Nurse Anesthesia

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https://hdl.handle.net/20.500.11888/3201

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    COMPARING THE USE OF IDOCAINE WITH NITROGLYCERIN VERSUS LIDOCAINE FOR PATIENTS UNDERGOING CARDIAC CATHETERIZATION FROM A RADIAL ROUTE IN TERMS OF PAIN INTENSITY, PATIENT SATISFACTION, AND SIDE EFFECTS
    (An-Najah National University, 2024-04-10) Qadous, Mohammad
    Cardiac catheterizations are specific and complex procedures that are performed either as therapeutic or diagnostic approaches in ischemic heart disease and coronary artery disease. Despite their undisputable benefits, they can also be associated with procedural and post-procedural complications including bleeding, hematoma, pain, radial artery spasms, and occlusion. This study was conducted to investigate and compare the effects of adding nitroglycerin to lidocaine compared to lidocaine for patients undergoing cardiac catheterization from a radial route. This was a single-center prospective randomized double-blind study that was conducted among patients scheduled for trans-radial cardiac catheterization. The interventional cardiologist and the patient were blinded to the type of anesthesia. The patients were assigned to receive either the intervention (Group A) or the standard treatment (Group B, control). The intervention consisted of subcutaneous 40 mg of lidocaine with 200 µg of nitroglycerin and intra-arterial 200 µg of nitroglycerin. The standard treatment (control) consisted of subcutaneous 40 mg of lidocaine and intra-arterial 200 µg of nitroglycerin. The assignment was made randomly. A total of 100 patients were selected randomly and distributed into two groups: 50 patients were allocated to Group A and 50 patients were allocated to Group B. The study patients in both groups were not different in demographic, clinical, and procedural variables (P-value > 0.05). In this study, the addition of nitroglycerin caused significantly less paleness and coldness as an indication of causing less ischemia to the hand (P-value < 0.05). Additionally, the patients who received nitroglycerin in addition to lidocaine reported statistically significant higher satisfaction compared to the patients who received lidocaine (P-value < 0.05). The findings of this study demonstrated that adding nitroglycerin to lidocaine significantly decreased indicators of hand ischemia as indicated by reduced paleness and coldness. Additionally, adding nitroglycerin to lidocaine significantly increased patient satisfaction. There were no statistically significant differences or increases in puncture time and duration of the intervention. The findings reported in this study might be used by interventional cardiologists and other healthcare providers to improve the provision of trans-radial cardiac catheterization care by reducing complications and improving the safety and recovery of patients. Based on the findings of this study, interventional cardiologists are recommended to add nitroglycerin to lidocaine to reduce hand ischemia and improve patient satisfaction.
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    ASSESS THE EFFICACY OF INTRAVENOUS DEXAMETHASONE IN DECREASING INCIDENCE OF SPINAL ANESTHESIA INDUCED HYPOTENSION, NAUSEA AND VOMITING IN PARTURIENT UNDERGOING CESAREAN SURGERY IN LARGE TWO HOSPITAL IN PALESTINE: COHORT OBSERVATIONAL STUDY
    (An-Najah National University, 2024-10-02) Abdallah, Ayala
    Spinal anesthesia is the method most commonly used for caesarean sections because of its rapid onset and provides better analgesia, but it may lead to hypotension, nausea, and vomiting, as well as compromise maternal and fetal outcomes. The aim of this observational study was to evaluate the effectiveness of intravenous dexamethasone in preventing hypotension, nausea, and vomiting, secondary to spinal anesthesia among women undergoing cesarean section at Rafidia Palestine Hospital. Standardized procedures for administering dexamethasone to patients undergoing spinal anesthesia during cesarean section should be established and implemented. And to be included in treatment plans A total of 100 parturient were included in the study, with one group receiving a standard dose of intravenous dexamethasone prior to spinal anesthesia and the control group receiving a placebo. The primary endpoints studied were the incidence of spinal anesthesia-induced hypotension, intraoperative nausea, and vomiting associated with its use as well as after surgery The results were analyzed using SPSS v22, and to describe the sample, descriptive analysis (mean and standard deviation) was used. A parametric statistical test called Repeated measures ANOVA was applied. For multivariate analyzes of variance (MANOVA), a parametric test statistic (Wilks' lambda) was used, and in order to determine the effect size, the partial eta² test (η²) was used. According to the findings, administering dexamethasone both before and after a caesarean section prevented blood pressure from dropping. The results also indicated a statistical significance for placebo at p ≤0.01 on hemodynamic markers including systolic blood pressure, DBP, and MAP during cesarean section. In contrast, there were no statistically significant effects of placebo at p ≤ 0.05 on heart rate, RR, SpO2, and body temperature during cesarean section. The size of the placebo effect on systolic blood pressure and MAP was moderate, with partial eta square values (0.60 and 0.59), respectively. Regarding DBP, SpO2 and body temperature, the effect size of placebo was small, with partial squared values (0.40, 0.22, 0.22), respectively. This study highlights the potential of dexamethasone as a beneficial adjunct in the management of spinal anesthesia-related complications, thereby improving the safety and comfort of parturient undergoing cesarean sections. future research should focus on, such as exploring different doses or comparing with other medications is recommended to confirm these findings and establish standardized protocols for the use of dexamethasone in this context.
