Anesthetic Experience Research Articles

Investigating the use of non-loss of resistance syringes for epidural insertion: experience on a mannequin

IntroductionThe Obstetric Anaesthetists’ Association has released a statement outlining the disruption to supply of the Portex® Loss of Resistance Syringe (Smiths Medical, UK) which is commonly used for epidural insertion within our Trust. We sought to investigate the use of standard available syringes for epidural insertion and whether tactile feedback when getting loss of resistance was similar. MethodsUsing an epidural trainer model, we asked anaesthetists regularly working in the maternity unit to trial three alternative syringes (10 mL BD Emerald, 10 mL BD syringe from our epidural packs, and 20 mL BD Plastipak) (Becton Dickinson U.K. Limited, UK) and to complete a qualitative questionnaire about their experience. ResultsResponses from 16 anaesthetists, including individuals with a range of obstetric anaesthetic experience who regularly provide obstetric anaesthesia, were collected. With the BD Emerald 10 mL syringe, 81% considered there was no difference or only a slight difference when feeling for loss of resistance. For the BD 10 mL syringe, this figure was 75%. With the 20 mL syringe 66% reported either a reasonable or marked difference in tactile feel. The most popular syringe was the 10 mL BD Emerald syringe. ConclusionUsing an epidural training mannequin, this study suggests that it is still possible to elicit clear loss of resistance using alternative syringes. Of the three alternative syringes commonly available in our organisation, the BD Emerald 10 mL syringe was the most popular.

Preoperative anxiety and its associated factors among women undergoing elective caesarean delivery: a cross-sectional study

BackgroundAnxiety is a behavioral expression of tension and unpleasant emotion that arises from multifactorial dimensions that might increase the mortality of patients during anesthesia and surgery. This study aimed to verify the prevalence and associated factors of preoperative anxiety among women undergoing elective cesarean delivery.MethodA cross-sectional study design was conducted on a total of 392 patients who underwent elective cesarean delivery in Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia from October 15, 2020, to September 15, 2021. Data was collected using a validated Amsterdam questionnaire, after translating to the local language (Amharic). Descriptive statistics were expressed in percentages and presented in tables. Bivariable and multivariable logistic analyses were done to identify factors associated with preoperative anxiety. The statistical significance level was set at P < 0.05 with 95% CI.ResultsThe overall prevalence of preoperative anxiety in women undergoing elective cesarean delivery was 67.9 [95% CI = (63.0–72.7)]. Participants who came from rural areas [AOR = 2.65; 95%CI: 1.27–5.53], farmers [AOR = 2.35; 95%CI: 1.02–5.40], participants with no previous surgical and anesthesia history [AOR = 2.91; 95%CI: 1.69–5.01], and primiparous women [AOR = 1.69; 95%CI: 1.01–2.83] were more significantly associated with preoperative anxiety.ConclusionThe prevalence of preoperative anxiety among elective cesarean deliveries was found to be high. So, preoperative maternal counseling and anxiety reduction services should therefore be given top priority, particularly for those women who came from rural areas, are farmers, have no prior surgical or anesthetic experience, and are primiparous.

Dynamics of lidocaine in topical anesthesia for office-based laryngeal procedures: A pilot study

ObjectivesTo study topical lidocaine for office-based laryngeal procedures recording onset, duration, and subjective experience of topical anesthesia. Study designNine healthy volunteers were anesthetized with 4 % lidocaine endoscopically. Laryngeal sensitivity prior to and during anesthesia was recorded until normal sensation returned measured by air-puff sensory testing. Subjective experience of the process was recorded. MethodsQuestionnaires regarding subjective experience were completed prior to, during, and after anesthesia. Laryngeal sensitivity via air-pulse trigger of the laryngeal adductor reflex (LAR) prior to and after 3 mL shower of 4 % lidocaine was recorded at 30 second intervals until the larynx was insensate with no LAR at 10 mmHg. Time to anesthesia was recorded and post-endoscopy questionnaire was given. Upon subjective change in sensation, sensitivity via air-pulse trigger of the LAR was recorded until baseline sensation returned. A post-anesthesia questionnaire recorded the subjective experience. ResultsAverage time to full anesthesia was 110 s (±31.2). Subjective return of sensation was noted at 10 min (±2.5), however time to return to normal LAR was 22 min (±5.8). Based on three standard deviations, 99.7 % of the population will be anesthetized at 3.4 min, report subjective change at 18.2 min and regain full sensation at 40 min. ConclusionsOffice-based laryngeal procedures should be performed at least 2 min following topical 4 % lidocaine with a window for manipulation of at least 16 min. Oral intake should be delayed for over 45 min to ensure complete return of sensation. The laryngeal shower of lidocaine is subjectively tolerated. Level of evidence2C Outcomes Research.

