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Background: Effective anesthetic management is essential for managing elective orthopedic spine surgeries. Dexmedetomidine (DEX), a highly selective alpha-2 adrenergic agonist, has emerged as a promising adjunct in anesthetic practice. Using DEX after surgery can provide benefits such as reduced opioid requirements, stable hemodynamics, and minimal respiratory depression (Hwang et al., 2015; Okello et al., 2018). However, its postoperative outcomes are not well studied. Purpose: This quality improvement project aimed to assess the effects of intraoperative DEX administration on hemodynamic stability, pain control, and respiratory outcomes in patients undergoing elective lumbosacral spine surgeries. Methods: Utilizing a descriptive correlational design and retrospective quantitative data analysis data from 50 patient charts, aged 35-75 undergoing 1-3 level lumbosacral spine surgeries at a tertiary community care hospital, were collected and analyzed to explore the postoperative effects of using DEX as compared to not using DEX. Results: No significant differences were found between the DEX and non-DEX groups in terms of hemodynamics stability, pain scores, or respiratory events. However, DEX was associated with a safe postoperative profile, with no increase in adverse effects like hypotension or bradycardia. Conclusion: DEX did not significantly improve outcomes, but it showed evidence of having a safe profile, making it a viable option in multimodal anesthesia. Further investigation is needed to explore its impact on opioid use and broader surgical outcomes.
Keywords: dexmedetomidine, lumbosacral spine surgery, hemodynamic stability, respiratory events, pain management, postoperative outcomes
Surgery causes the body to enter a catabolic state, which can lead to complications in the postoperative period. However, protocols have been created to overcome this state, starting preoperatively with surgical and anesthetic approaches. Therefore, we explored the implementation of the Enhanced Recovery After Surgery (ERAS) protocol compared to non-ERAS care at a rural hospital in South Charlotte for patients undergoing laparoscopic or robotic-assisted hysterectomies. Our overarching clinical question was: In 30- to 70-year-old female patients who underwent laparoscopic hysterectomies (with or without robotics), how did the use of an ERAS protocol compare to traditional care impact postoperative pain scores, postoperative nausea and vomiting, or length of stay at a community hospital in South Charlotte? Data were collected via a retrospective chart review of 50 charts per age group (30-50 years old and 51-70 years old), and information was analyzed using descriptive and correlational statistics. The retrospective chart review for this QI project found no significant difference in the medications provided in the preoperative, intraoperative, or postoperative setting, thus leading to no significant difference in postoperative pain, PONV, or length of stay between the ERAS and non-ERAS groups at this specific site. However, this is not a negative outcome. This showed that regardless of the surgeon’s particular order, most patients received multimodal anesthesia; therefore, if all patients received multimodal anesthesia, there should be an overall decrease in PONV, PACU pain, and LOS.
The purpose of this quality improvement (QI) project aims to assess current practice at a large level one trauma center and compare it to the most recent clinical guidelines. With this data, the project will determine if anesthesia practitioners are following evidence based guidelines. It is essential providers follow clinical guidelines to ensure patients are not underdosed or overdosed when given neuromuscular reversal agents.
In patients aged 18-44 undergoing laparoscopic abdominal surgeries requiring neuromuscular paralysis, how is sugammadex administered for neuromuscular blockade reversal at a large level one trauma center, compared to current evidence based guidelines? This includes train of four count, weight-based dosing, and timing of extubation.
The purpose of this quality improvement project aims to assess current practice at a large level one trauma center and compare it to the most recent clinical guidelines. With this data, the project will determine if anesthesia practitioners are following evidence based guidelines. It is essential providers follow clinical guidelines to ensure patients are not underdosed or overdosed when given neuromuscular reversal agents.
In patients aged 18 to 44 years undergoing laparoscopic abdominal surgeries requiring neuromuscular paralysis, how is neostigmine administered for neuromuscular blockade reversal at a large level one trauma center compared to current evidence based guidelines? This includes train of four count, weight-based dosing, and timing of extubation.
Background: Dexmedetomidine (DEX), a selective alpha-2 adrenergic agonist, has been shown to have a promising role in decreasing opioid consumption, normalized hemodynamics, and minimizing respiratory depression in spine surgeries. However, its postoperative outcomes are not well studied. Purpose: This quality improvement project aimed to assess the effects of intraoperative DEX on hemodynamic stability, pain control, and respiratory outcomes in patients undergoing elective lumbosacral spine surgeries. Methods: Using a retrospective, descriptive correlational design the data from 50 patients aged 35-75 undergoing 1-3 level lumbosacral spine surgeries at a Level 1 trauma center was analyzed. Postoperative outcomes between patients who received DEX and those who did not were compared. Results: No significant differences were found between the DEX and non-DEX groups in terms of hemodynamic stability, pain scores, or respiratory events. However, DEX was associated with a safe postoperative profile, with no increase in adverse effects like hypotension or bradycardia. Conclusion: DEX did not significantly improve outcomes, but it showed evidence of having a safe profile, making it a viable option in multimodal anesthesia. Further research is needed to explore its impact on opioid use and broader surgical outcomes.
Background: Dexmedetomidine (DEX), a selective alpha-2 adrenergic agonist, has been shown to have a promising role in decreasing opioid consumption, normalized hemodynamics, and minimizing respiratory depression in spine surgeries. However, its postoperative outcomes are not well studied. Purpose: This quality improvement project aimed to assess the effects of intraoperative DEX on hemodynamic stability, pain control, and respiratory outcomes in patients undergoing elective lumbosacral spine surgeries. Methods: Using a retrospective, descriptive correlational design the data from 50 patients aged 35-75 undergoing 1-3 level lumbosacral spine surgeries at a Level 1 trauma center was analyzed. Postoperative outcomes between patients who received DEX and those who did not were compared. Results: No significant differences were found between the DEX and non-DEX groups in terms of hemodynamic stability, pain scores, or respiratory events. However, DEX was associated with a safe postoperative profile, with no increase in adverse effects like hypotension or bradycardia. Conclusion: DEX did not significantly improve outcomes, but it showed evidence of having a safe profile, making it a viable option in multimodal anesthesia. Further research is needed to explore its impact on opioid use and broader surgical outcomes.
