Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Surgical site infections are the most common complication of surgery in the United states. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Surgical site infections are the most common complications of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle.

Treatment and Prevention of Spinal-Induced Hypotension in the Cesarean Section Patient: What Does the Evidence Say?

Most anesthesia providers prefer to do a subarachnoid block (SAB) for cesarean section because of its rapid onset and reliability to provide adequate anesthesia. However an effect of the SAB is that it causes a spinal-induced hypotension (SIH) in up to 85% of the population. There have been multiple studies that assessed fluid administration, vasopressor administration, maternal positioning, or serotonin blockers given prophylactically to attenuate the SIH response.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle.

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Surgical site infections are the most common complication of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle.

Effect of intraoperative intravenous lidocaine on postoperative pain and return of bowel function after laparoscopic abdominal gynecologic procedures.

Abdominal surgery has a high incidence of postoperative pain and dysfunctional gastrointestinal motility. This study investigated the effect of a continuous intraoperative infusion of lidocaine on patients undergoing laparoscopic gynecologic surgery. In this double-blind, placebo-controlled investigation, 50 subjects were randomly assigned to control and experimental groups.

Comparison of fascia iliaca compartment block and 3-in-1 block in adults undergoing knee arthroscopy and meniscal repair.

Peripheral nerve blocks have become a popular method for treatment of pain after lower-extremity surgical procedures. Two peripheral nerve blocks for knee arthroscopy include the 3-in-1 block and the fascia iliaca compartment block (FICB). There is limited research comparing the efficacy of these blocks in adults undergoing knee arthroscopy and meniscal repair who receive both the peripheral nerve block and general anesthesia.

Prophylactic isopropyl alcohol inhalation and intravenous ondansetron versus ondansetron alone in the prevention of postoperative nausea and vomiting in high-risk patients.

Patients identified as high risk for postoperative nausea and vomiting (PONV) are often treated prophylactically with intravenous (IV) ondansetron and an additional agent. Limited options exist for a second agent with no adverse effects. The purpose of this investigation was to determine if combining the prophylactic inhalation of isopropyl alcohol (IPA) vapors, an agent with no adverse effects, with IV ondansetron would be more effective than IV ondansetron alone in the prevention of PONV in high-risk patients.

Biphasic dosing regimen of meclizine for prevention of postoperative nausea and vomiting in a high-risk population.

The purpose of this study was to determine if giving 50 mg of meclizine the night before and on the day of surgery would effectively reduce postoperative nausea and vomiting (PONV) for the entire 24 hours after surgery in patients identified as being at high risk for PONV Subjects were randomly assigned to receive either 50 mg of oral meclizine (experimental group) or a placebo (control group) the night before and the day of surgery. All subjects were intravenously administered 4 mg of ondansetron before the conclusion of surgery. Seventy subjects (35 control; 35 experimental) were included in analysis.

Will the addition of a sciatic nerve block to a femoral nerve block provide better pain control following anterior cruciate ligament repair surgery?

Two common forms of postoperative analgesia used in patients following an anterior cruciate ligament repair (ACLR) are the femoral nerve block (FNB) and the combined femoral-sciatic nerve block (FSB). The purpose of this study was to determine if the addition of the sciatic nerve block to the FNB is truly beneficial in ACLR patients requesting regional anesthesia for postoperative pain control. All subjects scheduled for an ACLR, requesting general anesthesia and preoperative placement of a peripheral nerve block (PNB), were randomized to receive an FNB or an FSB.

Correlating an 11-point verbal numeric rating scale to a 4-point verbal rating scale in the measurement of pruritus.

Pruritus, the subjective sensation of itch, can be a difficult symptom to assess and treat. Evaluating levels of patient discomfort across populations has proven to be challenging because of a lack of a standardized measurement tool to quantify levels of itch. The most widely used tool is the 4-point verbal rating scale (VRS-4), but others use an 11-point verbal numeric rating scale (VNRS-11).

Effect of timing of fluid bolus on reduction of spinal-induced hypotension in patients undergoing elective cesarean delivery.

Spinal-induced hypotension remains the most common complication associated with spinal anesthesia for cesarean delivery. Recent evidence indicates that a 20-mL/kg bolus via pressurized infusion system administered at the time of subarachnoid block (SAB) (coload) may provide better prophylaxis than the traditional administration of a 20-mL/kg crystalloid infusion (preload) approximately 20 minutes before SAB; however, this method raises some concerns. We hypothesized that administering half of the fluid bolus (10 mL/kg) before and half immediately following injection of the SAB would provide benefit.

Perceived deprivation in active duty military nurse anesthetists.

There is a shortage of military Certified Registered Nurse Anesthetists (CRNAs). Relative deprivation is a perception of unfairness due to discrepancies between what one has and what one could or should have that is dependent on feelings (subjective data) and facts (objective data). Feelings of relative deprivation could contribute to the military CRNA shortage.

Comparison of 2 laryngeal tracheal anesthesia techniques in reducing emergence phenomena.

