Abstract 359: Unit-Specific Influences on Conscious Sedation Nursing Practices: Comparing Medication Utilization and Patient Outcomes

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Linda Parone ◽  
Sahil Rawal ◽  
Allison Ellis ◽  
Bryant Peterson ◽  
Lourdes Escalante ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
General Anesthesia ◽  
Clinical Outcomes ◽  
Median Time ◽  
Conscious Sedation ◽  
Adverse Outcomes ◽  
P Value ◽  
Medication Utilization ◽  
American Society ◽  
Cardiac Catherization

Background: Unit-Specific influences may determine the amount of sedation given to patients and lead to deviations in patient satisfaction and clinical outcomes due to vague guidelines (4). This study aims to compare medication utilization, clinical outcomes and patient satisfaction in order to determine safety and efficacy of nurse administrated conscious sedation. Methods: Data from outpatient procedures in Cardiac Catherization Lab (Cath Lab) and Interventional Radiology (IR) departments were collected including comorbidities, labs, procedural characteristics, clinical outcomes, and post-sedation questionnaires. Results: Mean age was 63 ± 14 years and 124 (54.9%) were males. Cath Lab n=132 and IR n=94. Procedure duration(min) was found to be longer in the Cath Lab 55 (37,81), than in IR 24 (16,45), p-value of <0.001. The American Society of Anesthesiologist (ASA) scores of Cath Lab 26(21%), IR 29(30.9%), p-value (0.1). Total amount of versed (mg) given in the Cath Lab 2 (1,2), significantly less than IR 3 (1,4.5) with a p-value of <0.01. Total amount of fentanyl (mcg) for Cath Lab 50(50,100), and IR 100 (50,100) with a p-value of <0.01. Median time between 1 st and 2 nd dose of versed in Cath Lab 0 (0,1), IR 9 (5, 16). Median time between 2 nd and 3 rd dose of versed for Cath Lab 0 (0,0), IR 6 (0,13.5) with a p-value <0.001. Median time between 1 st and 2 nd dose of fentanyl in Cath Lab 1 (0,14.8), IR 12.5 (6.8, 24) with a p-value <0.001. Median time between 2 nd and 3 rd dose of fentanyl for Cath Lab 0 (0,0), IR 0,(0,15), p-value <0.001. Median second dose of versed in Cath Lab 0 (0,1), IR 1 (1,1). Median second dose of fentanyl in Cath Lab 25 0 (0,25), IR 25 (25,50), p-value <0.001. Post-Sedation Questionnaire completed by 57 patients, Cath Lab n=30, IR n=27. Patients that felt uncomfortable during their procedure in Cath Lab 11(36.7%), compared to IR 1 (3.7%). The choice of sedation that patient would choose if undergoing a similar procedure again if under general anesthesia Cath Lab 6(20%), IR 0(0%), p-value 0.03. Patients stated that they would recommend conscious sedation to others based on their previous experience, Cath Lab 24 (80%), IR 27(100%). Conclusion: Patients receiving conscious sedation while undergoing procedures in both the Cath Lab and IR were found to have no adverse outcomes and were considered safe. The procedural duration of catheterization procedures was significantly longer than IR with no adverse outcomes, but patients in the Cath lab received less sedation medication and were found to be less satisfied with their procedure. Patients from Cath Lab received less initial sedation medication and rarely received an additional dose. Cath Lab patients were more likely to not recommended conscious sedation to others (20%), and 6 (20%) stated they would rather undergo a similar procedure under general anesthesia; 36.7% of Cath Lab patients stated that they were uncomfortable during the procedure.

scholarly journals Lumbar Disc Herniation and Preoperative Modic Changes: A Prospective Analysis of the Clinical Outcomes After Microdiscectomy