Views, Experiences, and Challenges of Anesthetists and Anesthesia Technologists on Parental Presence During Induction of Anesthesia in Children: A Mixed Method Study.

Parental presence during induction of anesthesia (PPIA) has a potential positive impact on the pediatric patient, parents, and anesthesia staff. Several studies have explored the effectiveness of PPIA. However, there are no recent studies that explore the anesthesia staff's views, experiences, and challenges toward PPIA. The aim of this study was to discover the views, experiences, and challenges of anesthetists and anesthesia technologists regarding PPIA within a hospital in Saudi Arabia. This study followed a mixed-method design with a qualitative descriptive approach. A methodologic triangulation of data collection, comprising phase one, quantitative Likert-scale questionnaires, and phase two, qualitative semi-structured interviews. Thirteen anesthetic practitioners were recruited in the questionnaire phase, and then six anesthetic practitioners participated in the interviews. The quantitative data set was analyzed using Microsoft Excel and results are given using descriptive statistics. The qualitative data set used thematic analysis and results are given using themes and participants' quotes. The data analysis identified representative themes and revealed no major differences in the opinions and experiences of anesthetists and anesthesia technologists on PPIA support. Based on the anesthesia staff's experiences, they believed in PPIA benefits, such as reduction in sedation use, minimizing the child's anxiety, and enhanced level of cooperation with the staff. Several points were raised indicating that there were challenges of PPIA with anxious parents and hospital policy being the main concern. The study provides evidence from anesthetic practitioners that PPIA is seen in a positive light within the Saudi hospital. The study's findings support further research to improve pediatric anesthesia practice, including a review of the hospital guidelines and policy.

Our Anesthesia Experience in Catheterization and Angiography Procedures in the Cardiac Catheterization Laboratory in Pediatric Patients with Congenital Heart Disease: Single Center 360 Cases

Our Anesthesia Experience in Catheterization and Angiography Procedures in the Cardiac Catheterization Laboratory in Pediatric Patients with Congenital Heart Disease: Single Center 360 Cases

Anesthesia Management in An Adult Patient with Desbuquois Syndrome

Desbuquois syndrome (DS) is a rare disease that can be accompanied by a difficult airway. In the literature, there are usually case reports about the mortal forms in childhood. We wanted to share our anesthesia experience in an adult patient with DS who underwent orthopedic surgery. We used videolaryngoscopy for intubation with coronavirus precautions. Adult patients with DS can be managed safely with adequate difficult airway preparation.

Effect of intramuscular midazolam premedication on patient satisfaction in women undergoing general anaesthesia: a randomised control trial

ObjectiveTo determine the effect of premedication with intramuscular midazolam on patient satisfaction in women undergoing general anaesthesia.Trial design, setting and participantsDouble-blind, parallel randomised control trial at a tertiary care medical...

Peripartum Ηysterectomy: A Four-Year Obstetric and Anesthetic Experience in a Tertiary Referral Hospital in Greece.

