Scholarship Symposium

Presenter: Stacy Stahl
Faculty Advisor: Gwendolyn Randall

Anesthetists have historically treated the physiological side effects of fear and anxiety through pharmacologic means. The purpose of this study was to assess current evidence and provide evidence-based practice recommendations on whether communication techniques are beneficial in reducing the need for pharmacologic treatment in fearful and anxious perioperative patients. A review of the current literature showed that certain communication techniques can be beneficial in decreasing fear and anxiety in the perioperative patient. It was also found that certain communication techniques or lack of communication can negatively affect the experience of the perioperative patient. This information and examples of communication techniques were compiled into a presentation for nurse anesthesia students and nurse anesthetists practicing in the Memphis, Tennessee area. The information disseminated in the presentation will aid in assisting anesthesia providers in incorporating beneficial communication techniques and avoiding harmful communication techniques into their clinical practice.

Presenter: Joel Ryan Palmer
Faculty Advisor: Andrew Rice

Healthcare costs in the United States consistently increases each year and hospitals are always looking for ways to decrease costs while maintaining quality care. Anesthesia-related costs comprise a large expenditure and hospitals can decrease expense and save money based on the anesthesia model used. There are multiple types of anesthesia providers that are able to practice in the U.S., but certified registered nurse anesthetists and physician anesthesiologists make up the large majority of those providers. This study assesses the change in student registered nurse anesthetist's knowledge of anesthesia provider cost-effectiveness and safety. Participants were exposed to an intervention on the subject and the researchers found a significant increase in knowledge after intervention participation.

Presenter: Abe Rummell
Faculty Advisor: Tracy Walker

Pseudocholinesterase deficiency is a rare condition that can have detrimental effects on the surgical patient population. Although, challenging to diagnose, pseudocholinesterase deficiency can cause prolonged neuromuscular blockade, in the postoperative period. These select patients will require prolonged ventilation after surgery. The condition and postoperative care are well documented in literature published for the anesthesia community, but the information is not readily available to the nursing community as a whole. This study aims to create a helpful educational tool to instruct nurses who care for pseudocholinesterase deficiency patients after surgery. Although rare, this condition needs to be well understood by the entire healthcare team that will care for them postoperatively to provide the safest evidence-based care.

Presenter: Holden McCall
Faculty Advisor: Andrew Rice

A review of current literature indicated that the use of dexmedetomidine as an adjuvant to local anesthetic in spinal anesthesia increases the length and effectiveness of the block. This information was compiled into a presentation for second- and third-year nurse anesthesia students (n=20) currently participating in clinical training. A post-presentation Likert survey was completed by the study participants and the results reflected an increase in knowledge and awareness of dexmedetomidine utilization in spinal anesthesia. The results also indicated that student registered nurse anesthetists are more likely to incorporate dexmedetomidine in their anesthetic plans for patient receiving spinal anesthesia. Increasing awareness and knowledge of this novel use of dexmedetomidine will equip future anesthesia providers with the tools to provide diverse anesthetic techniques to meet patient needs.

Presenter: Matthew Bell
Faculty Advisor: Jordan Palmer

An integrated research review was performed to collect information regarding the pre-operative administration of midazolam and its effect on emergence delirium in adult patients with PTSD undergoing general anesthesia. Subsequently, a presentation was created to disseminate the results found during the review. To assess the effectiveness of the presentation as an educational component, SRNAs were recruited to participate in a research project to determine if a significant difference in participants' knowledge over the subject matter occurred after viewing the presentation. Pre- and post-tests were created that contained questions over the findings discussed in the presentation. Participants were instructed to complete the pre-test, review the presentation, and complete the post-test. It was found that a significant difference in higher scores occurred between the pre-test and post-test. Since a higher score indicates a higher number of questions answered correctly, the results suggest that the presentation increased participants' knowledge over the subject matter.

Presenter: Reni Valimattathil
Faculty Advisor: Jordan Palmer

This research project examines provider's education regarding neuraxial labor analgesia and its risks and benefits. It also focused on common misconceptions regarding neuraxial labor analgesia among parturients. The most common fears about neuraxial labor analgesia among parturients included harm to neonates, back pain and extra cost. Some of the negative effects of neuraxial analgesia revealed by literature review were increase in duration of second stage of labor and an increase in instrumental delivery. The research results were used to create a PowerPoint presentation in order to educate providers regarding the true risks and benefits of neuraxial labor analgesia. A pre-test was conducted followed by review of PowerPoint, and then a post-test. The results of the post-tests revealed significantly improved scores when compared to pre-test. The research has revealed that there is a lack of proper knowledge regarding the negative and positive outcomes of neuraxial anesthesia among parturients and providers.

