Shobha Nagar, difficult visualisation of larynx using the following preoperative airway predictors: Delhi-Jaipur Highway, MMC (Modified Mallampati Classification), RHSMD (Ratio of Height to Sternomental Jaipur - 302013, Distance), RHTMD (Ratio of Height to Thyromental) and HMDR (Hyomental Rajasthan, India. Distance Ratio) and comparison of these with WRSS (Wilson Risk Sum Score), in E-mail: [email protected] isolation and in combination. DOI: 10.18410/jebmh/2020/620 METHODS A double-blind, prospective study was carried out on 300, ASA grade I or II How to Cite This Article: patients posted for elective surgery in supine position under general anaesthesia. Kumar D, Bhargava S, Sisodiya RS, et al. A comparison of Wilson risk sum score Different parameters were recorded in pre-op period and Cormack-Lehane grading and combination of modified Mallampati and difficulty of intubation was recorded at the time of intubation. -
Thyromental Distance Ratio in Predicting Difficult Intubation
THE EFFECTIVENESS OF EXTENDED MALLAMPATI TEST, HYOMENTAL DISTANCE RATIO AND NECK CIRCUMFERENCE – THYROMENTAL DISTANCE RATIO IN PREDICTING DIFFICULT INTUBATION BY EZIKE AMECHI CHUKWUDUM DEPARTMENT OF ANAESTHESIA UNIVERSITY OF CALABAR TEACHING HOSPITAL CALABAR, NIGERIA A DISSERTATION SUBMITTED TO NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILLMENT OF THE FINAL FELLOWSHIP OF THE MEDICAL COLLEGE IN ANAESTHESIA (FMCA) EXAMINATION REQUIREMENT MAY 2017 1 SUPERVISORS ATTESTATION We hereby affirm that we supervised this study carried out by Dr. Amechi Chukwudum Ezike titled EFFECTIVENESS OF EXTENDED MALLAMPATI SCORE, HYOMENTAL DISTANCE RATIO AND NECK CIRCUMFERENCE- THYROMENTAL DISTANCE RATIO IN PREDICTING DIFFICULT INTUBATION , in partial fulfillment for the requirement of the award of the Fellowship of the National Postgraduate Medical College of Nigeria. First Supervisor……………………………………………… Date…………………………….. Prof. Atim I. Eshiet (MBBCh, DA, FMCA, FICS, FWACS) Consultant Anaesthetist, University of Calabar Teaching Hospital, Calabar, Nigeria. Second Supervisor …………………………………… Date……………………………… DR. Iniabasi Udoh Ilori (MBBCh; DA; FWACS). Consultant Anaesthetist, University of Calabar Teaching Hospital, Calabar, Nigeria. 2 CERTIFICATION I affirm that this dissertation titled ‘Effectiveness Of Extended Mallampati Score, Hyomental Distance Ratio And Neck Circumference-Thyromental Distance Ratio In Predicting Difficult Intubation’ was carried out by Dr. Ezike Amechi Chukwudum and supervised by consultants in the Department of Anaesthesiology, University of Calabar Teaching Hospital. This is in partial fulfillment of the requirement for the award of the Fellowship of the National Postgraduate Medical College of Nigeria. …………………………………………… Date………………………. DR. OBOKO OKU (MBBCh; DA; FWACS). The Head, Department of Anaesthesiology, University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. 3 DECLARATION I hereby declare that this work is original unless otherwise stated. -
Dcanesthesiamanualvo
ii Any or all parts of this manual may be reproduced, provided the parts reproduced are free- not for sale. For commercial purposes, no part of this manual may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher. The intent of this manual is to be freely used, copied, and distributed in Developing Countries for the teaching and promotion of basic anesthesia knowledge/skills. The purpose of this manual is to provide developing countries with a copyright free basic anesthesia manual. This manual can be freely copied and translated into a native language for the promotion of basic anesthesia knowledge/skills. Contributors with credited pictures and illustrations have graciously given permission for their material to be used for this specific purpose. The author and publishers of this manual cannot accept liability from the use of this manual or errors in translation. It is up to each translator to ensure that the translation is correct. Knowledge about the art and science of anesthesia continues to change. It is up to each anesthesia provider to continue to learn and upgrade their knowledge. This manual only contains basic knowledge and is not a replacement for more comprehensive anesthesia information. iii “Every prudent man acts out of knowledge.” Proverbs 13:15 Soli Deo Gloria iv Acknowledgements This project would not have been possible without the help of many. The World Health Organization and Michael B. Dobson MD kindly gave permission to utilize illustrations from the publication Anaesthesia at the District Hospital, WHO, Geneva, 2000 for two earlier editions, published in Afghanistan and Cambodia. -
Pediatric Neuraxial Blockade
