Using Simulation to Enhance Education Regarding Epidural Analgesia for Registered Nurses.

Background: Registered nurses (RNs) receive didactic training regarding caring for patients receiving epidural analgesia. Although RNs are tested on their knowledge after this training, their ability to critically think through adverse events has not been assessed at our institution.

Aim: The aim of this study was to examine the feasibility and effectiveness of simulation education for RNs regarding the assessment and management of patients receiving epidural analgesia.

Pain After Unilateral Total Knee Arthroplasty: A Prospective Randomized Controlled Trial Examining the Analgesic Effectiveness of a Combined Adductor Canal Peripheral Nerve Block with Periarticular Infiltration Versus Adductor Canal Nerve Block Alone Versus Periarticular Infiltration Alone.

Background: Total knee arthroplasty is a painful surgery that requires early mobilization for successful joint function. Multimodal analgesia, including spinal analgesia, nerve blocks, periarticular infiltration (PI), opioids, and coanalgesics, has been shown to effectively manage postoperative pain. Both adductor canal (AC) and PI have been shown to manage pain without significantly impairing motor function.

Prediction of the time to complete a series of surgical cases to avoid cardiac operating room overutilization.

Purpose: Operating room (OR) efficiency could be improved by reducing overutilization. In this article we suggest a methodology to accurately determine the time to complete a series of surgical cases in a single cardiac OR to avoid overutilization. Our methodology includes the basic assumptions that the first case starts on time, there are no add-on cases, and there is a predetermined OR time allocation.

Speckle tracking for the intraoperative assessment of right ventricular function: a feasibility study.

Objectives: Speckle tracking is an ultrasound method that assesses B-mode features to measure tissue displacement and derive deformation parameters. The objective of this study was to assess the feasibility of using speckle tracking in the measurement of right ventricular (RV) longitudinal strain during cardiac surgery using transesophageal echocardiography (TEE).

Design: This was a prospective, observational cohort study.

From a project to transformation: how "going against the flow" led to improved access and patient flow in an academic hospital.

A results-driven approach to optimizing patient flow, grounded on quality improvement, change management and organizational learning principles, is described. Tactics included collaborative governance, performance management, rapid process improvements and implementation toolkits. Results included an 83.

Induction of anesthesia does not alter tricuspid annular velocities: a tissue Doppler assessment.

Purpose: In this prospective observational cohort study, we investigated whether tricuspid annular velocities (TAV) are altered after induction of anesthesia in patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: Twenty-four elective CABG patients were assessed before and after induction of anesthesia, and a convenience sample of nine healthy volunteers was used for comparison of TAV only. Measurements included mean arterial pressure (MAP), heart rate (HR), pulmonary artery pressure (PAP), and cardiac index (CI) as assessed post-induction.

The effect of heart rate on tricuspid annular velocities in cardiac surgical patients with atrial fibrillation.

Objectives: Tricuspid annular isovolumic acceleration is a load-independent measure of contractility, but its relationship to heart rate is unknown in humans. The authors investigated the effect of heart rate on measurements of isovolumic acceleration and systolic wave velocities in postoperative cardiac surgical patients with atrial fibrillation.

Design: This was a prospective observational study.

Regional differences in color tissue Doppler-derived measures of longitudinal right ventricular function using transesophageal and transthoracic echocardiography.

Objective: This study was designed to compare the right ventricular (RV) Doppler tissue imaging parameters of tricuspid annular isovolumic acceleration (IVA), systolic velocity (S), and basilar myocardial strain and strain rate (SR) by using both transesophageal echocardiography (TEE) (inferior wall) and transthoracic echocardiography (TTE) (free wall) in a cardiac surgical population under general anesthesia.

Design: Prospective observational study.

Setting: University hospital.

Right ventricular tissue Doppler parameters in a patient with massive pulmonary embolus.

We present right ventricular tissue Doppler findings in a 41-year-old man with pelvic fracture who had a near-fatal pulmonary embolus. We found small early systolic lengthening and reduced delayed systolic shortening using strain and strain rate imaging. There were also delayed and fused diastolic waves.

Tricuspid annular velocity in patients undergoing cardiac operation using transesophageal echocardiography.

Background: The complex geometry of the right ventricle (RV) and poor endocardial definition make quantitative assessment of RV function difficult. Doppler tissue imaging may be helpful in quantifying RV function through measurement of tricuspid annular velocity (TAV). This prospective study assessed the feasibility of using color Doppler tissue imaging to measure TAV using a novel transgastric RV inflow view in patients undergoing cardiac surgery.