Endotracheal intubation (ETT) can cause emergence phenomena (EP) including coughing, sore throat, and dysphonia. Two methods used to prevent EP are the administration of local anesthetics directly onto airway structures using a specialized laryngotracheal instillation of topical anesthesia (LITA) tube (Sheridan Catheter Corporation, Argyle, New York) or the placement of a local anesthetic into the ETT cuff. The purpose of this study was to determine which method was better at preventing ERl In this prospective, randomized, comparative analysis, a sample of 160 ASA class I through III patients were randomly assigned to receive their EP prophylaxes either by placement of alkalinized lidocaine directly into the ETT cuff at intubation or by injection into a specialized port on the LITA tube approximately 30 minutes before extubation.

The efficacy of ketorolac as an adjunct to the Bier block for controlling postoperative pain following nontraumatic hand and wrist surgery.

Research indicates that using a combination of ketorolac and lidocaine in the administration of a Bier block results in significant postoperative analgesia and decreased inflammation; however, the optimal dose of ketorolac to coadminister with the local anesthetic has not been established. This study was performed to determine if a 20-mg dose of ketorolac is effective in providing prolonged postoperative analgesia without adverse effects. A total of 55 patients (29 lidocaine-ketorolac, 26 lidocaine-placebo) were enrolled in this randomized, double-blind, placebo controlled study.

Meclizine in combination with ondansetron for prevention of postoperative nausea and vomiting in a high-risk population.

Postoperative nausea and vomiting (PONV) is prevalent in surgical patients with known risk factors: general anesthesia, female, nonsmoker, motion sickness history, and PONV history. Common treatment involves ondansetron; however, the effects are short-lived, and supplemental medication may be required. Meclizine, a long-acting drug with a low side-effect profile, may be ideal in combination with ondansetron for at-risk patients.

A comparative analysis of isopropyl alcohol and ondansetron in the treatment of postoperative nausea and vomiting from the hospital setting to the home.

We compared the efficacy of inhaled isopropyl alcohol (IPA) with ondansetron for the control of postoperative nausea and vomiting (PONV) during a 24-hour period in 100 ASA class I-III women undergoing laparoscopic surgery. Nausea was measured postoperatively using a 0 to 10 verbal numeric rating scale (VNRS). The control group received ondansetron, 4 mg intravenously, and the experimental group inhaled IPA vapors.

Comparison of two approaches to brachial plexus anesthesia for proximal upper extremity surgery: interscalene and intersternocleidomastoid.

We conducted a prospective, randomized study to compare differences between groups of patients given a brachial plexus block using an interscalene (IS) or an intersternocleidomastoid (ISCM) approach. Specific variables analyzed included overall success rates, time to achieve sensory and motor anesthesia, time to place block, and incidence of side effects. For the study, 81 patients were randomized to receive a brachial plexus blockade using the IS or ISCM approach followed by general anesthesia for their surgical procedure.

The effect of transdermal scopolamine on the incidence and severity of postoperative nausea and vomiting in a group of high-risk patients given prophylactic intravenous ondansetron.

Specific risk factors place patients at greater risk for postoperative nausea and vomiting (PONV). Routinely, these patients are treated prophylactically with intravenous (IV) ondansetron or transdermal (TD) scopolamine. No study has examined what effect using a combination of these prophylactic treatments would have on the incidence of PONV in a group of high-risk patients.

The effect of Pencan needle orientation on spinal anesthesia outcomes.

Slow resolution of block and incidence of side effects deter many practitioners from choosing spinal anesthesia for out-patient surgical procedures. Some studies suggest that controlling bevel or side port orientation of a spinal needle during anesthetic injection can affect occurrence of side effects and time to block resolution. The objective of this study was to determine the effects of varying Pencan spinal needle (B-Braun, Bethlehem, Pa) side port orientations on duration of block and incidence of side effects in groups of patients receiving spinal anesthesia.

Comparison of the effects of propofol versus thiopental induction on postoperative outcomes following surgical procedures longer than 2 hours.

The use of propofol as an induction agent for surgeries lasting less than 2 hours has been shown to result in a faster emergence from anesthesia. Our study was performed to analyze the impact of propofol on surgical procedures lasting longer than 2 hours. A convenience sample of 84 men and women undergoing nonemergency laparoscopic procedures scheduled for longer than 2 hours were enrolled in this prospective study and randomly assigned to receive a standardized induction with thiopental or propofol.

An evaluation of the histological effects of intra-articular methadone in the canine model.

Methadone hydrochloride is an opiate that has pharmacodynamic and pharmacokinetic properties that suggest it may provide longer analgesia than morphine when administered via the intra-articular route. However, no studies to date have been conducted examining the effects of intra-articular methadone hydrochloride on local tissues. Therefore, the purpose of this study was to determine the histopathologic effects of intra-articular methadone hydrochloride on local tissues in the canine knee.

Comparison of inhaled isopropyl alcohol and intravenous ondansetron for treatment of postoperative nausea.

Postoperative nausea, a common complication in patients receiving general anesthesia, was studied in this randomized investigation to compare the efficacy of 70% inhaled isopropyl alcohol and intravenous ondansetron. For the study, 100 healthy women, ASA physical status I or II, scheduled for outpatient gynecologic laparoscopic procedures randomly received 4 mg of intravenous ondansetron or isopropyl alcohol for the treatment of postoperative nausea. Nausea was measured on arrival to the postanesthesia care unit, at first complaint of nausea, every 5 minutes after initiation of therapy until nausea resolution, and every 15 minutes thereafter using a 0 to 10 verbal numerical rating scale.