Emily M. Funk

The purpose of this project was to assess the feasibility and cost of high-flow nasal oxygenation therapy for gastrointestinal procedures in an endoscopy clinic. An observational, convenience sample design was used to evaluate multiple variables, including the frequency of high-flow nasal oxygenation therapy utilization, clinician satisfaction, setup duration, airway interventions, complications, procedure length, and alternative airway device use. A cost analysis compared high-flow nasal oxygenation therapy to other commonly used airway devices at this site. High-flow nasal oxygenation therapy was frequently utilized and received high clinician satisfaction ratings. The median length of gastrointestinal procedures with high-flow nasal oxygenation therapy was 30 minutes, with a median setup time of 2 minutes between cases. Although high flow nasal oxygenation therapy had a higher fixed cost than traditional airway devices, the cost was comparable to that of a nasal ventilation mask. Despite the initial expense, high-flow nasal oxygenation therapy’s rapid setup and clinician preference suggest it is feasible in the endoscopy setting. The high fixed cost may be offset by increased patient volumes and sustained device utilization.

Transitioning to new facilities can challenge certified registered nurse anesthetists (CRNAs), affecting confidence, job satisfaction, and turnover. Orientation programs may support this transition, yet formal evaluations remain limited. This mixed-methods program evaluation examined a structured CRNA orientation at a Southeastern U.S. academic hospital using a survey and focus groups. Participants reported high satisfaction and confidence across most clinical domains. Findings highlighted the value of structured orientation, mentorship, and supportive culture in facilitating successful practice transitions.

This project aimed to reintroduce and evaluate a pediatric ketamine sedation protocol at a Zonal Referral Center in Mwanza, Tanzania, where nonanesthesia clinicians provide sedation when trained anesthesia personnel are unavailable. The objectives were to assess knowledge retention, confidence, and protocol compliance. The study design used a pre- and postintervention design. Nonanesthesia clinicians at a > 1,000-bed hospital were surveyed to assess their knowledge and confidence about ketamine sedation. Over 10 days, 50 clinicians received training that included lectures and cognitive aid resources in English and Swahili (the local language). Knowledge and confidence were measured using paired surveys. Clinicians were observed for compliance, skill demonstration, and feedback during postimplementation sedation encounters. Results showed significant improvements in knowledge (M = 6.93-8.77; P = .001) and confidence (M = 5.94-8.98; P = .001). Seven sedation encounters were observed over a 7-day period, and compliance with the presedation assessment was 100% for last food or drink intake, allergy history, and medication history. Reintroducing this protocol in a low-resource setting led to improvements in knowledge, confidence, and skills among nonanesthesia clinicians.

Williams syndrome is a rare congenital disorder affecting connective tissue and the cardiovascular and central nervous systems. Pediatric patients diagnosed with Williams syndrome face significant risk for cardiac collapse and death when undergoing anesthesia. We sought to evaluate our institution's historical practices, evaluate individual risk stratification, and create detailed standardized perianesthesia guidelines for management of this population, particularly during noncardiac procedures. The study included a retrospective chart review of pediatric patients with Williams syndrome who received anesthesia over a 10-year period at a single institution. A total of 23 patients underwent 46 procedures. At time of procedure, median age was 5.8 years (range, 0.4-17.6 yr), and the majority (n = 19) had a "low" Williams syndrome risk category and required anesthesia for noncardiac procedures. Most (61%) had no cardiac involvement beyond mild supravalvar or branch pulmonary artery stenosis. No intraprocedure adverse cardiac events were identified. One patient experienced an adverse cardiac event approximately 60 minutes postanesthesia emergence which included ST segment depression and development of refractory ventricular fibrillation, necessitating deployment of venoarterial extracorporeal membrane oxygenation. This patient was eventually stabilized and was taken to the operating room 3 days later for definitive severe supravalvar aortic stenosis repair. Patients with Williams syndrome have a reported risk for sudden cardiac death that is 25 to 100 times greater than that of the age-matched general population. The incidence of adverse cardiac events in our cohort of patients with Williams syndrome undergoing anesthesia was lower compared with previous studies, which reported rates ranging from 4.2% to 11%. These findings support the idea that risk stratification and institutional practice guidelines can aid anesthesia providers in making informed decisions, and standardization of pre-, intra-, and postprocedural care according to existing guidelines may further reduce risks. Our review offers valuable insight into historical anesthesia management and contributes to a broader interdisciplinary understanding of care provision for this high-risk group.

People with alternating hemiplegia of childhood undergoing general anesthesia are at risk for severe complications including critical bradycardia and hemiplegic incidents. We performed a 10-year historical cohort study and completed a subgroup analysis of patients who specifically underwent general anesthesia. Patients with ATP1A3 positive variants were compared with those without such variants. The 14 patients reviewed underwent general anesthesia a combined total of 39 times. Two patients had a short QTc documented prior to anesthesia and presented with bradycardia in the recovery room. Two other patients experienced a suspected seizure and hemiplegic incident; one of those patients received no facility-administered medications prior to experiencing a hemiplegic incident, and the other experienced a hemiplegic incident on emergence from anesthesia with subsequent cardiac arrest and successful resuscitation. No apparent association was identified between type of anesthesia and the development of bradycardia or hemiplegic incidences. Of the four patients experiencing critical events, three had the ATP1A3-D801N variant. Although additional research is necessary to confirm such associations, patients with alternating hemiplegia of childhood, specifically the ATP1A3-D801N variant, appear to be at elevated risk for complications associated with general anesthesia, suggesting the need for an increased anticipation of complications for this population.

Pediatric patients who undergo spinal corrective surgery often require multiple blood product transfusions. The use of antifibrinolytics, especially tranexamic acid (TXA), to mitigate intraoperative blood loss has increased in popularity. The goal of this quality improvement project was to evaluate provider compliance with a TXA dosing protocol during pediatric corrective spine procedures. A retrospective chart review was conducted to compare pre- and postimplementation data on cell saver and packed red blood cell (PRBC) administration and dose of antifibrinolytic administered. A total of 486 patients (68% idiopathic and 32% neuromuscular) were evaluated over a 9-year period. Following implementation of the protocol, patients of idiopathic origin experienced a 20% reduction in cell saver administration, a 10% reduction in PRBC administration, and a 37% increase in provider compliance with the dosing protocol. Patients of neuromuscular origin experienced a 53% increase in provider compliance with the recommended TXA dosing protocol; however, this patient population did not experience a statistically significant reduction in transfusion requirements. Implementation of an antifibrinolytic protocol can facilitate compliance with recommended TXA dosing parameters and potentially decrease intraoperative blood loss, reducing blood product transfusion requirements.