-
Prospective Students
-
Faculty and Staff
-
Current Students
-
Alumni and Friends
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.
In the perioperative setting, obstructive sleep apnea (OSA) may result in difficult airway management and postoperative complications, necessitating reduced benzodiazepine and opioid dosages. Because many patients with OSA are not formally diagnosed, risk identification is vital to improve perioperative care and can be achieved with the STOP-BANG questionnaire. This scholarly project examined current care practices for benzodiazepine and opioid administration to perioperative patients with a high-risk of OSA to aid in formulating future best practice recommendations. The guiding PICOT question was: In adult patients ages 40 to 60, who underwent surgical procedures in an ambulatory surgery 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 frame of May 2024 to June 2024?
This quality improvement project occurred at an ambulatory surgery center. Data were collected via a retrospective chart review of 100 charts, 53 with a STOP-BANG score ≥ 3 and 47 with a STOP-BANG score < 3. Descriptive statistics were conducted for sample demographics. T-tests were used to compare the two groups. No statistically significant differences were noted in the amount of benzodiazepines or opioids administered between the two groups. Clinically, this is a significant finding as it shows there may be room for education and increased awareness on the effects of these medications on high-risk OSA patients. Limitations included convenience sampling, missing data in the electronic health record, and lack of variety in surgical cases. Recommendations include education and guideline implementation at this ambulatory surgery center.
Perioperative care practices for the management of patients taking long-acting Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) is a relatively new anesthetic concern due to rapidly increased use of these medications. Potential adverse consequences for surgical patients taking GLP-1 RAs include pulmonary aspiration, longer hospital stay, gastrointestinal side effects, and mortality. By examining clinical practices and patient outcomes at a one-day/ambulatory surgical center, the goal was to provide recommendations for perioperative care practices of adult patients taking long-acting GLP-1 RAs. The guiding clinical question was: Among adult patients at an ambulatory surgical center taking long-acting GLP-1 RAs, what are the perioperative care practices being implemented, and how do these affect patient outcomes while receiving anesthesia during surgery? Data were collected via a retrospective chart review of 50 charts and analyzed using descriptive and correlational statistics. In addition, an anonymous survey of anesthesia providers at this clinical site was administered to garner further input on perioperative care practices and outcomes, and findings were analyzed using descriptive statistics and content analysis. Both the chart reviews and the provider survey revealed various clinical practices and inconsistent following of current guidelines. No patients experienced perioperative vomiting or aspiration, and six patients reported postoperative nausea. There was an overarching agreement among survey respondents regarding an increase in concern for patient safety for patients who take GLP-1 RAs, in addition to a reported need for education regarding the anesthetic management of these patients. Recommendations include POCUS education and training for all anesthesia providers, guidelines to promote consistent clinical practices, and increasing awareness of safe perioperative care practices for patients taking GLP-1 RA medications.
The perioperative care practices related to the management of patients taking long-acting Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) are a relatively new anesthetic concern, as these medications have recently become increasingly popular. Surgical-related consequences of these medications include gastrointestinal side effects, pulmonary aspiration, longer hospital stay, and mortality. Through the examination of clinical practices and patient outcomes at a level 1 trauma center, this quality improvement project sought to provide recommendations for perioperative care practices for adult patients taking long-acting GLP-1 RAs. The clinical question was: Among adult patients taking long-acting GLP-1 RAs at a level 1 trauma center, what are the perioperative care practices being implemented and how do these affect patient outcomes while receiving anesthesia during surgery? Data were collected via a retrospective chart review of 56 charts, six of which were excluded due to being emergent cases. Data were analyzed using descriptive and correlational statistics. In addition, an anonymous survey was completed by 47 anesthesia providers to provide further descriptive information about perioperative care practices and outcomes. Findings showed a lack of POCUS use, inconsistent practices noted in chart review and survey, and providers desiring for further education on this topic, especially in regard to adequate medication hold time. Continued research and projects on this topic are imperative. Recommendations include provider education, implementation of POCUS in the preoperative setting, and creation of a clear policy for these patients that will help guide safe practice.
Perioperative care of patients taking long-acting Glucagon-Like Peptide 1 Receptor Agonists (GLP-1 RAs) is a relatively new anesthetic concern because of the increasing popularity of these medications for promoting weight loss and improving blood glucose. The potential adverse consequences for surgical patients taking GLP-1 RAs include pulmonary aspiration, longer hospital stay, and mortality. Through examining clinical practices and patient outcomes at a community hospital, this quality improvement project’s goal was to be able to provide recommendations for perioperative care practices for adult patients taking long-acting GLP-1 RAs. The clinical question of interest asked: Among adult patients taking long-acting GLP-1 RAs at a community hospital, what are the perioperative care practices being implemented and how do these affect patient outcomes while receiving anesthesia during surgery? A retrospective chart review of 50 charts was conducted and analyzed using descriptive and correlational statistics. Additionally, to further understand perioperative care practices and outcomes, an anonymous survey was distributed to anesthesia providers. This specific set of data were analyzed using descriptive statistics and content analysis. Findings showed inconsistent clinical practices, with limited use of steps to promote patient safety such as preoperative ultrasound (POCUS) and rapid sequence intubation (RSI). Based on this project’s findings, further research is warranted, especially in regard to community hospitals, to be able to create clear clinical guidelines for anesthesia providers. In addition, education is imperative among anesthesia professionals, particularly on conducting POCUS. Establishing and frequently updating a site policy on the care of patients taking GLP-1 RAs is necessary to establish uniformity of care practices among anesthesia professionals.