Preoperative anxiety is a common problem for patients undergoing general anesthesia and can create untoward hemodynamic effects for patients in the operating room. Dexmedetomidine is an Alpha-2 adrenergic agonist commonly used for sedation by continuous infusion. Dexmedetomidine is now used for preoperative anxiolysis, however, there are no clinical recommendations for dosing and appropriate patient selection. Due to the hemodynamics of the medication, administration can result in the adverse effects of hypotension and bradycardia.
The Quality Improvement project consisted of a retrospective chart review of 100 patients. 50 patients were aged 65-85 at a large urban trauma center and 50 patients were aged 45-64 at a smaller affiliate site. The dose of dexmedetomidine ranged from 4 to 20 micrograms.
At both sites, heart rate change was not significantly associated with age, ASA status, or dexmedetomidine dose. Blood pressure change was not significantly associated with age, ASA, or dexmedetomidine dose.
This project found that in patients aged 46-85 at both sites doses of 4-20mcg for anxiolysis did not commonly result in bradycardia or hypotension. This suggests that it is safe to administer small doses of dexmedetomidine up to 20 mcg without the need for vasopressor support to lessen preoperative anxiety.
Literacy is a civil right that every child should have access to. Despite decades of research on how children best learn to read, literacy rates continue to be diminished in the United States, leading children to lives of poverty, unemployment and even crime. Via policy and research, the focus in literacy has shifted to teacher learning as a means to improve student achievement in reading. However, teachers’ voices are largely omitted from discussions regarding how this learning should take place and how they are empowered to apply new knowledge in their classrooms. Through an examination of teachers’ experiences with state mandated reading professional development, it is possible to glean understandings of what professional development practices are most helpful to teachers, particularly in rural areas. The proposed study seeks to answer two essential questions: 1) What factors contribute to rural elementary teachers’ experiences with LETRS professional development? and 2) In what ways do these factors act as facilitators and barriers to teachers' professional development? This study will follow a case study design, collecting data through focus groups. The findings of this study will highlight the experiences of teachers in rural areas, who are often omitted from educational research. More specifically, it will provide valuable guidance around the considerations of context when designing and delivering professional development.
Obstructive sleep apnea (OSA) can lead to difficult airway management and perioperative complications. This necessitates individualized anesthetic planning including the reduction in doses of benzodiazepines and opioids. Risk identification is vital to improve perioperative care, as any patients with OSA are undiagnosed. This can be achieved with the STOP-Bang questionnaire. The purpose of this scholarly project was to evaluate current perioperative care practices for benzodiazepine and opioid administration to patients with a high risk of OSA to aid in formulating future recommendations for practice. The guiding PICOT question was: In adult patients ages 40 to 60, who underwent surgical procedures in a community hospital, did a STOP-Bang score ≥ 3, compared to a STOP-Bang score < 3, result in a reduced dose of benzodiazepines and opioids administered perioperatively during the time period of January 2023 to June 2024?
The project took place at a community hospital that is part of a major urban medical center. Data were collected via a retrospective chart review. The sample size was 100 charts. A descriptive analysis of the data was conducted, and significant differences were detected using t-tests and Pearsons r correlations. Although the data analyses revealed no statistically significant findings, clinically relevant findings were apparent because the STOP-Bang score ≥ 3 should have received significantly lower dosages of benzodiazepines and opioids. The results highlight the need for enhanced provider awareness to STOP-Bang scores. Practice recommendations include the use of the STOP-Bang questionnaire for preoperative screening of all patients and the development of a best practice advisory (BPA) to enhance provider awareness.
Obstructive sleep apnea, (OSA) in the perioperative setting can result in difficult airway management and postoperative complications. It is essential that anesthetic plans are individualized and incorporate a reduction in dosages of benzodiazepines and opioids being administered. Owing to the fact that many patients with OSA are not formally diagnosed, risk identification is crucial to improving perioperative care and can be accomplished with the STOP-BANG questionnaire. The purpose of this scholarly project was to examine current perioperative care practices for benzodiazepine and opioid administration to patients with a high-risk of OSA to aid in formulating future practice recommendations. The PICOT question was: In adult patients ages 40 to 60, who underwent surgical procedures in a level one trauma center, does a STOP-BANG score ≥ 3, compared to STOP-BANG score < 3, result in a reduced dose of benzodiazepines and opioids administered perioperatively during the time period of January 2023 to June 2024?
The project took place at a level one trauma center in a major urban medical center. Data were collected via retrospective chart review. Sample size was 100 patient charts, with 50 patients having a STOP-BANG score ≥ 3 and 50 patients having a STOP-BANG score < 3. Analysis of the data included t-tests, ANOVA, and Pearson r correlations. Results concluded that the STOP-BANG group ≥ 3 received higher doses of benzodiazepines (M=1.88mg) and opioids (M=1230.11mg) than those in STOP -BANG group <3 (M=1.68mg and 1065.09mg), although this difference was not statistically significant. Project recommendations are: a system wide protocol to guide administration of benzodiazepines and opioids in patients scoring ≥ 3 on the STOP-BANG questionnaire, reimplementation of the blue wrist bands from a prior QI project, and a QR code attached to patient charts to provide key facts and anesthetic recommendations in caring for the at-risk OSA patient.