BackgroundAlthough peripartum hysterectomy (PH) is a life-saving procedure in cases of abnormal placentation and postpartum hemorrhage, it can be associated with major obstetric and anesthetic complications. This retrospective study aimed to evaluate the incidence, etiology, perioperative anesthetic and obstetric management, complications, and fetal outcomes in women undergoing PH in a single tertiary referral hospital in Greece.MethodologyThis was a retrospective analysis of medical records of women who underwent emergency or elective PH in our hospital between January 2015 and December 2018.ResultsDuring the study period, 69 women who underwent a PH were identified. The incidence rate of elective and emergency PH was 4 and 1.2 per 1,000 deliveries, respectively. The main indication for PH was abnormal placentation (81.2%), followed by uterine atony (13%). Conversion to general anesthesia (GA) was performed in 21 (30.4%) cases.ConclusionsThis study showed a high prevalence of PH in our hospital compared to high-income countries. A neuraxial-only technique may be a safe alternative in individual cases of abnormal placentation. Conversion to GA can be reserved for complex surgical cases when massive hemorrhage is anticipated and, if possible, after the neonate has been delivered.

Prospective randomized double blind study to evaluate the analgesic efficacy of low dose of intrathecal neostigmine in combination with fentanyl and bupivacaine for lower abdominal and lower limb surgery

More than 80% of patients undergoing surgical procedures under spinal anesthesia experience acute post-operative pain. The aim of the study was to compare the analgesic efficacy and side effects of addition of neostigmine to fentanyl and bupivacaine. 50 patients scheduled for elective lower abdominal and lower limb surgeries likely to finish within 3 hours, were put into two groups. 25 patients in each group aged between 18 to 60 years of either sex belonging to the ASA grade I &amp; II. Group A was given Intrathecal Bupivacaine 12.5 mg (2.5 ml) + Fentanyl 20 µg (0.4 ml)+0.1 ml Normal Saline (Total 3 ml) and Group B was given Intrathecal Bupivacaine 12.5 mg (2.5 ml) + Fentanyl 20 µg (0.4 ml) + Neostigmine 1µg (0.1 ml) (Total 3 ml). Subjects were monitored for occurrence of any adverse events after spinal injection. We observed statistically significant difference between the two groups in the onset of sensory blockade and recovery of sensory blockade. Onset of sensory blockade was earlier in Group B and recovery time was prolonged in Group B. No difference was seen in maximal sensory blockade.

Anesthetic experience does not reduce accidental dural puncture in surgical patients: a retrospective case-controlled study

BackgroundAccidental dural puncture (ADP), which is a complication of epidural anesthesia, still exists and leads to worse outcomes in surgical patients. While residency training is important for epidural competency, it remains unknown whether anesthetic experience reduces ADP in surgical patients. Using an incident reporting system along with anesthetic records, this case-controlled study retrospectively investigated risk factors associated with ADP in surgical patients.MethodsPatients who experienced ADP during epidural anesthesia who were registered in the incident reporting system of our institution between April 2012 and March 2019 were enrolled. Patients with ADP were control-matched with those who without ADP in a 1:3 ratio, to compare the potential risk factors and calculated odds ratios (ORs) for ADP. The primary hypothesis was that anesthesiologists’ experience reduces the incidence of ADP. The secondary hypothesis was that there are risk factors for ADP. Between-group differences in anesthesiologists’ experience were compared using the Mann–Whitney U test. Significance was set at P < 0.05.ResultsThirty-five patients who experienced ADP were identified from the incident reporting system. These were matched with 69 patients who did not experience ADP. There was no difference in the years of experience of anesthesiologists between the groups that did and did not experience ADP (8 [3–20] vs. 9 [3–18] years, respectively; P = 0.65).ConclusionsHaving an experienced anesthesiologist did not guarantee the prevention of ADP. Daily individual training and briefings would be needed to reduce the incidence of ADP.