Presenter: John Shields
Faculty Advisor: Tracy Walker

Studies indicate that obstructive sleep apnea is the most common undiagnosed co-morbidity in patients presenting for surgery. Understanding its impact on pulmonary hypertension and the best approach to management for these patients, during the perioperative stages of surgery, is imperative. Evidence-based pathways and protocols, for this patient population, are incomplete. Considerations, towards improving anesthesia practice, include consistent interventions involving positioning, continuous positive airway pressure, baseline hemodynamic continuity, and regional/multimodal pain management approaches including peripheral nerve blocks. Databases searched and utilized for this integrated research review included ScienceDirect, EBSCO, PubMed, and CINAHL. Inclusion criteria were publications from the years 2009-2020; patients diagnosed with obstructive sleep apnea and pulmonary hypertension undergoing surgical procedures with general anesthesia were examined throughout each perioperative phase of surgery. Commonly used medications, for the anesthetic management of this patient population, may result in postoperative complications that can be prevented.

Presenter: Jaspa Kungu
Faculty Advisor: TaMara Carter

Anesthetics used as primary sedatives during monitored anesthesia care (MAC) can cause significant respiratory depression. Recent studies and research indicate dexmedetomidine may have beneficial use as an ideal primary anesthetic that does not cause respiratory depression during procedures requiring MAC. Both low and high-risk patients may benefit from the delivery of dexmedetomidine as a MAC sedative that minimizes adverse reactions and respiratory distress experienced when using propofol, opioids, or benzodiazepines during procedures. The objective is to identify and evaluate research needs in studies offering an assessment of dexmedetomidine utilization as the primary anesthetic during MAC. Further research revealed that dexmedetomidine has demonstrated efficacy for specifically identified procedures and may be utilized without significant respiratory depression. Use of dexmedetomidine is currently cost prohibitive when compared to existing MAC anesthetics. Additional research concerning specific procedure benefits may increase interest and reduce comparative cost differences enough to justify use recommendations for providers.

Presenter: Morgan Grones
Faculty Advisor: Andrew Rice

Research shows that patients who have a radical mastectomy are likely to have moderate to severe postoperative pain. Two peripheral nerve blocks used to aid in postoperative pain in mastectomy patients are the thoracic paravertebral nerve block and the pectoral nerve block. A literature review was conducted, and the findings were presented to anesthesia providers at Magnolia Regional in Corinth, MS. The purpose of this research was to bring awareness and understanding of the effectiveness of the thoracic paravertebral block compared to the pectoral nerve block in mastectomy patients. At the conclusion of the presentation, a 5-Point Likert Scale was conducted to evaluate the understanding of the blocks prior to the presentation, the effectiveness of the presentation, and the likelihood of the anesthesia providers using each block in their future practice. The presentation of this material proved to be effective and is likely to lead to future practice change.

Presenter: Brenda Ramirez-Lopez
Faculty Advisor: Andrew Rice

The ESPB is a new interfascial nerve block that has been a successful analgesic intervention for thoracic surgery. The recent implementation of the ESPB for breast surgery pain management has decreased the amount of opioid necessary for analgesia, contributed to multimodal pain modalities, and decreased the current opioid crisis. The purpose of this quality improvement study was to examine current research and review the postoperative analgesic effect of ESPB through the amount of opioid consumption, as well as to evaluate the effectiveness and applicability of the findings to SRNA education and practice. The evidence showed the ESPB was effective for postoperative pain management after breast surgery. Data from the anonymous survey showed the results were applicable and effective to SRNA education and practice as evidenced by a Likert average score of 4.75 students that strongly agreed, 7 students that agreed, and 0.25 students that neither agreed nor disagreed.

Presenter: Rebecca Woods
Faculty Advisor: Jordan Palmer

Migraines are a disabling illness that are still poorly understood and undertreated. While common treatment regimens are often suboptimal, the utilization the sphenopalatine ganglion blockade (SPG) has shown promising outcomes for migraine sufferers. The purpose of this project is to examine the current studies on the effectiveness of local anesthetic application to the SPG for migraine relief. The research concludes that the SPG blockade is a valuable medical intervention, however, this technique is underused due to a knowledge deficit exhibited by health professionals. The development of an education tool which evaluated the anesthesia providers understanding on the SPG blockade revealed that medical professionals benefited from continued education. The hope is that with proper training, providers will gain more competence and confidence in using this type of block.

