A research report submitted to the Faculty of Medicine, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Anaesthesia. / Spinal anaesthesia for Caesarean section is associated with an unacceptably high incidence of hypotension despite the administration of an intravenous fluid preload and the use of uterine displacement. The theoretical benefits of preventing hypotension as opposed to treating it as it occurs are the avoidance of considerable maternal discomfort, a reduced risk of serious cardiovascular or respiratory depression and the avoidance of transient foetal asphyxia. The use of prophylactic intramuscular ephedrine prior to spinal anaesthesia has been recommended but not well studied. The advantages of the intramuscular route for ephedrine administration are its simplicity and its favourable pharmacokinetic profile. Cardiovascular support is sustained throughout the surgery and into the post operative period. Opposition to the use of intramuscular ephedrine in the prevention of hypotension is based on two studies in which spinal anaesthesia was not used [1,2]. These studies showed an unacceptably high incidence of hypertension, a deleterious effect on foetal gas exchange and a lack of efficacy when intramuscular ephedrine was used in epidural and general anaesthesia respectively. This research report describes a randomised, double blind, interventional study designed to assess the safety (prevalence of hypertension, tachycardia or foetal compromise) and efficacy (prevalence of hypotension) of 37,5mg of ephedrine given prior to spinal anaesthesia for Caesarean section. Forty patients who had given informed consent were entered into the study. Blood pressures and pulse rates were recorded for 90 minutes after ephedrine administration, samples of umbilical venous blood were collected and Apgar scores assessed. This study found that giving 37,5mg of intramuscular ephedrine prior to spinal anaesthesia was safe from a maternal point of view in that it was not associated with reactive hypertension or tachycardia. When the ephedrine was given 10 minutes prior to induction of the spinal the technique proved to be effective in reducing the incidence and severity of hypotension. When used in the above manner the technique was not associated with foetal depression or acidosis. / WHSLYP2016

by Cindy Sui Tee Aun. / Thesis (M.D.)--Chinese University of Hong Kong, 1994. / Includes bibliographical references (leaves 159-184). / Table of contents --- p.ii / Signed statement --- p.iv / Abstract --- p.v / List of tables --- p.xi / List of figures --- p.xiii / List of abbreviations --- p.xv / Publications and presentations resulting from the work of the thesis --- p.xviii / Chapter SECTION I --- INTRODUCTION --- p.1 / Chapter Chapter 1 --- Hypothesis and Objective --- p.3 / Review of literature --- p.4 / Research plan --- p.28 / Chapter SECTION II --- METHODS --- p.30 / Chapter Chapter 2 --- Research methods --- p.32 / Equipment --- p.34 / Assay and protein binding of propofol --- p.38 / Pharmacokinetic analysis --- p.42 / Statistical methods --- p.48 / Chapter SECTION III --- INDUCTION OF ANAESTHESIA --- p.52 / Chapter Chapter 3 --- Induction dose requirement / Chapter Chapter 4 --- Influence of propofol dose on haemodynamic changes --- p.68 / Chapter Chapter 5 --- Comparison of cardiovascular effects of propofol and thiopentone --- p.76 / Chapter Chapter 6 --- Single dose pharmacokinetics --- p.91 / Chapter SECTION IV --- MAINTENANCE OF ANAESTHESIA --- p.110 / Chapter Chapter 7 --- Pharmacokinetic-model-controlled infusion of propofol --- p.111 / Chapter SECTION V --- ANAESTHESIA AND RECOVERY --- p.131 / Chapter Chapter 8 --- Comparison of anaesthesia and recovery of four anaesthetic techniques --- p.132 / Chapter SECTION VI --- SUMMARY AND CONCLUSIONS --- p.147 / Chapter Chapter 9 --- Summary --- p.148 / Chapter Chapter 10 --- Conclusions --- p.156 / Chapter SECTION VII --- REFERENCES --- p.159 / Chapter SECTION VIII --- APPENDICES --- p.185 / Chapter A --- Acknowledgements --- p.186 / Chapter B --- Calibration data of propofol --- p.189 / Chapter C --- Patient data tables --- p.191 / Chapter D --- Personal Work --- p.224 / Chapter E --- Ethical Committee Approval Certificates --- p.226

Walden University College of Health Sciences This is to certify that the doctoral study by Rickey King has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Marisa Wilson, Committee Chairperson, Health Services Faculty Dr. Murielle Beene, Committee Member, Health Services Faculty Dr. Deborah Lewis, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2015 Abstract Development of Emotional Intelligence Training for Certified Registered Nurse Anesthetists by Rickey King MSNA, Gooding Institute of Nurse Anesthesia, 2006 BSN, Jacksonville University, 2003 ASN, Oklahoma State University, 1988 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University February 2016 The operating room is a high stress, high stakes, emotionally charged area with an interdisciplinary team that must work cohesively for the benefit of all. If an operating room staff does not understand those emotions, such a deficit can lead to decreased effective communication and an ineffectual response to problems. Emotional intelligence is a conceptual framework encompassing the ability to identify, assess, perceive, and manage emotions. The research question for this project is aimed at understanding how an educational intervention could help to improve the emotional intelligence of anesthetists and their ability to communicate with other operation room staff to produce effective problem solving. The purpose of this scholarly project was to design a 5-week evidence-based, educational intervention that will be implemented for 16 nurse anesthetists practicing in 3 rural hospitals in Southern Kentucky. The Emotional and Social Competency Inventory - University Edition will be offered to the nurse anesthetists prior to the educational intervention and 6 weeks post implementation to determine impact on the 12 core concepts of emotional intelligence which are categorized under self-awareness, social awareness, self-management, and relationship management. It is hoped that this project will improve emotional intelligence, which directly impacts interdisciplinary communication and produces effective problem solving and improved patient outcomes. The positive social change lies in the ability of the interdisciplinary participants to address stressful events benefitting patients, operating room personnel, and the anesthetist by decreasing negative outcomes and horizontal violence in the operating room.

