Need help with a research project!!

Post-Operative Nausea and Vomiting (PONV) is a huge topic in anesthesia, that has an impact on nursing as well. PONV is one of the most common unwanted side effects of anesthesia/drugs and has effects on patient satisfaction, length of hospital stay, post-op complications, etc.... So I think it would be a good topic in light of the fact that both RN's (in the PACU, ICU, etc...) and CRNA's deal with PONV on a regular basis. Hope this helps! Good luck to you!!!

Post-Operative Nausea and Vomiting (PONV) is a huge topic in anesthesia, that has an impact on nursing as well. PONV is one of the most common unwanted side effects of anesthesia/drugs and has effects on patient satisfaction, length of hospital stay, post-op complications, etc.... So I think it would be a good topic in light of the fact that both RN's (in the PACU, ICU, etc...) and CRNA's deal with PONV on a regular basis. Hope this helps! Good luck to you!!!

That's interesting, thanks!

I was also looking at the use of beta blockers prophylactically in non-cardiac patients.

Any other suggestions?

Since no one took me up on it last year, I will offer it here....

I want to know whether keeping the endotracheal cuff pressure less than 30 cm H2O during surgery results in a decreased incidence of sore throat. Of course, you will have to control for ease of intubation, # of attempts, etc.

It appears that most Anesthesia practitioners inflate the balloon of the endotracheal tube by feel. Very few use a manometer, although this has long been the standard of care in ICU settings to prevent tracheal necrosis.

Anesthesiology. 2001 Nov;95(5):1120-4.

Comment in:

Anesthesiology. 2002 Sep;97(3):757; author reply 758.

Intracuff pressure and tracheal morbidity: influence of filling with saline

during nitrous oxide anesthesia.

Combes X, Schauvliege F, Peyrouset O, Motamed C, Kirov K, Dhonneur G,

Duvaldestin P.

Department of Anesthesia, Hopital Henri Mondor, Creteil, france.

[email protected]

BACKGROUND: Diffusion of nitrous oxide into the cuff of the endotracheal tube

results in an increase in cuff pressure. Excessive endotracheal tube cuff

pressure may impair tracheal mucosal perfusion and cause tracheal damage and

sore throat. Filling the cuff of the endotracheal tube with saline instead of

air prevents the increase in cuff pressure due to nitrous oxide diffusion. This

method was used to test whether tracheal morbidity is related to excess in

tracheal cuff pressure during balanced anesthesia. METHODS: Fifty patients with

American Society of Anesthesiologists physical status I or II were randomly

allocated to two groups with endotracheal tube cuffs initially inflated to 20-30

cm H(2)O with either air (group A) or saline (group S). Anesthesia was

maintained with isoflurane and nitrous oxide. At the time of extubation, a

fiberoptic examination of the trachea was performed by an independent observer,

and abnormalities of tracheal mucosa at the level of the cuff contact area were

scored. Patients assessed their symptoms (sore throat, dysphagia, and

hoorificeness) at the time of discharge from the postanesthesia care unit and 24 h

after extubation on a 101-point numerical rating scale. RESULTS: Cuff pressure

increased gradually during anesthesia in group A but remained stable in group S.

The incidence of sore throat was greater in group A than in group S in the

postanesthesia care unit (76 vs. 20%) and 24 h after extubation (42 vs. 12%; P

0.05). Tracheal lesions at time of extubation were seen in all patients of group

A and in eight patients (32%) of group S (P

endotracheal tube cuff pressure during balanced anesthesia due to nitrous oxide

diffusion into this closed gas space causes sore throat that is related to

tracheal mucosal erosion.

Anesth Analg. 1992 Jun;74(6):897-900.

Sore throat after endotracheal intubation.

Mandoe H, Nikolajsen L, Lintrup U, Jepsen D, Molgaard J.

Department of Anesthesia, Central Hospital, Herning, Denmark.

Nitrous oxide can diffuse into the cuff of an endotracheal tube during tracheal

intubation, and the cuff pressure against the tracheal wall may cause mucosal

damage. An endotracheal tube has been developed (Brandt Anesthesia Tube) that

effectively limits nitrous oxide-related intracuff pressure increases. We

determined whether the incidence of postoperative sore throat could be reduced

by using this tube. Forty-eight female patients, 18-50 yr of age, were included

in the study. Endotracheal intubation was performed with either a Brandt

Anesthesia Tube or a Mallinckrodt endotracheal tube. All patients were

interviewed postoperatively after 20-30 h by individuals who did not know which

tube was used. In the Mallinckrodt group, 12 of 20 patients had a sore throat

and 10 patients had intracuff pressures greater than 25 mm Hg. Only 3 of 20

patients in the Brandt group had a sore throat. We found that the incidence of

sore throats after intubation could be significantly reduced by using the Brandt

Anesthesia Tube (P less than 0.005).

research propofol for sedation in ICU, or its use by non-anesthesia personnel

research propofol for sedation in ICU, or its use by non-anesthesia personnel

Cuff pressure idea was best one - very small and specific, could be done. Forget the others - concepts way to broad and have been done over and over and over. Think of something small - using IM ephridrine for spinals in OB, efficacy of tilting OR table after spinals, etc.