A comparison between Austin-Moore and Corail prosthesis regarding intraoperative periprosthetic femur fractures in hip hemiarthroplasty

Hip hemiarthroplasty is considered the treatment of choice for displaced femoral neck fractures in elderly less active patients. One important complication of this procedure is an intraoperative periprosthetic femur fracture (IPF), which may lead to poor functional outcome and may increase morbidity and mortality. Our primary aim in this study is to compare between Austin-Moore and Corail prosthesis regarding IPFs. Our secondary aim is to assess patient and surgical technique related risk factors for the development of this complication. Inclusion criteria included patients older than 65 years of age who had a displaced femoral neck fracture and were operated for hip hemiarthroplasty between the years 2014–2018. Patient-specific data was collected retrospectively including age, gender, comorbidities, pre-injury ambulatory status, duration of surgery, surgical approach, use of Austin-Moore or Corail prosthesis, surgeon’s experience and type of anesthesia applied. In addition, radiographs were reviewed for measurement of calcar to canal ratio (CDR) and classification of Dorr canal type. 257 patients with an average age of 83.7 years were enrolled in the study. 118 patients (46%) were treated with an Austin-Moore prosthesis, while 139 (54%) were treated with a Corail prosthesis. A total of 22 patients (8.6%) had intraoperative fractures. Fracture prevalence was significantly higher in the Corail group compared with the Austin-Moore group (12.2% vs. 4.2%, p = 0.025). The majority of patients had a Dorr A type femoral canal, while the rest had Dorr B type canal (70% vs. 30%). There was no difference in fracture prevalence between Dorr A and B canal type patients. We didn’t find any significant risk factor for developing an IPF, neither patient wise (age, gender, and comorbidities) nor surgical technique related (surgical approach, type of anesthesia, and surgeon’s experience). Intraoperative periprosthetic fracture prevalence was significantly higher in the Corail patient group compared with the Austin-Moore group. This may be an important advantage of the Austin-Moore prosthesis over the Corail prosthesis.

Integrative review of non-pharmacological intervention and multidimensional evaluation for intraoperative anxiety under spinal anaesthesia.

Patients under spinal anaesthesia experience high levels of anxiety during surgery. Clinical nurses tried to manage patient's anxiety under spinal anaesthesia using non-pharmacological interventions for its benefit. Thus, it is required to identify comprehensive evidences of various non-pharmacological interventions and of how to measure anxiety under spinal anaesthesia. This study aims to review current research on the non-pharmacological interventions to relieve intraoperative anxiety under spinal anaesthesia and to identify subjective and objective measures of intraoperative anxiety under spinal anaesthesia. Wittemore and Knafl's integrative review methodology was used. Researchers conducted five scientific rigor steps; problem identification, searching literature, evaluation of literature, analysis of literature and presentation of results. The PRISMA checklist was used. To evaluate the level of evidence, critical appraisal tools of Joanna Briggs Institute were used. Eleven studies were included in this integrative review. Delivering music is the most frequently used as non-pharmacological intervention by researchers. They tried to manage intraoperative anxiety under spinal anaesthesia with using diverse genre and application of music. In addition, dry cupping method, progressive muscle relaxation (PMR) exercise and virtual reality (VR) goggles were used in included studies. Researchers measured intraoperative anxiety under spinal anaesthesia with objective or subjective way. The State-Trait Anxiety Inventory and visual analogue scale were used as subjective method to approach intraoperative anxiety. In contrary, researchers tried to obtain objective evidence of intraoperative anxiety with vital signs, cortisol, blood glucose, alpha-amylase and adrenocorticotropic hormone. Various types of non-pharmacological interventions are effective to manage patient's intraoperative anxiety under spinal anaesthesia. It is recommended to measure intraoperative anxiety under spinal anaesthesia with using both objective and subjective methods. Clinical nurses can use non-pharmacological interventions to manage intraoperative anxiety under spinal anaesthesia by comprehensive monitoring with diverse measures.