University of Massachusetts Medical School eScholarship@UMMS Anesthesiology and Perioperative Medicine Publications Anesthesiology and Perioperative Medicine 1993-7 Pediatric neuraxial blockade John Pullerits University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/anesthesiology_pubs Part of the Anesthesiology Commons Repository Citation Pullerits J, Holzman RS. (1993). Pediatric neuraxial blockade. Anesthesiology and Perioperative Medicine Publications. https://doi.org/10.1016/0952-8180(93)90131-W. Retrieved from https://escholarship.umassmed.edu/anesthesiology_pubs/82 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Anesthesiology and Perioperative Medicine Publications by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. Pediatric Neuraxial Blockade John Pullerits, MD, FRCPC,* Robert S. Holzman, MD? Department of Anesthesiology, University of Massachusetts Medical Center, Worcester, MA, and Department of Anesthesia, Children’s Hospital, Boston, MA. Regional anesthetic techniques for children have recently enjoyed Historical Perspective a justified resurgence in popularity. Intraoperative blockade of August Bier’s investigation of spinal anesthesia in Ger- the neuraxis, whether by the spinal or epidural route, provides many’ and Siccard’s* and Cathelin’$ studies of caudal excellent analgesia with minimal physiologic -
Airway Assessment Authors: Dr Pierre Bradley Dr Gordon Chapman Dr Ben Crooke Dr Keith Greenland
Airway Assessment Authors: Dr Pierre Bradley Dr Gordon Chapman Dr Ben Crooke Dr Keith Greenland August 2016 Contents Part 1. Introduction 3 Part 2. The traditional approach to normal and difficult airway assessment 6 Part 3. The anatomical basis for airway assessment and management 36 Part 4. Airway device selection based on the two-curve theory and three-column assessment model 48 DISCLAIMER This document is provided as an educational resource by ANZCA and represents the views of the authors. Statements therein do not represent College policy unless supported by ANZCA professional documents. Professor David A Scott, President, ANZCA 2 Airway Assessment Part 1. Introduction This airway assessment resource has been produced for use by ANZCA Fellows and trainees to improve understanding and guide management of airway assessment and difficult airways. It is the first of an airway resource series and complements the Transition to CICO resource document (and ANZCA professional document PS61), which are available on the ANZCA website. There are four components to this resource: Part 1. Introduction. Part 2. The traditional approach to normal and difficult airway assessment. Part 3. The anatomical basis for airway assessment and management: i) The “two-curve” theory. ii) The “three-column” approach. Part 4. Airway device selection based on the two-curve theory and three-column assessment model. OVERVIEW The role of airway assessment is to identify potential problems with the maintenance of oxygenation and ventilation during airway management. It is the first step in formulating an appropriate airway plan, which should incorporate a staged approach to manage an unexpected difficult airway or the institution of emergency airway management. -
Short Thyromental Distance: a Predictor of Difficult Intubation Or An
Anesthesiology 2006; 104:1131–6 © 2006 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Short Thyromental Distance: A Predictor of Difficult Intubation or an Indicator for Small Blade Selection? Mukesh Tripathi, M.D., M.N.A.M.S.,* Mamta Pandey, M.D., P.G.D.H.H.M.† Background: Short thyromental distance (TMD; < 5 cm) has oropharyngeal structure,2 external anatomical airway been correlated with difficult direct laryngoscopic intubation in structures,3 and the size of the mandibular space.4 How- adult patients. The authors hypothesized that a smaller Macin- ever, some of these individual markers have been cri- tosh curved blade (No. 2 MCB) would improve the predicted 5 difficult laryngoscopy in short-TMD patients over that with a tiqued, and scoring systems including multiple variables 6,7 standard Macintosh curved blade (No. 3 MCB). have been proposed, with increased complexity of Methods: In a preliminary study of 11 consenting adults (7 assessment in clinical practice. Small thyromental dis- Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/104/6/1131/361138/0000542-200606000-00006.pdf by guest on 28 September 2021 females and 4 males), American Society of Anesthesiologists tance (TMD) Յ 6 cm is a simple, clinically used param- < physical status I and TMD 5 cm, lateral neck radiographs were eter that has been shown to correlate with a difficult recorded during laryngoscopy with a No. 2 and No. 3 MCB in 8 sequential fashion. In a prospective clinical study, laryngo- laryngoscopy and tracheal intubation. However, some scopy and tracheal intubation were evaluated in 83 adult pa- have questioned whether a small TMD, in isolation, is a tients with TMD < 5cm by randomly assigning them to two reliable predictor of a difficult laryngoscopy.9–11 In fact, groups for the blade used at first intubation. -
Can Thyromental Distance Be Measured Accurately?