2021 ◽  
pp. 219256822097608
Author(s):  
Dinesh Kumarasamy ◽  
Shanmuganathan Rajasekaran ◽  
Sri Vijay Anand K. S ◽  
Dilip Chand Raja Soundararajan ◽  
Ajoy Prasad Shetty T ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Back Pain ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Rating Scale ◽  
Lumbar Disc ◽  
Modic Changes ◽  
P Value ◽  
Functional Scores

Study design: Prospective comparative cohort study. Objectives: The study aims to elucidate the relationship between Modic endplate changes and clinical outcomes after a lumbar microdiscectomy. Methods: Consecutive patients undergoing microdiscectomy for lumbar disc herniation (LDH) were prospectively studied. Pre-operative clinical and radiological parameters were recorded. The pain was assessed by Numeric pain rating scale (NPRS), and functional assessment by Oswestry Disability Index (ODI). Minimal clinically important difference (MCID) in outcome was calculated for both the groups. Complications related to surgery were studied. Follow-up was done at 6 weeks, 3 months, 6 months and 1 year. Mac Nab criteria were used to assess patient satisfaction at 1 year. Results: Out of 309 patients, 86 had Modic changes, and 223 had no Modic changes. Both groups had similar back pain (p-value: 0.07) and functional scores (p-value: 0.85) pre-operatively. Postoperatively patients with Modic changes had poorer back pain and ODI scores in the third month, sixth month and 1 year (p-value: 0.001). However, MCID between the groups were not significant (p-value: 0.18 for back pain and 0.58 for ODI scores). Mac Nab criteria at 1 year were worse in Modic patients (p-value: 0.001). No difference was noted among Modic types in the pre-operative and postoperative pain and functional outcomes. Four patients in Modic group (4.7%) and one patient in the non-Modic group (0.5%) developed postoperative discitis (p-value: 0.009). Conclusions: Preoperative Modic changes in lumbar disc herniation is associated with less favorable back pain, functional scores and patient satisfaction in patients undergoing microdiscectomy.

Anticancer Therapy in COViD-19 Patients: A Descriptive Literature Review

2021 ◽  
Vol 36 (8) ◽  
pp. 365-373
Author(s):  
Nishita Tripathi ◽  
Daniya Sheikh ◽  
Demetra Antimisiaris
Keyword(s):  
Literature Review ◽  
Older People ◽  
Cancer Patients ◽  
Clinical Outcomes ◽  
Anticancer Therapy ◽  
Included Study ◽  
Adverse Outcomes ◽  
Control And Prevention ◽  
Anticancer Treatment ◽  
American Society

OBJECTIVE: To provide a descriptive literature review about the effects of anticancer treatment on clinical outcomes because of active COVID-19 infection in older people. DATA SOURCES: A literature search was conducted in Google Scholar, PubMed, American Society of Clinical Oncology, European Society for Medical Oncology, and the Center for Disease Control and Prevention. Articles published in English between December 1, 2019, to September 1, 2020, were included. STUDY SELECTION: Nine studies assessing the effectiveness of various modalities for cancer treatments in patients infected with COVID-19 infection were reviewed. The studies reviewed the severity of COVID-19 infection outcomes in patients who underwent any anticancer treatment. Studies exclusively focused on older people could not be found, but all studies included older people. DATA SYNTHESiS AND RESULTS: Early pandemic studies suggested avoiding anticancer treatment during a COVID-19 infection because of poor clinical outcomes and increased mortality. However, the totality of studies reviewed found no association between the continuation of anticancer treatment and adverse COVID-19 outcomes in cancer patients. Adverse COVID-19 infection outcomes and high mortality rates were associated with older cancer patients independent of anticancer therapy. CONCLUSION: Treatment of cancer could be challenging because of the COVID-19 pandemic. Interruption or delaying the anticancer therapy could increase the burden of overall mortality. This literature review indicated that adverse outcomes because of COVID-19 are associated with advanced age independent of anticancer therapy. Further exploration of the correlation between cancer, anticancer treatments, and COVID-19 infection outcomes is needed.