Thesis (M.S.)--Ohio State University, 2009. / Title from first page of PDF file. Includes vita. Includes bibliographical references (p. 44-54).

Thesis (MMedVet (Anaes) (Companion Animal Clinical Studies, Veterinary Science))--University of Pretoria, 2009. / Includes bibliographical references. Also available in print format.

Thesis (Ph.D.)--Ohio State University, 2003. / Title from first page of PDF file. Document formatted into pages; contains xvii, 175 p.; also includes graphics (some col.). Includes abstract and vita. Advisor: Robert L. Hamlin, Dept.of Veterinary Biosciences. Includes bibliographical references (p. 159-175).

Thesis (M.S.)--Worcester Polytechnic Institute. / Keywords: LabVIEW; fuzzy logic control; anesthesia. Includes bibliographical references (p. 71-74).

Artifacts caused by regional anesthesia can influence image interpretation of ultrasound and nuclear scintigraphy. Perineural and intrasynovial anesthesia is commonly performed prior to magnetic resonance imaging (MRI); and the effects on MR images, if any, is unknown. The objectives of this prospective, randomized, blinded experiment were to determine if perineural and intrasynovial anesthesia of structures in the equine foot cause iatrogenic changes detectable with MRI. A baseline MRI of both front feet was performed on 15 horses 2 to 6 days prior to mepivacaine injection adjacent to the lateral and medial palmar digital nerves (PDN), and into the podotrochlear bursa (PB), digital flexor tendon sheath (DFTS), and distal interphalangeal joint (DIPJ) of one randomly assigned forelimb. MRI was repeated at 24 and 72 hours post-injection; then qualitative and quantitative assessments of MRI findings were performed. The results of this study showed MRI findings associated with the PDN, PB and DIPJ at 24 and 72 hours after mepivacaine injection did not alter significantly from those at baseline. Compared to baseline, a significant increase in synovial fluid volume of the DFTS was detected with MRI at 24 and 72 hours post-injection. Therefore, perineural anesthesia of the PDN and intrasynovial anesthesia of the PB or DIPJ did not interfere with the interpretation of MRI examinations performed at 24 or 72 hours after injection. However, intrasynovial anesthesia of the DFTS caused an iatrogenic increase in synovial fluid, which was detectable on MRI for at least 72 hours. Although a definite time frame for resolution of DFTS distension was not determined, we recommend waiting greater than 3 days between intrasynovial anesthesia of the DFTS and evaluation with MRI. / Equine Guelph

Problem: The risk of serious postoperative cardiovascular and respiratory complications (SPCRCs) in patients with obstructive sleep apnea (OSA) is poorly defined. Methods: In this cohort study (n = 21221), patients with clinically diagnosed OSA were matched to controls without OSA to compare the risk of postoperative death and SPCRCs in an administrative database. Results: Compared to non-OSA controls, OSA patients were at increased risk of postoperative respiratory failure both before and after diagnosis with OSA. Prior to diagnosis, OSA patients, particularly those with severe OSA, were also at increased risk of cardiac arrest and SPCRCs . After diagnosis with OSA, except for postoperative respiratory failure, the risk of SPCRC’s was not different from controls. Also, the risk of postoperative death among OSA patients after diagnosis was not different from controls. Other important predictors of SPCRCs and death included admission in an intensive care unit at the time of surgery, a history of congestive heart failure, a higher Charlson comorbidity index score and the type of surgery. Conclusions: OSA was associated with an increased risk of SPCRCs, especially prior to diagnosis and in severe disease. This suggests that screening for and treating OSA in preoperative patients would reduce the risk of SPCRCs. However, the significant influences of the type of surgery and the presence of medical comorbidities on the risks of SPCRCs and death, regardless of the presence of OSA, must be considered in planning efficient and equitable interventions to reduce these risks.

Problem: The risk of serious postoperative cardiovascular and respiratory complications (SPCRCs) in patients with obstructive sleep apnea (OSA) is poorly defined. Methods: In this cohort study (n = 21221), patients with clinically diagnosed OSA were matched to controls without OSA to compare the risk of postoperative death and SPCRCs in an administrative database. Results: Compared to non-OSA controls, OSA patients were at increased risk of postoperative respiratory failure both before and after diagnosis with OSA. Prior to diagnosis, OSA patients, particularly those with severe OSA, were also at increased risk of cardiac arrest and SPCRCs . After diagnosis with OSA, except for postoperative respiratory failure, the risk of SPCRC’s was not different from controls. Also, the risk of postoperative death among OSA patients after diagnosis was not different from controls. Other important predictors of SPCRCs and death included admission in an intensive care unit at the time of surgery, a history of congestive heart failure, a higher Charlson comorbidity index score and the type of surgery. Conclusions: OSA was associated with an increased risk of SPCRCs, especially prior to diagnosis and in severe disease. This suggests that screening for and treating OSA in preoperative patients would reduce the risk of SPCRCs. However, the significant influences of the type of surgery and the presence of medical comorbidities on the risks of SPCRCs and death, regardless of the presence of OSA, must be considered in planning efficient and equitable interventions to reduce these risks.