Presenter: Meagan Meketi Seratt
Faculty Advisor: Tracy Walker

There is a rising number of patients with cardiac implantable electronic devices (CIEDs) requiring anesthesia for surgical procedures. Significant confusion surrounds the appropriate perioperative and anesthetic management of these patients due to the advancement of CIED technology and diverse programming capabilities of devices. This confusion is especially apparent regarding CIED magnet application and subsequent deactivation of certain device functions. An integrated research review (IRR) was conducted in an attempt to address this issue. This review revealed that more evidence is necessary to formulate a more standardized, evidence-based protocol regarding the perioperative anesthetic care of patients with CIEDs. Further studies should examine the occurrence of clinically significant electromagnetic interference, optimal dispersive electrode positioning, and safety of magnet application versus device interrogation during the perioperative period. Using current evidence, a clinical reference tool was constructed. This tool can be used to facilitate optimal perioperative anesthetic management until further studies can be completed.

Presenter: Aaron Davis
Faculty Advisor: Gwendolyn Randall

Postoperative delirium is a frequent psychological complication in adult patients undergoing general anesthesia. It leads to prolonged hospitalizations and increased morbidity and mortality. Literature suggests administration of dexmedetomidine, an alpha-2 agonist as treatment in preventing postoperative delirium, but results have been variable, lacking consensus amongst researchers. The purpose of the quality improvement project was to examine the knowledge of student registered nurse anesthetists (SRNA) regarding the use of dexmedetomidine as an effective adjunct in the prevention of postoperative delirium, based on evidence-based data. Results from this project revealed there was an improved understanding of postoperative delirium amongst SRNAs and a perceived value in the utilization of dexmedetomidine in helping to prevent postoperative delirium in adult patients. Targeting the increase in morbidity and mortality, additional means to prevent postoperative delirium should be explored by anesthesia providers.

Presenter: John “Adam” Miller
Faculty Advisor: TaMara Carter

• Objective: To evaluate current evidence regarding reducing FiO2 levels during general anesthesia in adult patients and the impact this will have on the reduction of atelectasis in the postoperative period.
• Background: The routine use of high FiO2 levels has become prevalent in the anesthesia community. Recent studies suggest that high oxygen concentrations can lead to alveolar collapse, postoperative complications, and poor outcomes. Design. This is an integrative research review.
• Methods: Searched databases included CINAHL, PubMed, Google Scholar, and several anesthesia specific journals.
• Inclusion criteria were as follows: population must be adult patients undergoing general anesthesia who received either a high or low FiO2 level as an intervention, publication within the last twenty years (2000-2020), and studies must include an outcome for each respective intervention.
• Results: Results indicate that high FiO2 levels are associated with increased atelectasis formation, increased incidence of pulmonary complications, and have the potential to cause poor outcomes. Once atelectasis occurs, a cascade of events including impaired gas exchange, shunting, and increased free radical release are responsible for negatively affecting patient care.
• Conclusions: Routine use of high FiO2 levels can be harmful and should not be used unless deemed necessary by the provider.
• Relevance to clinical practice: FiO2 levels should be selected based on patient history, assessment, and ideal oxygen saturation needed to safely complete the procedure, avoid post-op complications, and achieve good outcomes.

Presenter: Shelby Darnell
Faculty Advisor: Gwendolyn Randall

Nurse Anesthesia Track (NAT) graduate programs are habitually associated with increased stress levels which often lead to pathophysiological effects that hinder student registered nurse anesthetists' (SRNA) abilities to reach their full potentials throughout their NAT programs. Since the 1960s there has been growing recognition that while stress is an inevitable aspect of the human condition, it is coping that makes the big difference in adaptational outcome. The effects of stress are deleterious. This research project was designed to investigate the various coping mechanisms used by student registered nurse anesthetists secondary to the stressful rigors of their educational program, and to evaluate the perceived knowledge regarding the use of exercise as a healthy coping mechanism. There is some research data addressing the topic in the certified registered nurse anesthetist population, but none for student registered nurse anesthetists (SRNAs). Exercise can lead to improved performance in both the clinical and classroom settings.

