Browsing by Author "Brown, Howard"

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    Dexmedetomidine for Cardiac Surgery Education Intervention
    Sellers, Nathaniel; Hines, Cheryl B.; Brown, Howard
    Cardiac surgery is the definitive treatment for many cardiac defects. Cardiac surgery is a high risk surgery that is associated with a systemic inflammatory response that can lead to increased morbidity and mortality postoperatively. Dexmedetomidine is a presynaptic alpha-2 agonist that reduces sympathetic outflow via negative feedback and has been shown to reduce this systemic inflammatory response. This is associated with improved postoperative outcomes. There was a knowledge gap on the benefits of dexmedetomidine in cardiac surgery amongst anesthesia providers. Methods: An educational intervention was provided to the anesthesia staff on the current literature for the uses of dexmedetomidine in cardiac surgery. The retrospective chart review was completed five weeks prior to the intervention and five weeks after the intervention. Statistical analysis was carried out and results were presented to the anesthesia staff. Results: This has led to increased usage of dexmedetomidine in cardiac surgery. Dexmedetomidine was used during cardiac surgery in 88% of cases prior to the intervention vs. 98.6% in the postintervention group. Discussion: Dexmedetomidine has shown promising results in improving patient outcomes when used in cardiac surgery. By educating the cardiac anesthesia staff, the cardiac anesthetists have gained a better understanding of dexmedetomidine in cardiac surgery. This led to increased usage.
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    Evaluating Outcomes of Sugammadex Administration: Robotic Surgery Recovery Implications
    Brown, Howard; Smith, Todd; Moore, Sean; University of Alabama Tuscaloosa
    Introduction: Enhanced recovery after surgery (ERAS) protocols are frequently combined with robotic surgery in order to provide safe, efficient, high quality patient care. Previous research has shown that the use of sugammadex for reversal of neuromuscular blockade (NMB) after general anesthesia for minimally invasive robotic surgery prevents many complications. This study will compare the efficacy of neostigmine reversal, sugammadex reversal, no pharmacological reversal or both reversal agents for patients following minimally invasive robotic surgery. Methodology: 562 patients at the Promedica Toledo Hospital (PTH) undergoing robotic surgery were selected randomly based on inclusion criteria to see if sugammadex provided an enhanced recovery. Patients having robotic surgery from May 2020 to May 2021 were divided into four groups by type of reversal drug: sugammadex, neostigmine, no reversal or both reversals. Using a chi-square goodness of fit test, we determined if there were significant differences between the patients in each of the four groups during the post-anesthesia recovery period as related to post_x0002_operative nausea and vomiting, time in PACU, pulmonary complications and unplanned admission for pulmonary complications. Results: A total of 562 cases were included in our analyses. No statistical significance was found across the four independent variables. However, we found clinical significance in a 15.78-minute mean reduction in PACU time for the sugammadex group when compared to the neostigmine group. Clinical significance was also indicated in the neostigmine group as 58.5% of those patients required a rescue dose of sugammadex to prevent complications of residual NMB. Discussion: For the reversal of NMB, the cost of sugammadex is higher than neostigmine. However, this additional costs of sugammadex could be offset by improved outcomes and potentially lead to financial healthcare savings. Also, quality outcome indicators could be more effectively met through an ERAS protocol combining minimally invasive surgery and sugammadex.