107 Nursing Interventions in the Temperature Management of Acute Burn Patients in the Burn Operating Room

IntroductionThe development of hypothermia in the operating room is a known risk that has been well documented in the literature. The typical surgical patient undergoing general anesthesia experiences a temperature loss of approximately 4°F without warming interventions. Burn patients are at a higher risk for hypothermia due to the greater body surface area exposure and evaporative losses related to their burn injury and length of their operative interventions. The purpose of this review is to determine the average loss of body temperature of the burn surgical patient as it pertains to total body surface area (TBSA) injury and the use of warming interventions.MethodsA two year retrospective review was performed on acute burn surgical cases in our two dedicated burn operating rooms within our burn center. Data obtained included TBSA of each case, pre and post-procedure patient temperatures, maximum OR room temperature, and use of adjunctive warming interventions. The surgical procedures were categorized by percent TBSA burn of < 10%, 10-20%, 21-40%, and >40%.ResultsWe identified 415 cases that were included in this review from 2019 and 2020. As expected, patients with larger TBSA involvement led to a greater temperature decline. As seen in Table 1, forced warm air devices were utilized in 67.2% of cases. In our large Burn OR suite, we utilize a heat panel that is integrated in the ceiling above the OR table. Utilization of these devices is determined by the Burn OR nurse. They are either initiated prior to the start of the case or intra-operatively if the patient’s temperature is declining and intervention is required. Mean operating room temperatures were 80.1°F in all cases with cooler room temperatures in the smallest TBSA group. Our average patient temperature decline was 1.25°F in all cases. However, in the largest TBSA group, the mean temperature loss was 2.68°F which is significantly less than the 4°F loss in general anesthesia procedures without warming interventions.ConclusionsThe use of elevated ambient operative room temperatures along with other warming interventions aid in the maintenance of core body temperature in the burn surgical patient. Having dedicated burn operative nurses with investment in the outcome of the burn surgical patient contributes to the overall safety and the maintenance of temperature homeostatic state.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery.

Comparison of ultrasound-guided transversus abdominis plane (TAP) block and quadratus lumborum (QL) block in inguinal hernia surgery.

Eye-Tracking Technology to Determine Procedural Proficiency in Ultrasound-Guided Regional Anesthesia.

Eye-tracking measures attention patterns, which may offer insight into evaluating procedural expertise. The purpose of this study was to determine the feasibility of using eye tracking to assess visual fixation patterns when performing an ultrasound-guided regional anesthesia procedure and to assess for differences between experienced, intermediate, and novice practitioners. Participants performed an ultrasound-guided sciatic nerve block 3 times on a fresh cadaver model while wearing eye-tracking glasses. Gaze fixation and dwell time on each location were compared between participants. Eye-gaze paths were used to derive a measure of entropy, or how often participants switched gaze fixations between locations. Five attending anesthesiologists, 5 third-year anesthesiology residents with prior ultrasound-guided regional anesthesia experience, and 5 medical students completed the study. Individuals with more experience were more likely to successfully perform the sciatic nerve block (5/5 attendings, 5/5 residents, 0/5 students; P = .002) and performed the procedure faster (average: attendings 62.6 seconds, residents 106.4 seconds, students 134.4 seconds; P = .089). Participants were progressively faster with practice (Trial 1: 41.8 seconds, Trial 2: 29.2 seconds, Trial 3: 28.9 seconds; P = .012), and the average number of eye shifts per trial decreased from 10.8 to 6.5 to 6 (P = .010). Attending physicians spent significantly less time fixating on the ultrasound monitor compared to trainees (P = .035). Average visual entropy progressively decreased from Trial 1 to Trial 3 (P = .03) and with greater experience (P = .15). There was a strong correlation between entropy and time on task (r(16) = 0.826, P = .001). Experienced providers make fewer back-and-forth visual fixations, spend less time in the procedure, and demonstrate less entropy during ultrasound-guided regional anesthesia procedures. Mobile eye-tracking has the potential to provide additional objective measures of performance that may help not only determine procedural competence but also distinguish between levels of proficiency.

Development and validation of Daycare Anesthesia Satisfaction (DAS) questionnaire to assess patient's satisfaction with daycare anesthesia.