Presenter: Brittney Wright
Faculty Advisor: Jordan Palmer

The increasing prevalence of Acute Flaccid Myelitis (AFM) and its lifelong residual effects increase the likelihood of anesthesia providers encountering AFM in clinical practice. To provide safe and effective care, providers must be knowledgeable of the disease and its anesthetic implications. The objective of this study was to identify anesthetic strategies that prevent perioperative residual muscle weakness and prolonged ventilation in AFM patients so that an educational presentation could be developed, and anesthesia providers' knowledge enhanced. Methods included an Integrative Research Review for the identification of prevention strategies and a Quality Improvement project with a pretest posttest design for the evaluation of providers' knowledge. Inflammatory mediator prevention, lung protective ventilation, lung recruitment maneuvers, rapid sequence induction, and other strategies were found to be crucial in optimizing outcomes in this population. Findings also indicate that educational presentations are an effective method for improving providers' knowledge of the disease and strategies.

Presenter: William Spratlin III
Faculty Advisor: Jordan Palmer

This study aims to examine current evidence and asses the outcomes of acute normovolemic hemodilution (ANH) versus blood transfusion as it relates to surgical blood loss and transfusion reactions. Based on research, education was provided using evidence-based practice and a quality improvement program was created using a pre and posttest. Recent studies have revealed that although it is not commonly performed, ANH has proven superior to blood transfusions at reducing surgical blood loss, reducing the amount of blood transfusions, and results in fewer blood transfusion reactions. This review revealed that more study is needed before standard practice can be decisively changed. Many practitioners also merit an ethical debate on ANH being the standard of care in blood product management.

Presenter: Lekeisha Carter
Faculty Advisor: Gwendolyn Randall

This quality improvement project was an examination of current evidence that analyzed the etiology of the adverse reactions of Sugammadex (Bridion). Sugammadex is used for the reversal of aminosteroidal neuromuscular blocking agents. While there are many benefits of using Sugammadex, the development of potentially life-threatening side effects such as severe hypotension, QT interval prolongation, and severe bradycardia have been reported. The goal was to evaluate knowledge deficits, among nurse anesthesia students, and develop a teaching tool to improve the delivery of care based on practice recommendations. The results of this project demonstrates that senior nurse anesthesia students are now able to recognize possible adverse reactions that may occur after Sugammadex administration, potential treatment recommendations, and practice recommendations to decrease its occurrence.

Presenter: Ruben Dettman
Faculty Advisor: Andrew Rice

Simulation training is beneficial for learning ultrasound-guided central line insertion, but commercial simulation models are often cost-prohibitive. This study compared a self-developed 3D print and silicone elastomer central line insertion model with a BluePhantom training manikin. Nineteen nurse anesthesia students performed blinded central line insertions on each model and rated them for realism of palpation and appearance, ultrasound picture, feel during needle insertion, overall realism, and usefulness as a training tool. Evaluation scores were compared using paired sample t-tests. The self-developed model achieved higher mean scores on all test items, with a statistically significant difference to a p-value of <0.05 for realism of palpation and appearance and overall realism. The material cost of the self-developed model was under $200 compared with a retail value of $1,599 for the BluePhantom model. The self-developed model performed as well as the BluePhantom training model at only a fraction of the price.

Presenter: Jennifer L. Neyman
Faculty Advisor: Tracy Walker

This integrative research review aims to examine current evidence and compare outcomes of malignant hyperthermia (MH) patients following administration of either Ryanodex or standard dantrolene, in order to develop a decision-making algorithm for safe and cost-efficient treatment. Current evidence indicates that timely administration of a ryanodine receptor antagonist (Ryanodex or dantrolene) improves patient outcomes. Ryanodex, 150 times more concentrated than dantrolene, can be reconstituted in considerably less time than its predecessor. Research reveals that both formularies result in similar outcomes if administered immediately upon symptom recognition. However, further data is needed to develop a cost-benefit ratio that is facility specific. Clinical practice should focus on knowledge of facility's MH policy, the drug available, and proper preparation and administration to avoid delays in treatment.