Journal of Clinical Monitoring and Computing https://doi.org/10.1007/s10877-017-0090-3 ORIGINAL RESEARCH Can thyromental distance be measured accurately? Bin Wang1 · Hui Peng2 · Weidong Yao1 · Ling Guo1 · Xiaoju Jin1 Received: 22 June 2017 / Accepted: 6 December 2017 © The Author(s) 2017. This article is an open access publication Abstract Using the thyromental distance (TMD) measured based on the ultrasonographic location of the thyroid cartilage prominence as the criterion, we investigated the accuracy of TMD measurement by surface landmark identification of the thyroid carti- lage prominence. Twenty-nine anesthetist resident volunteers were recruited, including 10 first-year residents, 9 second-year residents and 10 third-year residents. Each volunteer measured the other 28 volunteers’ TMD. Then, the thyroid cartilage prominence of each volunteer was identified by ultrasonography of the junction of the vocal cord and thyroid cartilage, and the TMD was measured precisely. The error of the TMD measurement was determined by the minimal detectable differ- ence (MDD) compared to the ultrasound measurement. A difference of greater than 5.4 mm between the TMD measured by volunteers and that based on ultrasound localization was defined as a measurement error. The measurement error rate of females’ TMD was significantly higher than that of males’ (50 vs 10%, P < 0.001). The error rates of anesthetist residents of first-year, second-year and third-year were 34, 27, and 31%, respectively, and were not significantly different. The error of TMD measurement by surface landmark identification is often, especially for women. More clinic experience don’t improve it. Keywords Airway management · Thyroid cartilage · Anatomic landmarks · Accuracy · Ultrasonography · Volunteers 1 Introduction in a normal adult [12–14], whereas others have considered cut-off points of 7.0 cm [7], 6.0 cm [15], 5.5 cm [16] and Managing a difficult airway remains a significant problem even 4 cm [10]. -
SOAP Thrombocytopenia Consensus Statement FINAL
The Society for Obstetric Anesthesia and Perinatology Interdisciplinary Consensus Statement on Neuraxial Procedures in Obstetric Patients with Thrombocytopenia Melissa E. Bauer DO1, Katherine Arendt MD2, Yaakov Beilin MD3, Terry Gernsheimer MD4, Juliana Perez Botero MD5, Andra H. James MD6, Edward Yaghmour MD7, Roulhac D. Toledano MD, PhD8, Mark Turrentine MD9, Timothy Houle PhD10, Mark MacEachern MLIS11, Hannah Madden, BS10, Anita Rajasekhar, MD MS12, Scott Segal MD13, Christopher Wu MD14, Jason P. Cooper MD, PhD4, Ruth Landau MD15, Lisa Leffert, MD10 1Department of Anesthesiology, University of Michigan 2Department of Anesthesiology and Perioperative Medicine, Mayo-Clinic 3Department of Anesthesiology, Perioperative and Pain Medicine, and Obstetrics Gynecology and Reproductive Sciences Icahn School of Medicine at Mount Sinai 4Department of Medicine, University of Washington School of Medicine 5Department of Medicine, Medical College of Wisconsin and Versiti 6Department of Obstetrics and Gynecology, Duke University 7Department of Anesthesiology, Vanderbilt University 8Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health 9Department of Obstetrics and Gynecology, Baylor College of Medicine. Liaison for the American College of Obstetricians and Gynecologists 10Department of Anesthesiology, Massachusetts General Hospital 11Taubman Health Sciences Library, University of Michigan 2 12Department of Medicine, University of Florida 13Department of Anesthesiology, Wake Forest University School of Medicine 14Department