The patient's satisfaction can be considered as a unique indicator of the quality of healthcare provided. The advantages of patient satisfaction surveys rely heavily on using standardized, psychometrically tested data collection approaches. There is a lack of a proper, psychometrically robust instrument to evaluate the patient's perioperative satisfaction following all types of anesthesia in daycare facility. Hence, this study aimed to develop a Daycare Anesthesia Satisfaction (DAS) questionnaire to measure the patient's satisfaction with the experience of daycare anesthesia services. A preliminary pool of questions was generated from research literature, expert consultations, and pilot tested on patients. The internal consistency and reliability of the preliminary questionnaire was evaluated by calculating Cronbach's alpha, intraclass correlation coefficient (ICC), and feasibility with the formation of a final 27-item questionnaire. In the next step, the questionnaire was distributed to a larger group of patients in the phase 2 of postanesthesia care unit (PACU). The results were subjected to confirmatory factor analysis to determine the goodness of fit of the questions under each domain. The internal consistency of the preliminary questionnaire as measured by Cronbach's alpha was 0.929. Intraclass correlation coefficient measured for test-retest reliability was 0.97 (95% confidence interval [CI]). Feasibility was confirmed, as 75% of the patients could fill the questionnaire within 15 min. In the second step of confirmatory factor analysis (CFA), questionnaire has been shown to have goodness of fit with Bentler's comparative fit index (CFI) of 0.99 that is greater than the suggested cutoff of 0.90. The root mean square error of approximation (RMSEA) of 0.09 is also close to the suggested cutoff of 0.06. This systematically developed and validated, 27-item DAS questionnaire can be tentatively recommended to be used to measure patient's satisfaction with day care anesthesia services following all types of surgical procedures, under various types of anesthesia.

Body Mass Index and Airway Surgery

“How big is too big?” As the prevalence of obesity continues to increase across the United States, healthcare providers continually look for answers to this question. The answer, however, is not as simple as one might think since it will always be a moving target. There are several variables continuously at play including: equipment and readiness of the facility, type of surgical procedure, continual evolutions in surgical and anesthetic techniques, training and experience of the healthcare personnel involved, and of course, the size of the patient.

An anesthetic experience of hereditary angioedema type I patient undertook total laparoscopic hysterectomy - A case report -

BackgroundHereditary angioedema (HAE) is an autosomal dominant disorder. The characteristic of HAE is recurrent angioedema episodes due to low C1 esterase inhibitor (C1-INH) level. HAE symptoms, especially those affecting oropharynx or larynx may develop respiratory distress syndrome due to impaired airway, which can be potentially fatal.Case We report a clinical case of a 57 year-old female patient, with type I HAE, scheduled for total laparoscopic hysterectomy under general endotracheal anesthesia, which was done successfully without inducing airway edema. Danazol, which increases liver synthesis of C1-INH, was administered and fresh frozen plasma (FFP), which contained C1-INH, was transfused after induction.ConclusionsFor HAE patients, the greatest concern is that general anesthesia can induces upper airway edema by direct mucosal irritation by the endotracheal tube. The perioperative management should include both prophylactic increase of C1-INH production and on-demand administration of C1-INH or FFP.

Patient and Surgeon Reported Experiences of Locoregional Anesthesia in Hand Surgery

Introduction Locoregional anesthesia techniques have been increasingly adopted for use in hand surgery in recent years. However, locoregional anesthesia techniques may place patients under significant psychological stress, and there has been limited evaluation of acceptance and satisfaction rates of these techniques.Materials and Methods An observational study was conducted in a single tertiary institution. Data were collected from patients undergoing upper limb surgery procedures with locoregional anesthesia. After completion of surgery, a questionnaire adapted from Evaluation du Vecu de l’Anesthesie LocoRegionale (EVAN-LR), with scores from 1 to 5 on the Likert scale, was conducted on the same day to evaluate patient satisfaction. Responses were also obtained from the operating surgeon to assess satisfaction.Results A total of 101 patients were evaluated as part of the study. All EVAN-LR domains received a mean score >4.5. Responses from surgeons also showed good acceptance of locoregional anesthesia techniques with almost all giving scores ≥4 on the Likert scale.Conclusion The results of this study showed good satisfaction and acceptance of locoregional anesthesia among patients for upper limb procedures. This provides reassurance regarding the quality of care with locoregional anesthesia techniques. It remains important to be aware of potential sources of discomfort such as tourniquet pain to minimize discomfort and maximize patient satisfaction.

Retrospective evaluation of anesthesia experience of patients who underwent sleeve gastrectomy

Retrospective evaluation of anesthesia experience of patients who underwent sleeve gastrectomy