Presenter: Roger Brewer
Faculty Advisor: TaMara Carter

• Objectives. To examine current evidence regarding risk factors, diagnosis, and treatment recommendations for negative pressure pulmonary edema (NPPE) in the postoperative period.
• Background. No recent clinical studies available in the literature characterizing listed objective.
• Design/Method. Integrated research review of Union University's electronic databases. Results. NPPE occurs more often in young, healthy patients and twice as likely to affect males than females and twice as likely when ETT is used versus LMA. Many cases develop after witnessed laryngospasm. Typical presentation of NPPE includes hypoxia, respiratory distress, adventitious lung sounds, production of pink, frothy sputum, and abnormal chest radiography. Treatments vary greatly, but focus on supportive care. Patient outcomes were largely positive with rapid resolution of symptoms. One study citied one fatality.
• Conclusions. This review supports the need for prospective, randomized studies evaluating NPPE in order to develop evidence-based, standardized clinical guidelines for the diagnosis and treatment of NPPE.

Presenter: Alan Bowles
Faculty Advisor: Gwendolyn Randall

Administering spinal anesthesia to obese obstetric patients is difficult and can be associated with an increase in failed neuraxial anesthetics. Clinical interventions to improve the success of neuraxial anesthesia in obese patients have been distinguished, and as the obstetric population reflects the national trend of increased body mass these interventions will be utilized more regularly. These interventions include increased training, use of low concentration local anesthetic with opiates, frequent assessment of sensory block, leaving increased length of catheter in the epidural space, identification of vertebral midline using tactile feedback from supraspinous ligament, and identification of the vertebral midline using patient feedback from placement attempt. Currently there is a lack of quantitative studies focusing on the obese parturient and by summarizing research and synthesizing a more complete perspective this Quality Improvement Project will contribute to the body of knowledge regarding the challenges and solutions in providing obese obstetric neuraxial anesthesia.

Presenter: Amy K. Howell
Faculty Advisor: TaMara Carter

• Objectives: Analyze diagnostic criteria and assess outcomes of patients treated with Atropine, ondansetron, and ketorolac (A-OK) or extracorporeal membrane oxygenation (ECMO) therapy for obstetric patients diagnosed with an amniotic fluid embolism (AFE).
• Background: Rapid diagnosis and treatment lead to better patient outcomes and lower mortality rates.
• Design: A literature review. Methods: Searches were conducted on the Union University library website and Google Scholar. Inclusion criteria were peer-reviewed articles published from 2013-2020. The population was obstetric patients diagnosed with AFE who received either A-OK or ECMO.
• Results: No internationally accepted diagnostic tool or criteria used to diagnose AFE exists. The pathophysiology is not entirely understood, making diagnosis and treatment difficult. A-OK and/or ECMO may produce positive outcomes.
• Conclusions: AFE is rare but devastating. It needs to be reported and studied further before best practice can be determined. Relevance to clinical practice:Concentrate on education, rapid diagnosis, and treatment.

Presenter: George Sciple
Faculty Advisor: Tracy Walker

Opioid-induced respiratory depression (OIRD) is a low, but potentially fatal consequence for patients receiving opioid analgesics during both inpatient and/or outpatient surgical and/or diagnostic procedures. Naloxone has been the mainstay of treatment for reversing OIRD; however, its biggest drawback is the reversal of analgesia. Furthermore, renarcotization is also a risk with Naloxone administration. The purpose of this integrative research review (IRR) was to examine current published evidence regarding the use of non-naloxone rescue drugs for OIRD and assess whether non-naloxone drugs are a safe alternative to naloxone for reversing OIRD. Overall synthesis of the results from this IRR demonstrated that the adverse effects seen with naloxone can be reduced by giving small, incremental doses and titrating to the patient's respiratory rate rather than level of consciousness. Additionally, this IRR revealed that further studies are needed before determining if non-Naloxone drugs are safe alternatives to Naloxone for the reversal of OIRD.

Presenter: William Cobb
Faculty Advisor: TaMara Carter

This research reviews the purpose of positive pressure during extubation to determine its efficacy in preventing post-extubation complications among general anesthetic patients. Life-threatening respiratory complications can occur during all phases of anesthesia however, they most frequently occur during the extubation and post-anesthesia recovery phases. These complications can be very detrimental to the patient and may even cause the patient to die. Positive pressure during extubation is one method of extubation that is utilized to help prevent respiratory complications after general anesthesia. This technique is mentioned in multiple anesthesia textbooks and in anesthesia literature as playing a significant role in the extubation process. However, very few anesthesia providers consistently use positive pressure upon extubating their patients. Various theories and explanations exist as to its purpose, performance, and the exact mechanism of action that this maneuver entails.