795 Factors Associated with Time to Initial Debridement in a Pediatric Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S233-S234
Author(s):  
Sheila Giles ◽  
Krista K Wheeler ◽  
Renata Fabia ◽  
Kimberly Lever ◽  
Junxin Shi ◽  
...  
Keyword(s):  
Median Time ◽  
Conscious Sedation ◽  
Total Body Surface Area ◽  
Adverse Outcomes ◽  
Mechanism Of Injury ◽  
Wound Debridement ◽  
Factors Associated ◽  
Burn Center ◽  
Pain Scores ◽  
Significant Difference

Abstract Introduction There is sparse literature addressing the time of initial burn debridement. The purpose of this study was to describe factors associated with time to initial debridement in one American Burn Association (ABA) verified pediatric burn center. Methods Quality improvement data was prospectively collected for pediatric burn patients admitted from July 2018 through June 2019. The data included sedation method, total body surface area (TBSA) burn, mechanism of injury, and time to burn wound debridement. Adverse outcomes were also recorded. Nonparametric methods were used to evaluate associations. Medians are presented with interquartile ranges (IQR). Results There were 137 patients included in this study. The median time to initial debridement was 261 minutes (IQR: 166–321). Most patients (80%) received conscious sedation for their first debridement. The median time to debridement was significantly lower for patients receiving sedation as opposed to those without sedation, 240 minutes (IQR: 163–308) vs 338 minutes (IQR: 257–442), p=0.0004. Patients with TBSA burn &gt; 5% (n=46) also had a significant earlier time to debridement as compared with patients with smaller burns, 183 minutes (IQR: 150–277) vs 283 minutes (IQR: 197–360), p&lt; 0.0001. There was a significant difference in time to initial debridement based on mechanism of injury, p=0.0213. The median time to debridement for flame burns was 173 minutes (IQR: 149–308) as compared with scald burns with a median of 247 (IQR: 157–298) and contact burns, median 286 (IQR: 197–389). There were no adverse outcomes observed during the study period. Conclusions In an ABA verified pediatric burn center, conscious sedation, larger TBSA burn, and flame burns appeared to contribute to earlier time to debridement, with no adverse outcomes. Further analysis are ongoing as to whether pain scores differed for these initial burn dressings and if conscious sedation had any effects on subsequent dressings. Applicability of Research to Practice This study adds to the sparse literature regarding time to initial debridement and identifies factors associated with an earlier time to debridement. This study also raises further opportunities for investigation regarding the relationship between initial sedated debridement procedures and pain scores during subsequent dressing changes.

scholarly journals Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 417
Author(s):  
Corinne Fischer ◽  
Sonja Vulcu ◽  
Johannes Goldberg ◽  
Franca Wagner ◽  
Belén Rodriguez ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
General Anesthesia ◽  
Clinical Outcomes ◽  
Cerebral Vasospasm ◽  
Conscious Sedation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Vasodilator Therapy ◽  
Significant Difference ◽  
Vasodilator Treatment

Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually.

scholarly journals Comparison of General versus Spinal Anesthesia in Patients undergoing Percutaneous Nephrolithotomy: A Prospective Randomized Study

2016 ◽  
Vol 5 (1) ◽  
pp. 37-42
Author(s):  
Rupak Bhattarai ◽  
Chittarranjan Das ◽  
Bandana Paudel ◽  
Sailoj Jung Dangi
Keyword(s):  
Patient Satisfaction ◽  
Blood Loss ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Percutaneous Nephrolithotomy ◽  
P Value ◽  
Recovery Duration ◽  
Significant Difference ◽  
Hospital Stays ◽  
Surgical Duration

