Horner's Syndrome Secondary to Epidural Anesthesia After Scoliosis Correction: A Case Report.

Horner's syndrome is a clinical triad composed of ptosis, miosis, and facial anhidrosis. Overall, this complication is rare but well-documented in the obstetric population receiving labor epidural analgesia, which usually follows a relatively benign transient course. Less commonly, few cases of Horner's syndrome have been reported in the pediatric population following surgical correction of scoliosis with epidural placement. We present a rare case of a pediatric patient that developed Horner's syndrome secondary to epidural anesthesia following surgical correction of scoliosis.

Anesthetic Management in Familial Hyperkalemic Periodic Paralysis: A Case Report.

Hyperkalemic periodic paralysis (HyperPP) is the rarer of two forms of potassium-associated familial paralysis characterized by episodic flaccid weakness secondary to an increase in serum potassium. The rarest of the dyskalemic paralyzes, the incidence of the hyperkalemic variety has been estimated to be 1:500,000. Known precipitating factors are potassium intake, fasting, hypothermia, infection, stress, rest after exercise, and anesthesia. The key to successful management is avoidance of triggering factors, vigilant monitoring of potassium, and aggressive treatment of hyperkalemia. We present a case of a 41-year-old male with HyperPP who underwent general anesthesia successfully.

Measuring handoff quality in labor and delivery: development, validation, and application of the Coordination of Handoff Effectiveness Questionnaire (CHEQ).

BACKGROUND: A prospective, nonblinded intervention study was conducted (1) to evaluate the psychometric properties of a new questionnaire, the CHEQ (Coordination of Handoff Effectiveness Questionnaire) for measuring the quality of handoff interactions in labor and delivery (L&D) and (2) to demonstrate the utility of the CHEQ in evaluating the effectiveness of a previously described intervention, the tangible handoff, for standardizing handoffs in L&D. METHODS: The CHEQ incorporates three existing handoff-related scales: teamwork climate, job satisfaction, and burnout. Two new scales--information quality and process quality--were developed, refined, and evaluated. The CHEQ was administered to 56 eligible L&D nurses pre- and post-implementation of the tangible handoff intervention. RESULTS: Baseline and postintervention response rates for the CHEQ were 98% and 84%, respectively. Overall, the teamwork climate scale significantly improved from 57.17% to 68.35% (t = -2.84, p = .006), and the burnout scale significantly decreased from 49.70% to 36.21% (t = -2.56, p = .012) following implementation of the tangible handoff. Job satisfaction improved, although not at a statistically significant level. Cronbach's alpha results ranged from .68 to .96 for all scales, both pre- and post-intervention. CONCLUSIONS: The CHEQ is psychometrically sound for evaluating handoffquality, is practical to administer, achieves high response rates, and is amenable to straightforward statistical analysis. The CHEQ is useful for evaluating handoff quality and gauging the responsiveness to a unit-level intervention in the scope of unit-level climate. The CHEQ may be replicated or adapted for other clinical areas to investigate handoffs and inform the design and evaluation of handoff interventions.

The tangible handoff: a team approach for advancing structured communication in labor and delivery.

The tangible handoff tool, a standardized, patient-specific, two-sided pocket card that guides nurses through transfer of care at each shift, is intended to improve continuity and coordination of care in labor and delivery.