Preoperative Cryoneurolysis for Total Knee Arthroplasty: A Case Series.

PURPOSE: The purpose of this pilot project case series is to describe the use of preoperative cryoneurolysis for 10 patients presenting for total knee arthroplasty (TKA). DESIGN: Descriptive research design. METHODS: Billing codes were used to identify 10 patients who had previously undergone TKA, preoperative cryoneurolysis and physical therapy (PT) at a Midwestern community hospital. Data collected included anesthetic management strategies, multimodal analgesic therapies, postanesthesia care unit pain scores (PACU), pain scores during physical therapy, and achievement of a range of motion during physical therapy. FINDINGS: Nine of 10 patients who received preoperative cryoneurolysis had PACU pain scores of 0 (0-10 scale) up to 90 minutes postoperatively. Pain scores immediately following cryoneurolysis therapy were reduced in all patients reporting pain greater than 0 (1-10 pain scale) before their treatment. Increased active range of motion trends were noted with reports of decreased pain scores during postoperative physical therapy sessions. CONCLUSIONS: This pilot project case series demonstrates potential benefits of using preoperative cryoneurolysis to provide postoperative pain control and aid with physical therapy recovery following TKA.

Sensitivity and Specificity of Gastric Ultrasonography in Determination of Gastric Contents.

Perioperative pulmonary aspiration (PPA) is a major cause of morbidity and mortality. During anesthesia, airway reflexes become depressed, placing patients at risk of PPA. Gastric ultrasonography (GUS) can be used to qualitatively differentiate between solids, liquids, and empty gastric contents. The purpose of this study was to determine the sensitivity and specificity of GUS in identifying gastric contents after participants were randomly assigned to consume 1 donut, drink 360 mL of water, or remain fasted (n=60 each group). Ultrasonography was performed by a blinded scanner, and qualitative findings were recorded by 2 sonography examiners and the primary scanner. Findings from the water group included a sensitivity of 95% to 100% and specificity of 87.5% to 90% for identification of liquids. Interrater reliability results yielded an intraclass correlation coefficient (ICC)=.781 for the solid group; ICC=.950 for the fluid group; and ICC=.761 for the fasted group. Statistically significant differences were found for the effect that body mass index classifications had on sensitivity and specificity of GUS for predicting gastric content. Results of this study demonstrated that GUS is highly sensitive, specific, and reliable with low false-positive and false-negative rates in the identification of fluid gastric content.

Anesthetic Management in Early Recovery After Surgery Protocols for Total Knee and Total Hip Arthroplasty.

The aim of this integrative review was to provide current, evidence-based anesthetic and analgesic recommendations for inclusion in an Enhanced Recovery After Surgery (ERAS) protocol for patients undergoing total knee arthroplasty (TKA) or total hip arthroplasty (THA). Articles published between 2006 and December 2016 were critically appraised for validity, reliability, and rigor of study. The administration of nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, gabapentinoids, and corticosteroids resulted in shorter hospital length of stay (LOS) and decreased postoperative pain and opioid consumption. A spinal anesthetic block provided benefits over general anesthesia, including decreased 30-day mortality rates, hospital LOS, blood loss, and complications. The use of peripheral nerve blocks for postoperative pain management resulted in lower pain scores, decreased opioid consumption, fewer complications, and shorter hospital LOS. Perioperative anesthetic management in ERAS protocols for patients undergoing TKA and THA should include the administration of acetaminophen, NSAIDs, gabapentinoids, and corticosteroids. Preferred intraoperative anesthetic management in ERAS protocols should consist of spinal anesthesia with light sedation. Postoperative pain should be managed with peripheral nerve blocks such as adductor canal block or femoral nerve block supplemented with sciatic nerve block or local infiltrated anesthesia.

Community of inquiry model: advancing distance learning in nurse anesthesia education.

The number of distance education courses offered by nurse anesthesia programs has increased substantially. Emerging distance learning trends must be researched to ensure high-quality education for student registered nurse anesthetists. However, research to examine distance learning has been hampered by a lack of theoretical models. This article introduces the Community of Inquiry model for use in nurse anesthesia education. This model has been used for more than a decade to guide and research distance learning in higher education. A major strength of this model learning. However, it lacks applicability to the development of higher order thinking for student registered nurse anesthetists. Thus, a new derived Community of Inquiry model was designed to improve these students' higher order thinking in distance learning. The derived model integrates Bloom's revised taxonomy into the original Community of Inquiry model and provides a means to design, evaluate, and research higher order thinking in nurse anesthesia distance education courses.

Psychometric testing of the Pecka Grading Rubric for evaluating higher-order thinking in distance learning.

This article describes development of the Pecka Grading Rubric (PGR) as a strategy to facilitate and evaluate students' higher-order thinking in discussion boards. The purpose of this study was to describe psychometric properties of the PGR. Rubric reliability was pilot tested on a discussion board assignment used by 15 senior student registered nurse anesthetist enrolled in an Advanced Principles of Anesthesia course. Interrater and intrarater reliabilities were tested using an interclass correlation coefficient (ICC) to evaluate absolute agreement of scoring. Raters gave each category a score, scores of the categories were summed, and a total score was calculated for the entire rubric. Interrater (ICC = 0.939, P < .001) and intrarater (ICC = 0.902 to 0.994, P < .001) reliabilities were excellent for total point scores. A content validity index was used to evaluate content validity. Raters evaluated content validity of each cell of the PGR. The content validity index (0.8-1.0) was acceptable. Known-group validity was evaluated by comparing graduate student registered nurse anesthetists (N = 7) with undergraduate senior nursing students (N = 13). Beginning evidence indicates a valid and reliable instrument that measures higher-order thinking in the student registered nurse anesthetist.