Epidural analgesia has increased in usage dramatically in the United States as a means of comfort for labor pain. Prior studies have connected epidural analgesia to an increase in cesarean birth rate, an increase in use of instrumentation, an increase in length of labor, episiotomy rate, and maternal fever. Epidural analgesia has produced additional costs to the patient and society. The purpose of this study is to examine the relationship between epidural analgesia during childbirth and childbirth outcomes. The data for this study were obtained from a retrospective patient record review of 200 systematically selected labor patients who delivered in 2002 at a midwestern hospital. The epidural analgesia rate was 72% at this facility in 2002, a significant increase from the previous 5 years. Using the Chi-square test of independence, 3 relationship was established between epidural analgesia and four of the variables examined. A statistically significant relationship was found to exist between epidural analgesia and cesarean birth rate, pitocin augmentation, and the first and second stages of labor with the total sample. The results of the study are important for healthcare providers who are relaying influential wellness information to childbearing women and their partners. The results indicate a need for further education for healthcare providers on alternative methods of pain relief for their patients during childbirth.

The aging population and increase of ambulatory surgeries have greatly increased strain on surgical and post-surgical staff that decreases the safety of care. Our overall goal is to find ways to decrease the time of anesthetic recovery to allow for more efficient post-surgical treatment. The specific aims of this study were to assess the correlations between neurocognitive recovery measures of attention and vigilance to brain dynamics. We analyzed reaction time via auditory psychomotor vigilance testing (aPVT) testing and the Richmond agitation-sedation scale (RASS) scores in 145 patients prior to and preceding surgery. Intraoperative electroencephalogram was also recorded for 115 of those patients. Data was analyzed to associate aPVT performance to recovery time and intraoperative brain dynamics. We found an association coefficient between reaction time and RASS recovery of 0.022 (p-value = 0.0001) showing a significant association. Further, we found age to be a significant confounding variable (p=0.04421) and included this in our association model. Lastly, there was no significant association found between intraoperative burst suppression and reaction time values (p=0.497). Overall, aPVT was found to be a robust test to assess recovery timeline in peri-operative anesthesia care unit patients. These results highlighted the potential use of an objective metric to track neurocognitive recovery after anesthesia, especially in elderly patients undergoing surgery.

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Seit Mitte der 1990er Jahre haben sich Fast-Track-Behandlungskonzepte in der Kardioanästhesie etabliert. Diese zielen darauf ab, unter Verwendung kurzwirksamer Anästhetika eine frühzeitige postoperative, tracheale Extubation der Patienten zu gewährleisten, und folgend die Dauer der postoperativen Behandlung auf der Intensivstation und im Krankenhaus sowie die Inzidenz an Komplikationen zu senken. Kernstück eines multimodalen, kardioanästhesiologischen Fast-Track-Konzeptes am Herzzentrum in Leipzig (HZL) ist eine postanästhesiologische Aufwacheinheit (PACU) mit 3 Patientenplätzen, in der Patienten postoperativ betreut werden, ohne dass eine Aufnahme auf die Intensivstation (ICU) erfolgen muss. Ziel dieser Arbeit ist, den Einfluss der PACU im Rahmen des Fast-Track-Konzeptes im Vergleich zur Behandlung auf der Intensivstation zu untersuchen. Hierzu führten wir eine prospektiv-randomisierte kontrollierte Studie mit insgesamt 200 elektiven, kardiochirurgischen Patienten durch. Resultat der Studie war eine signifikant kürzere Dauer bis zur Extubation in der PACU im Vergleich zur Kontrollgruppe, zudem war die Verweildauer in der PACU im Median signifikant kürzer als auf der ICU. Hinsichtlich der postoperativen Mortalität und Morbidität zeigten sich keine wesentlichen Unterschiede. Hieraus lässt sich schlussfolgern, dass eine postoperative Fast-Track-Behandlung in einer dedizierten PACU im Vergleich zur ICU zur früheren Extubation und Verlegung auf die weiterversorgenden Stationen führt, ohne dass die Sicherheit der Patienten beeinträchtigt wird.