Background Percutaneous Nephrolithotomy, widely used procedure by urologists for removing renal stones nowadays. Generally, it is preferred in general anesthesia but here in our study we have compared it with spinal anesthesia to know its safety and efficacy.Material and Methods Sixty patients of either sex, aged between 20-60 years, ASA – Grade I and II, with stones size larger than 15 mm posted for Percutaneous Nephrolithotomy were randomly selected. Patient was divided in two groups 30 each, Spinal Anesthesia (S) and General Anesthesia (G). Patient’s stones sizes, numbers & location, Anesthesia duration, Surgical duration, Recovery duration, Blood loss and Blood transfusion, Analgesic demand, post-operative Nausea & Vomiting, Patient satisfaction, Hospital stays and Heart Rate and Mean arterial pressure between two groups were compared.Results There was no significant difference in terms of mean age, weight, stones sizes, and numbers and its location. The p value for Anesthesia duration and surgical duration were 0.144 and 0.22 which was insignificant. Recovery duration (p-value 0.007), Blood loss (p-value 0.004) were significantly lesser in spinal anesthesia group. There was no significant difference in nausea and vomiting, patient satisfaction when compared between two groups. But Analgesic demand, Blood Transfusion and Hospital stays significantly found to be decreased in spinal anesthesia groups (p<0.05). The mean of MAP showed no significant difference except in 10 and 20 minutes.Conclusion Spinal anesthesia tends to be as effective as general anesthesia for PCNL and beneficial in terms of recovery duration, blood loss, analgesic demands, hospital stays, hence decrease the cost of patient. Journal of Nobel Medical CollegeVolume 5, Number 1, Issue 8, January-July 2016, Page: 37-42

scholarly journals Effect of General Anesthesia and Conscious Sedation During Endovascular Therapy on Infarct Growth and Clinical Outcomes in Acute Ischemic Stroke

2018 ◽  
Vol 75 (4) ◽  
pp. 470 ◽  
Author(s):  
Claus Z. Simonsen ◽  
Albert J. Yoo ◽  
Leif H. Sørensen ◽  
Niels Juul ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
General Anesthesia ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Endovascular Therapy ◽  
Conscious Sedation

scholarly journals COMPARISON OF NEONATAL APGAR SCORES AND PATIENT SATISFACTION LEVELS IN SPINAL VERSUS GENERAL ANESTHESIA IN ELECTIVE CESAREAN SECTIONS

2021 ◽  
Vol 71 (4) ◽  
pp. 1183-87
Author(s):  
Syed Khurram Naseer ◽  
Aijaz Ali ◽  
Shizan Hamid Feroz ◽  
Dr Danish ◽  
Amir Sohail
Keyword(s):  
Patient Satisfaction ◽  
Cesarean Section ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Elective Cesarean Section ◽  
Military Hospital ◽  
P Value ◽  
Apgar Scores ◽  
Significant Difference ◽  
Elective Cesarean

Objective: To compare patients undergoing cesarean section under spinal and general anesthesia in terms of neonatal APGAR scores and patient satisfaction. Study Design: Comparative cross-sectional study. Place and Duration of Study: Departments of Anesthesia and Gynecology and Obstetrics, Combined Military Hospital Peshawar, for six months from Mar to Aug 2019. Methodology: In this study, 120 females with a singleton pregnancy of 36-40 weeks, and requiring a non-emergency elective cesarean section were enrolled through consecutive sampling in the study. The patients were randomly allocated into two equal groups of 60 women each through random table numbers. Group A received spinal anesthesia and group B general anesthesia. APGAR score was assessed at 5 minutes after delivery, and score of ≥7 was taken as satisfactory. Patient's satisfaction level regarding anesthesia was recorded on a visual analogue scale of 0 (extremely unsatisfied) to 10 (completely satisfied), and score of ≥7 was taken as satisfactory. Results: Women receiving general anesthesia were more satisfied as compared to receiving spinal anesthesia (95% vs. 78.3%; p-value 0.007). There was no significant difference in terms of APGAR scores in general anesthesia and spinal anesthesia (83.33% versus 90%; p-value 0.283). Conclusion: After an elective caesarean section, more mothers were satisfied after receiving general anesthesia as compared to spinal anesthesia. However, both types of anaesthesia were found to be equally safe for babies born in terms of APGAR scores at 5 minutes.

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