Meta Analysis Of Thoracic Epidural Anesthesia

The role of the nurse anesthetist gradually developed as the demand increased for individuals who were highly and meticulously trained in anesthesia administration in an era where knowledge of germs, antisepsis and surgical interventions was emerging. During the 1800s, medical students were often responsible in the administration of anesthesia under the direct supervision of surgeons but the increased mortality rates in intraoperative patients suggested the need to reevaluate who would provide anesthesia. As a result of negative patient outcomes, surgeons turned to nurses, who served to be an adequate and reliable replacement. This trend proved to be catalytic in the movement of the nurse anesthetist.

The purpose of this paper is to present an analysis of a quantitative article using Melnyk & Fineout-Overholt’s (2015) rapid critical appraisal (RCA) for a randomized clinical trial. Topics included are the validity of the research, results of the research and how the information can be applied to the clinical care of my own patient population.

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

The history of the Nurse Anesthetist dates back prior to the Civil War and were considered by many as the pioneers of the practice of anesthesia. As the complexity of administering anesthesia increased, physicians deemed the practice of anesthesia to be equivalent to the practice of medicine. As time progressed, some physicians attempted to have the practice of anesthesia banned from the nursing scope of practice. It was not until a case was brought in front of the California Supreme Court where they ultimately established the legal precedent granting nurse anesthesia its legality. Specifying that nurses can administer anesthesia and that they would be operating under their scope of practice as long as it was done under the guidance of a supervising physician (Hamric, Tracy, & O 'Grady, 2014). That law was federally mandated until 2001, when the Centers for Medicare and Medicaid changed the federal supervision rule of Anesthesiologist and Nurse Anesthetists in order for facility to receive reimbursement of care ("Certified Registered Nurse Anesthetists Fact Sheet", 2016). This offered states an “opt-out” rule allowing the unsupervised practice of nurse anesthetists. This change led to conflict in the anesthesia community between physicians and Certified Registered Nurse Anesthetists (CRNA) as the debate of a CRNA’s ability to practice autonomously was now the center of attention. With the costs of healthcare rising and the

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

The investigation of how anesthesia effects cognitive functioning has had a long history. Overtime, it has been suggested that there is an association between anesthesia, surgery, delirium, dementia and postoperative cognitive dysfunction (Inan & Ozkose Satirlar, 2015). The theory of anesthesia’s impact on cognitive functioning was derived in 1887, by Savage, who began to observe the “insanity” that follows the use of anesthesia. He suggested that “Any cause which will give rise to delirium may set up a more chronic form of mental disorder quite apart from any febrile disturbance” (Savage, 1887, p. 1199). Delirium can be defined as an altered level of consciousness that may cause a sudden decline in attention and focus perception (Isik, 2015). Postoperative delirium was reevaluated in 1955 when Bedford used a series of case studies collected over a 50 year span to describe a connection between anesthesia and dementia. The results suggest that 10% of the patients had postoperative cognitive dysfunction (Bedford, 1955). Since these initial studies, research has persisted using a variety of methods, in an attempt to determine: both long- and short-term effects of anesthesia on cognitive functioning and memory; whether the anesthesia administration technique will change the outcome of postoperative cognitive dysfunction; and other risk factors that may be associated to AD.

It synthesizes the results of various primary studies by using strategies that reduces biases and random errors. These reviews follow a strict scientific design and provide consistent estimates about the effects of interventions, therefore, conclusions are defensible. Systematic reviews shows where knowledge is lacking and can be used to guide future research. These reviews are usually carried out in the areas of clinical tests such as diagnostic, screening and prognostic; public health interventions; economic evaluations; adverse effects and how and why interventions work. Cochrane reviews are systematic reviews undertaken by Cochrane Collaboration members, aims to help people to make well-informed decisions about healthcare by preparing, maintaining, and promoting the accessibility of systematic reviews of the effects of healthcare

The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies.

According to the American Pregnancy organization “more than 50% of woman giving birth at hospitals use Epidural Anesthesia”. These women turn to epidural to relieve the pain of labor; however this decision poses many risks to both mother and child. An epidural is a type of regional anesthesia where pain medication is administered to the lumbar and sacral region of the back near clusters of nerves. The placement allows for nerve impulses to be blocked from the lower regions of the body resulting in decreased sensations. Although the epidural is known for taking pain away it could very well cause it too. Epidurals include the use of various narcotics and have side effects like hypotension, fever, fetal malposition, decreased fetal heart rate, respiratory depression, breastfeeding complications, an increased likelihood of operative vaginal delivery and cesarean and many more. These are the effects faced in result to a procedure that is not definite to work. In Fact “One in every 8 women” (OAA) will experience inadequate pain relief and must venture to other means of medication. Therefore, mothers should abstain from epidural anesthesia due to the risks it poses to themselves and to the fetus.

Could you imagine going through a surgery without anesthetics? You know, an anesthesiologist isn't the only one who gives anesthesia—it's a team effort. Nurse anesthetists have been the primary administers of anesthesia since World War II. Many health care facilities do not have anesthesiologists on staff, but they have a CRNA, or a Certified Registered Nursing Anesthetist. They are the nurses that put IVs (intravenous sedatives) into patients before surgery, as well as a combination of other medicines to relax the patient ("Nurse Anesthetist" Career Articles). The anesthesia promotes a controlled state of unconsciousness, muscular relaxation, and insensitivity to pain. So when you go to the operating room, you will most likely have a nurse

According to the systematic review covered by Apfel, Turan, Souza, Pergolizzi & Hornuss, 2013 there is a significant reduction in postoperative nausea and vomiting and opioid use when using intravenous acetaminophen. The reviewers used Medline and Cochrane databases to conduct their search along with a hand search of abstracts to identify randomized-controlled trials using intravenous acetaminophen. The review was to determine if the acetaminophen was going to have a significant decline in nausea and vomiting following surgical procedures as

Being a registered nurse over the last fourteen years, I have witnessed firsthand that the healthcare industry is constantly evolving. And with all the government budget deficits, many models of health care are built on cost containment and managed care. This has resulted in a lot of conflicts between healthcare providers, especially between CRNAs and anesthesiologists. Historically the delivery of anesthesia has predominately been by nurses rather than doctors. However this balance began to shift when the delivery of anesthesia became

However, a potential internal validity threat would be the type of analgesic and the intervention after surgery such as ambulation that can skew the outcome of bowel recovery. Gum chewing starts immediately when the patient regains consciousness and the use medication varies with parenteral narcotics for pain control as opposed to other forms of pain control with less gastrointestinal side effect (i.e. non-steroidal anti inflammatory drugs) (Jakkaew & Charoenkwan, 2012). Different type of pain medication can cause threat to the study validity, by suggesting a trial that only prescribed narcotics or NSAIDs the outcome of the study will be relevantly different while having a control. The experiment performed as it was supposed to in order to evaluate the primary outcome. The reliability of the study had consistent findings compared to past studies in postoperative patients who chewed gum after abdominal surgery (Jakkaew & Charoenkwan,

Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.

None of the studies were evaluated by the author and he did not note their weaknesses. They were merely used as supporting factors for the argument presented by the author in the study. Interviewing the women on their experiences after surgery was were the main evidence was gotten and that aid in the argument