In 2001, the Institute of Medicine stated that one of the parameters needing to be addressed to improve health care was the creation of electronic health records for all patients. This goal has proven to be very challenging to health care providers. Many barriers exist that prevent the goal of computerizing health records such as high costs, usability problems, interface incompatibility, and fear of change. The purpose of this feasibility project was to evaluate the usefulness and acceptability of a digital pen and paper (DPP) system for anesthesia documentation. The specific DPP technology used in this evaluation was a product developed by Shareable Ink®. Seven certified registered nurse anesthetists (CRNAs) evaluated the DPP system through a cognitive walkthrough procedure. During the cognitive walkthrough, the participants talked aloud as they carried out a series of anesthesia documentation tasks. Just prior to the cognitive walkthrough, participants were given a questionnaire that measured their perceived computer knowledge, attitudes and skills. After the cognitive walkthrough, a second questionnaire was used to determine their satisfaction with the DPP and their opinions about its usefulness for use in multiple anesthesia work settings. In the second phase of the project, I interviewed other stakeholders in the hospital environment who would also be affected by implementation of a DPP system. This portion of the study was conducted at a community hospital without electronic record-keeping capability. Participation from several departments was sought via contact with hospital administration and department heads. Among those departments targeted for interviews were: Information Technology, Chief of Anesthesia, Anesthesia Billing, Medical Records and Nursing. Semi- structured interviews were conducted and the responses of the participants recorded both as field notes and via audio recording. This intent of this study was to test the feasibility of the digital pen and paper system for various types of anesthesia work environments by means of descriptive, survey and qualitative data analysis. Overall, the device was not only found to be usable by providers but also acceptable to stakeholders. Therefore, this device could be deemed a feasible solution toward implementing and adopting electronic documentation in some anesthesia work settings.

Modeling is a valuable tool in drug development, to support decision making, improving study design, and aid in regulatory approval and labeling. This thesis describes the development of pharmacometric models for drugs used in anesthesia and analgesia. Models describing the effects on anesthetic depth, measured by the bispectral index (BIS), for a commonly used anesthetic, propofol, and for a novel anesthetic, AZD3043, were developed. The propofol model consisted of two effect-site compartments, and could describe the effects of propofol when the rate of infusion is changed during treatment. AZD3043 had a high clearance and a low volume of distribution, leading to a short half-life. The distribution to the effect site was fast, and together with the short plasma half-life leading to a fast onset and offset of effects. It was also shown that BIS after AZD3043 treatment is related to the probability of unconsciousness similar to propofol. In analgesia studies dropout due to lack of efficacy is common. This dropout is not at random and needs to be taken into consideration in order to avoid bias. A model was developed describing the PK, pain intensity and dropout hazard for placebo, naproxen and a novel analgesic compound, naproxcinod, after removal of a wisdom tooth. The model provides an opportunity to describe the effects of other doses or formulations. Visual predictive checks created by simultaneous simulations of PI and dropout provided a good way of assessing the goodness of fit when there is informative dropout. The performance of non-linear mixed effects models in the presence of informative dropout, with and without including models that describe such informative dropout was investigated by simulations and re-estimations. When a dropout model was not included there was in general more bias. The bias increased with decreasing number of observations per subject, increasing placebo effect and increasing dropout rate. Bias was relatively unaffected by the number of subjects in the study. The bias had, in general, little effect on simulations of the underlying efficacy score, but a dropout model would still be needed in order to make realistic simulations.

Due to the early onset of caries in many children general anesthesia is often required in order to treat the dental disease. Unfortunately following dental treatment under GA, many children have caries relapse, which often requires a repeat GA in order to accomplish the new dental treatment. The objective of this study was to determine if recall frequency following treatment under general anesthesia affects the likelihood that children will require new dental treatment under a repeat GA. 674 charts were reviewed from a private Pediatric dental practice located in Winnipeg Manitoba Canada where patients who underwent a GA for dental treatment were investigated. It was found that those patients, who required new treatment following an initial treatment under GA, were less likely to receive a repeat GA for new dental treatment if they attended more frequently for a recall examination. / October 2016

M.Cur. / Epidural anaesthesia as a method of pain relief during labour has lately become very popular. statistics show that in some labour units up to 70 percent of all patients undergo epidural anaesthesia. The popularity of this method can be attributed to its effectiveness in relieving pain during labour. The anaesthetist commences an epidural block by introducing an epidural catheter into the epidural space. The anaesthetist administers the test dose and the first therapeutic dose. Within a short duration of time (10 to 20 minutes) the patient can already experience the numbing effect of the anaesthetic. This anaesthetic loses its numbing effect within two to three hours and effective pain relief can only be achieved by administering a further dose of local anaesthetic via the epidural catheter. This procedure can be repeated between three to six times during the average duration of labour. Alternatively a continuous epidural infusion procedure can be used. This last method however sometimes requires the administration of additional epidural "top-ups". If the additional "top-ups" are not administered timeously the patient can experience pain and discomfort. These delays in administering the anaesthetic often occur as a result of the anaesthetist being involved in the treatment of other patients - this often occurs in bigger labour wards where epidural anaesthesia is used during labour and caesarian sections by various patients. The active involvement of the midwife in these administrations can prevent the delays that often occur.