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    THE EFFECT OF CO2 INSUFFLATION ON ARTERIAL BLOOD GASES AND END TIDAL CO2 DURING LAPAROSCOPIC SURGERIES IN ADULTS
    (An-Najah National University, 2024-10-14) Souqi, Mohammad
    Theoretical background: During laparoscopic surgeries, surgeons prefer to inflate the abdomen using CO2 gas to make a space between abdominal layers and organs and the " pneumoperitoneum " procedure. Clinical significance was found, and the effect of CO2 insufflation on end-tidal CO2 levels and arterial blood gases was clarified during these procedures, especially in terms of patient ventilation and respiratory function. Aims: The purpose of the study was to discover the effect of co2 inflation during laparoscopic operations on the end-tidal co2 levels and arterial blood gases for adults patients. The main goal was to evaluate the physiological effects of CO2 insufflation and its connection with respiratory parameters. Methodology: 60 adult patients who underwent laparoscopic surgery were selected and divided into two groups with 30 participants in each group based on respiratory rate used and the study design was a prospective single-blind quasi-experimental design. Patients were monitored for ABG, vital signs and ETCO2 levels. Subgroup and sensitivity analysis were applied to assess the effect of CO2 insufflation on vital signs and respiratory system functions. Main results: The results showed significant differences in ABG and ETCO2 levels among the two groups, especially in respiratory rate, duration of CO2 insufflation and venting of CO2. Subgroup analysis showed changes in ABG based on the duration of CO2 insufflation, and sensitivity analysis indicated the possible effect of confounding variables on the study outcomes. Conclusions: The findings assure on the importance of carefully monitoring and managing CO2 levels during laparoscopic surgeries to provide optimal patient outcomes and gives important information about the physiological implications of CO2 insufflation, and emphasizes the need of standardized protocols and continuous monitoring during these surgical procedures. Keywords: Arterial Blood Gases (ABG), CO2-Insufflation, End-Tidal CO2 (ETCO2), Laparoscopic Surgeries and Respiratory Rate (RR).
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    ONDANSETRON VERSUS KETOROLAC WITH ONDANSETRON FOR THE PROPHYLAXIS OF POSTOPERATIVE NAUSEA AND VOMITING IN PEDIATRIC PATIENTS UNDERGOING STRABISMUS SURGERY
    (An-Najah National University, 2024-05-27) Osama Mohammed Sholi
    Background: Nausea and vomiting after strabismus surgery are frequent side effects that can cause electrolyte imbalance, dehydration, sub-conjunctival hemorrhage, and problems with surgical attachment. These ailments may necessitate re-admission, lengthen post-anesthesia care, and increase hospital stays and expenses. Aims: Evaluating the effects of Ondansetron by itself versus Ondansetron plus Ketorolac on pain thresholds, the frequency of postoperative nausea and vomiting, and the consequent requirement for rescue antiemetic and analgesic drugs in pediatric strabismus patients. Methods: Seventy pediatric patients (ASA I and II, ages 3 to 12) were split into two groups for elective strabismus surgery under general anesthesia: 40 for Ondansetron and 30 for Ondansetron plus Ketorolac. Postoperative nausea, vomiting, pain, and need for rescue medication were assessed from 30 minutes to 8 hours. Results: Results from the PACU showed that the Ondansetron group (n=13, 32.5%) had a substantially higher incidence of surgical site pain than the combined Ondansetron and Ketorolac group (n=3, 10%; p= 0.042). Nevertheless, there were no significant variations between the two groups in terms of postoperative nausea, vomiting, retching, or the need for rescue drugs. In the pediatric ward, all of the complications are significantly lower in prevalence in the combined group compared to the ondansetron group, including vomiting (0.0% vs 22.5%), p-value = 0.008), nausea (6.7% vs 32.5%, p-value = 0.017), retching (0.0% vs 22.5%, p-value = 0.008), surgical site pain (13.3% vs 42.5%, p-value = 0.009), use of analgesics (6.7% vs 35.0%, p-value = 0.008) and rescue antiemetic (0.0% vs 27.5%, p-value = 0.002), respectively. In 8 hours postoperatively, there is a significantly lower incidence in the combined group compared to the ondansetron group in terms of nausea (0.0% vs 10%, p-value = 0.013), retching (0.0% vs 10%, p-value = 0.013), and the use of rescue medications (0.0% vs 10%, p-value = 0.013), while no significant differences in the Incidence of vomiting (0.0% vs 7.5%, p-value = 0.125) and use of analgesics (3.3% vs 10%, p-value = 0.284), respectively. Conclusion: Ketorolac, administered as an adjuvant to Ondansetron in pediatric strabismus patients, has been shown to reduce pain and the subsequent need for analgesics and rescue antiemetic drugs, as well as postoperative nausea and vomiting. Keywords: